Conserving the Lymphatic Drainage of the Arm Using Axillary Reverse Mapping Procedure in Breast Cancer Patients

Axillary lymph node staging is a critical prognostic factor for clinical outcomes in breast cancer patients. The standard approach for axillary lymph node staging in breast cancer patients is axillary lymph node dissection (ALND), which may cause some complications, including ipsilateral upper extremity lymphedema due to a disruption of the ipsilateral upper extremity lymphatic drainage system. Therefore, with the purpose of reducing the incidence of lymphedema, sentinel lymph node biopsy (SLNB) haves been employed to avoid the unnecessary dissection of axillary lymph nodes. With the purpose of minimizing arm lymphedema after axillary staging surgeries in breast cancer patients, the axillary reverse mapping (ARM) technique has been developed to identify and preserve arm drainage system during axillary surgery. Previously, it was considered that preservation of the ARM lymphatics or lymph nodes is not oncologically safe in patients with axillary lymph node metastases. However, recent studies have demonstrated that the ARM procedure is oncologically feasible in clinically nodenegative, SLN-positive patients when ARM nodes do not coincide with SLNs. ARM is a feasible technique for identification and preservation of axillary arm lymphatics with an acceptable incidence of SLN crossover and that may prevent lymphedema in SLNB and/or ALND in patients with clinically determined low axillary nodal status breast cancer.