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Axillary Reverse Mapping in the Prevention of Lymphoedema: A Systematic Review and Pooled Analysis

  • Michael Co
    Affiliations
    Department of Surgery, School of Clinical Medicine, University of Hong Kong, Hong Kong

    Department of Surgery, Queen Mary Hospital, Hong Kong SAR
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  • Lucia Lam
    Affiliations
    Department of Surgery, School of Clinical Medicine, University of Hong Kong, Hong Kong

    Department of Surgery, Queen Mary Hospital, Hong Kong SAR
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  • Dacita Suen
    Affiliations
    Department of Surgery, School of Clinical Medicine, University of Hong Kong, Hong Kong

    Department of Surgery, Queen Mary Hospital, Hong Kong SAR
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  • Ava Kwong
    Correspondence
    Address for correspondence: Ava Kwong, FRCSEd, FACS, PhD, Chief of Division of Breast Surgery, HKU, K1401, Queen Mary Hospital, Hong Kong.
    Affiliations
    Department of Surgery, School of Clinical Medicine, University of Hong Kong, Hong Kong

    Department of Surgery, Queen Mary Hospital, Hong Kong SAR
    Search for articles by this author
Published:October 19, 2022DOI:https://doi.org/10.1016/j.clbc.2022.10.008

      ABSTRACT

      Background

      This is a systematic review of randomized controlled trials (RCT) comparing the use of axillary reverse mapping (ARM) with conventional technique for axillary dissection (AD) in breast cancer surgery.

      Methods

      This review was written in line with the PRISMA protocol. Articles were retrieved from PubMed, EMBASE, CINAHL and Cochrane databases, using keywords ..úaxillary reverse mapping..Ñ and “axillary lymph node dissection”. Non-RCT were excluded. Abstracts were screened independently by 2 reviewers. Data from eligible studies were retrieved for qualitative synthesis and pooled analysis. 73 publications were identified for initial screening.

      Results

      68 articles were excluded from analysis according to the pre-defined systematic review protocol. 5 RCTS with 1696 subjects were included for analysis. 802 patients received ARM, 894 patients received AD. Pooled ARM node detection rate was 84.9% (Range 79.2 - 94.9%). There was a lower rate of post-operative lymphedema in ARM group patients across all 5 RCTs. The pooled lymphedema incidence in the ARM group was 4.8% (37/766) when compared to 18.8% (164/873) in the AD group (P < .0001). Axillary recurrence rate with median followof 37 months was 1.03% (8/778) in the ARM group, which was identical to 1.03% (9/870) in the AD group (P = 1).

      Conclusion

      ARM resulted in decreased incidence of lymphedema. There was no significant increase in axillary recurrence at 37 months post-operation.

      Keywords

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