Yue, T., Zhuang, D., Zhou, P., Zheng, L., Fan, Z., Zhu, J., ... & He, Q. (2015). A prospective study to assess the feasibility of axillary reverse mapping and evaluate its effect on preventing lymphedema in breast cancer patients. Clinical Breast Cancer, 15, 301–306. 

To determine if lymphedema prevention is affected by the use of the axillary reverse mapping (ARM) procedure

Two groups of patients with breast cancer receiving modified radical mastectomies were randomized to a standard axillary lymph node dissection (ALND) or ALND with ARM.

• N = 265
• AVERAGE AGE = 50.14 years
• FEMALES: 100%
• KEY DISEASE CHARACTERISTICS: Breast cancer diagnosis; invasive and in situ ductal carcinomas; metastatic lymph nodes from 1–10+ included; any hormone receptor or HER2 status; all tumor sizes for staging
• OTHER KEY SAMPLE CHARACTERISTICS: Exclusion of neoadjuvant treatment patients and those with bilateral breast cancer; removal from study if experimental (ARM) group had positive ARM nodes on a pathology study

• SITE: Single site    
• SETTING TYPE: Outpatient    
• LOCATION: Jinan Military Hospital in Jinan, China

PHASE OF CARE: Active antitumor treatment

Randomized, controlled trial

• Preoperative Tc-Nanocoll injections with lymphoscintigraphy
• Methylene blue injections
• Intraoperative gamma probe
• Student T test
• Fisher exact test
• Arm circumference measurement

Between the experimental and the control group, there was a significant difference (p < 0.001) for both areas of circumference measurement in postoperative lymphedema evaluations. The experimental ARM group had less occurrence of lymphedema.

Based on the data presented by the investigators the incidence of lymphedema and the severity of lymphedema can be reduced by evaluating which lymph nodes really need to be removed to allow for the best lymphatic flow.

• Risk of bias (no blinding)
• Other limitations/explanation: Patient weight and height or body surface area not collected (can affect lymphedema risk); no mention of prior history of breast cancer or radiation to upper body; risk factors not included such as diabetes, vascular disease, or other cancers; risk of bias; no blinding; there was no blinding for the ARM versus standard procedure; but for follow-up measurement of arm circumference for lymphedema assessment; the person measuring was blinded

Although this intervention doesn't change what staff nurses may do for patients on a day to day basis, it does allow nurses to educate patients about options as well as to open discussion with the oncology team as to the use of this newer intervention.