Does Axillary Reverse Mapping Prevent Lymphedema after Lymphadenectomy?

Evan Tummel, Daniela Ochoa, Soheila Korourian, Richard Betzold, Laura Adkins, Maureen McCarthy, Stephanie Hung, Kyle Kalkwarf, Kristalyn Gallagher, Jeannette Y. Lee, Vicki Klimberg

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Background: We hypothesized that disconcerting lymphedema rates in both sentinel lymph node biopsy (SLNB) and axillary lymph node dissection (ALND) may be because of unrecognized vunerable variations in arm lymphatic drainage within the axilla. Axillary reverse mapping (ARM) facilitates identification and avoidance of arm lymphatics within the axilla and its use may reduce lymphedema. Methods: This institutional review board-approved study from June 2007 to December 2013 involved patients undergoing SLNB with or without ALND, or ALND alone. Technetium is injected subareolarly for localization of the breast SLN and isosulfan blue dye (5 mL) is injected in the ipsilateral upper arm for localization of nonbreast lymphatics. Data were collected on identification and preservation of arm lymphatics, crossover rates, blue node metastases, axillary recurrence, and lymphedema as measured by volume displacement. Results: A total of 654 patients prospectively underwent 685 ARM procedures with a SLNB and/or ALND. Objective lymphedema rates for SLNB and ALND were 0.8% and 6.5% respectively, with 26-month median follow up. Blue lymphatics were identified in 29.2% (138/472) of SLNB and 71.8% (153/213) of ALND. Crossover was seen in 3.8% (18/472) of SLNB and 5.6% (12/213) of ALND. Blue node metastases rate was 4.5% (2/44). Axillary recurrence rate was 0.2% and 1.4% for SLNB and ALND, respectively. Conclusions: ARM allows frequent identification of arm lymphatics in the axilla, which would have been transected during routine surgery. Rates of metastases in noncrossover nodes and axillary recurrences are low. Lymphedema rates are dramatically reduced using ARM when compared with accepted standards.

Original languageEnglish (US)
Pages (from-to)987-992
Number of pages6
JournalAnnals of Surgery
Volume265
Issue number5
DOIs
StatePublished - May 1 2017
Externally publishedYes

Fingerprint

Lymphedema
Sentinel Lymph Node Biopsy
Lymph Node Excision
Arm
Axilla
Neoplasm Metastasis
Recurrence
Research Ethics Committees
Technetium
Drainage
Breast
Coloring Agents

Keywords

  • axillary reverse mapping
  • breast
  • breast cancer
  • lymphedema

ASJC Scopus subject areas

  • Surgery

Cite this

Tummel, E., Ochoa, D., Korourian, S., Betzold, R., Adkins, L., McCarthy, M., ... Klimberg, V. (2017). Does Axillary Reverse Mapping Prevent Lymphedema after Lymphadenectomy? Annals of Surgery, 265(5), 987-992. https://doi.org/10.1097/SLA.0000000000001778

Does Axillary Reverse Mapping Prevent Lymphedema after Lymphadenectomy? / Tummel, Evan; Ochoa, Daniela; Korourian, Soheila; Betzold, Richard; Adkins, Laura; McCarthy, Maureen; Hung, Stephanie; Kalkwarf, Kyle; Gallagher, Kristalyn; Lee, Jeannette Y.; Klimberg, Vicki.

In: Annals of Surgery, Vol. 265, No. 5, 01.05.2017, p. 987-992.

Research output: Contribution to journalArticle

Tummel, E, Ochoa, D, Korourian, S, Betzold, R, Adkins, L, McCarthy, M, Hung, S, Kalkwarf, K, Gallagher, K, Lee, JY & Klimberg, V 2017, 'Does Axillary Reverse Mapping Prevent Lymphedema after Lymphadenectomy?', Annals of Surgery, vol. 265, no. 5, pp. 987-992. https://doi.org/10.1097/SLA.0000000000001778
Tummel E, Ochoa D, Korourian S, Betzold R, Adkins L, McCarthy M et al. Does Axillary Reverse Mapping Prevent Lymphedema after Lymphadenectomy? Annals of Surgery. 2017 May 1;265(5):987-992. https://doi.org/10.1097/SLA.0000000000001778
Tummel, Evan ; Ochoa, Daniela ; Korourian, Soheila ; Betzold, Richard ; Adkins, Laura ; McCarthy, Maureen ; Hung, Stephanie ; Kalkwarf, Kyle ; Gallagher, Kristalyn ; Lee, Jeannette Y. ; Klimberg, Vicki. / Does Axillary Reverse Mapping Prevent Lymphedema after Lymphadenectomy?. In: Annals of Surgery. 2017 ; Vol. 265, No. 5. pp. 987-992.
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abstract = "Background: We hypothesized that disconcerting lymphedema rates in both sentinel lymph node biopsy (SLNB) and axillary lymph node dissection (ALND) may be because of unrecognized vunerable variations in arm lymphatic drainage within the axilla. Axillary reverse mapping (ARM) facilitates identification and avoidance of arm lymphatics within the axilla and its use may reduce lymphedema. Methods: This institutional review board-approved study from June 2007 to December 2013 involved patients undergoing SLNB with or without ALND, or ALND alone. Technetium is injected subareolarly for localization of the breast SLN and isosulfan blue dye (5 mL) is injected in the ipsilateral upper arm for localization of nonbreast lymphatics. Data were collected on identification and preservation of arm lymphatics, crossover rates, blue node metastases, axillary recurrence, and lymphedema as measured by volume displacement. Results: A total of 654 patients prospectively underwent 685 ARM procedures with a SLNB and/or ALND. Objective lymphedema rates for SLNB and ALND were 0.8{\%} and 6.5{\%} respectively, with 26-month median follow up. Blue lymphatics were identified in 29.2{\%} (138/472) of SLNB and 71.8{\%} (153/213) of ALND. Crossover was seen in 3.8{\%} (18/472) of SLNB and 5.6{\%} (12/213) of ALND. Blue node metastases rate was 4.5{\%} (2/44). Axillary recurrence rate was 0.2{\%} and 1.4{\%} for SLNB and ALND, respectively. Conclusions: ARM allows frequent identification of arm lymphatics in the axilla, which would have been transected during routine surgery. Rates of metastases in noncrossover nodes and axillary recurrences are low. Lymphedema rates are dramatically reduced using ARM when compared with accepted standards.",
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AU - Korourian, Soheila

AU - Betzold, Richard

AU - Adkins, Laura

AU - McCarthy, Maureen

AU - Hung, Stephanie

AU - Kalkwarf, Kyle

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