Axillary reverse mapping (ARM) to promote minimally invasive surgery in breast cancer: A review

Introduction Minimizing the risk of breast cancer-related lymphedema (BCRL) through specific strategies has been crucial to the development of new integrative surgical approaches, such as the axillary reverse mapping (ARM) technique. By mapping and preserving the arm lymphatic drainage, its application was expected to minimize the risk of BCRL. There are still many controversies regarding its systemic use, oncological safety and the tracer to be used. Methods The aim of this systematic review was to identify randomized controlled trials (RCTs) using the ARM technique and to investigate whether there is a significant reduction in the incidence of BCRL. Articles were searched using PubMed, Cochrane Library and EMBASE. Key words included “axillary reverse mapping”, “breast cancer”, “lymphedema”. Results Six studies with 1826 patients were included in our analysis: 867 patients in the study arm received ARM + axillary lymph node dissection (ALND), and 959 patients in the control arm received ALND alone. The incidence in the study arm was 8.2% (67/822) compared to 23.1% (214/928) in the control arm among patients who completed follow-up. Conclusions The use of the ARM technique appears to reduce the incidence of BCRL. However, its surgical indications, its oncological safety in terms of preserving the identified lymph nodes, the standardization of the method and its learning curve remain to be clarified.