Abstract
BackgroundBreast cancer, with an incidence of 32%, is the most frequent cancer among Egyptian women. The frequency of arm lymphedema after axillary surgery for breast cancer ranges from 7 to 77%. Axillary reverse mapping is a technique aimed to distinguish and conserve upper-limb lymphatics and lymph nodes during the course of axillary surgery and could help to prevent arm lymphedema.MethodsPatients (n = 48) were prepared for axillary lymph-node dissection. The study group and the control group each contained 24 individuals. In the study group, following dye injection, stained arm lymph nodes and lymphatics were conserved during axillary dissection, whereas control-group participants underwent the conventional procedure. All participants were re-evaluated after 6 months, and the incidence of lymphedema was recorded by measuring arm circumference at a level 10 cm proximal to the medial epicondyle. Arm lymphedema was defined as a change in the circumference of the ipsilateral upper extremity > 2 cm during the follow-up period.ResultsAge, tumor size and N stage were not significantly different between the study and control groups. Lymph-node visualization was achieved in 20 participants (83.3%) in the study group. Suspicious stained lymph nodes were surgically removed from four individuals but showed no metastatic involvement. In 20 individuals in the study group, no stained lymph nodes were removed. The incidence of lymphedema in the control group was 16.7%, and the incidence in the study group was 4.2%.ConclusionsAxillary reverse mapping is a minimally invasive technique that can be performed during axillary lymph-node dissection, helping to prevent the subsequent development of arm lymphedema.Trial registration#SCURCTN3276, retrospectively registered on 11 April 2017 at Research Ethics Committee at the Faculty of medicine-Suez Canal University.
Highlights
Breast cancer, with an incidence of 32%, is the most frequent cancer among Egyptian women
Axillary reverse mapping (ARM) is a technique that has been devised based on the assumption that arm lymphedema results from disruption of arm lymphatics during axillary dissection
The axillary lymphatics and lymph nodes are anatomically linked to the lymphatic drainage of the arm; these nodes include the lateral or brachial group that lies below the axillary vein [4]
Summary
With an incidence of 32%, is the most frequent cancer among Egyptian women. The frequency of arm lymphedema after axillary surgery for breast cancer ranges from 7 to 77%. Axillary reverse mapping is a technique aimed to distinguish and conserve upper-limb lymphatics and lymph nodes during the course of axillary surgery and could help to prevent arm lymphedema. Worldwide, ~ 1.67 million women are diagnosed with breast cancer every year. Axillary reverse mapping (ARM) is a technique that has been devised based on the assumption that arm lymphedema results from disruption of arm lymphatics during axillary dissection. The. Faisal et al Patient Safety in Surgery (2019) 13:35 purpose of ARM is to differentiate the lymphatics and lymph nodes of the arm from those of the breast during axillary surgery, to enable preservation of the arm lymphatics [5]. Available methods for ARM are based on injection and tracking of blue dye, fluorescent dye or a radioisotope, as reviewed elsewhere [6]
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