Axillary reverse mapping for preventing lymphedema in axillary lymph node dissection and/or sentinel lymph node biopsy

Excerpt

Axillary lymph node dissection (ALND) is a standard surgical treatment in patients with involved axillary lymph nodes. Unfortunately, arm lymphedema develops in 2.7–5.0% of patients treated by partial ALND (level I and II), in 3.1–9.6% of those undergoing total ALND, and in 26–38% of patients treated with ALND and radiotherapy [1]. The risk of lymphedema is often used as an argument against ALND. Currently, sentinel lymph node (SLN) biopsy has become a highly utilized and widely accepted method for surgical staging of axillary lymph nodes in breast cancer. It can avoid an unnecessary ALND in patients with node-negative breast cancer, thereby preventing arm lymphedema. Nevertheless, recent short-term studies demonstrated that lymphedema develops in 2–7% of patients even with SLN biopsy alone [2‐4]. Transection of the arm lymphatics during ALND most likely results in lymphedema, but the ALND technique has changed little over the decades, and involves purely anatomical dissection. It is generally thought that the lymphatics reside juxtaposed to the vein, and the risk of lymphedema can be minimized if the surgeon takes care to avoid skeletonizing the vein. However, lymphatics with this positioning are rarely seen and SLN biopsy does not correct the problem of lymphedema, although it is less morbid than ALND [2]. …