The Role of Axillary Reverse Mapping in Reducing Lymphedema in Patients with Early Breast Cancer: A Prospective Randomized Study | ||
| Ain Shams Journal of Surgery | ||
| Volume 18, Issue 4, October 2025, Pages 348-354 PDF (448.28 K) | ||
| Document Type: Original Article | ||
| DOI: 10.21608/asjs.2025.412874.1227 | ||
| Authors | ||
| Kerolos Naem Fayez Farag* ; Hossam Ramadan Moussa; Mohamed Ali Mlees; Waleed Yusif El Sherpiny | ||
| Surgical Oncology Unit, General Surgery Department, Faculty of Medicine, Tanta University, Tanta, Egypt | ||
| Abstract | ||
| Introduction: Breast cancer–related lymphedema (BCRL) is a frequent and debilitating complication of axillary lymph node dissection (ALND). Axillary reverse mapping (ARM) aims to identify and preserve lymphatic drainage pathways of the upper limb to reduce postoperative lymphedema risk. Aim of work: To evaluate ARM feasibility, detection rate, and its efficacy in preventing lymphedema in early breast cancer. Pathients and methods: In this prospective randomized study, 80 women with early-stage breast cancer (T1– T2, non-palpable axillary nodes) were randomized to ARM + ALND (n = 40) or standard ALND (n = 40). ARM involved subdermal injection of 3 mL methylene or patent blue into the upper arm, with preservation of bluestained lymphatics unless oncologically suspicious. Arm circumference was measured preoperatively and at 6, 12, and 18 months post-operatively. Lymphedema was defined as ≥ 2 cm inter-arm difference at any anatomical site. Results: ARM identified blue-stained lymph nodes in 100% of cases (1–3 nodes per patient). Lymphedema incidence was significantly lower in the ARM group at 6 months (0% vs. 15%, p = 0.042), 12 months (5% vs. 45%, p = 0.035), and 18 months (10% vs. 55%, p = 0.023). Mean arm circumference was significantly smaller in the ARM group at all postoperative time points (p < 0.05). Conclusion: ARM is a feasible and effective technique for reducing postoperative lymphedema in early breast cancer patients undergoing ALND, without compromising oncological safety. Incorporating ARM into surgical practice may improve postoperative quality of life. | ||
| Keywords | ||
| Axillary reverse mapping; lymphedema; early breast cancer | ||
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