Tummel, E., Ochoa, D., Korourian, S., Betzold, R., Adkins, L., McCarthy, M., . . . Klimberg, V.S. (2016). Does axillary reverse mapping prevent lymphedema after lymphadenectomy? Annals of Surgery. Advance online publication.

DOI Link

Study Purpose

To further validate previous findings that an axillary reverse mapping (ARM) technique enabling the preservation of arm lymphatics can reduce the postoperative lymphedema rate in women having sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND)

Intervention Characteristics/Basic Study Process

ARM was conducted intraoperatively with technetium in the breast and blue dye in the arm. Arm volume displacement measures were conducted preoperatively and every six months. Follow-up ranged from 3–54 months, with an average of 20 months. Lymphedema rates of sample cases were compared to those of a group that did not have ARM.

Sample Characteristics

  • N = 504   
  • MEAN AGE = 57 years (SD = 13) 
  • FEMALES: 100%
  • KEY DISEASE CHARACTERISTICS: Of the participants, 90.6% had invasive cancer.

Setting

  • SITE: Single site   
  • SETTING TYPE: Inpatient

Phase of Care and Clinical Applications

  • PHASE OF CARE: Active antitumor treatment

Study Design

  • Single-arm, phase-II

Measurement Instruments/Methods

  • Arm water displacement

Results

SNLB mapping was successful in 98.5% of the patients, and ALND lymphatics or blue nodes were identified in 71.8% of the procedures. After SLND, 0.8% had findings of lymphedema, and 6.5% had lymphedema after ALND. In cases where blue lymphatics were identified and able to be preserved, the SLNB lymphedema rate was 1.2%; the lymphedema rate in ALND cases was 6.9%. These rates were compared to reported rates with SLNB ranging from 0%–13%.

Conclusions

ARM may help preserve lymphatic structures and reduce the rates of postoperative lymphedema.

Limitations

  • Risk of bias (no control group)
  • Risk of bias (no blinding)
  • Risk of bias (no random assignment)
  • Unintended interventions or applicable interventions not described that would influence results
  • Measurement/methods not well described
  • No other interventions for the prevention or treatment of lymphedema were reported.
  • Actual measurements used for rate determination were not clear.

Nursing Implications

A variety of surgical techniques aimed at reducing postoperative lymphedema are being examined. This study describes one method of ARM that may be beneficial. Further research is needed to determine efficacy with concurrent comparison, the techniques that are most effective, and the role of ARM in overall lymphedema prevention and management.