title: Systematic review of axillary reverse mapping in breast cancer.
abstract: BACKGROUND
  Axillary reverse mapping (ARM) assesses the lymphatic drainage of the arm simultaneously with that of the breast, enabling preservation of arm lymphatics during axillary surgery for breast cancer. This article systematically reviews the evidence on the lymphoedema rate and oncological safety of the ARM technique.
  
  
  METHODS
  PubMed, Embase and the Cochrane Library were searched systematically for studies that addressed the use of ARM during axillary surgery in breast cancer. Studies were eligible if they performed ARM during sentinel node biopsy (SNB) or axillary node clearance (ANC) for breast cancer in prospective studies of more than 50 patients, with assessment of lymphoedema and oncological outcomes during a minimum follow-up of 6 months.
  
  
  RESULTS
  Eight studies reported data on ARM in 1142 patients undergoing axillary surgery for breast cancer. Lymphoedema rates ranged from 0 to 6 per cent during ARM-assisted SNB, and from 5.9 to 24 per cent during ARM lymphatic preservation at ANC. Crossover nodes between the arm and breast lymphatics were identified in 0-10 per cent of patients, and metastases were present in 0-20 per cent of these patients. ARM nodes were not preserved in between 11 and 18 per cent of patients with ARM nodes identified, and metastases were detected in 0-19 per cent of these patients.
  
  
  CONCLUSIONS
  ARM can achieve low rates of lymphoedema, but the risk of metastasis in crossover and clinically suspicious ARM nodes, or those in close proximity to an involved sentinel node, warrants their excision.
authors.affiliation: Research Oncology, Division of Cancer Studies, King's College London, London, UK.|Department of Breast Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: M
authors.initials: M
authors.lastname: Ahmed
authors.affiliation: Breast Surgical Unit, Breast Cancer Centre, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
authors.forename: I T
authors.initials: IT
authors.lastname: Rubio
authors.affiliation: Department of Breast Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: T
authors.initials: T
authors.lastname: Kovacs
authors.affiliation: Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
authors.forename: V S
authors.initials: VS
authors.lastname: Klimberg
authors.affiliation: Research Oncology, Division of Cancer Studies, King's College London, London, UK.|Department of Breast Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors.forename: M
authors.initials: M
authors.lastname: Douek
mesh_terms: D001365:Axilla; D001943:Breast Neoplasms / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D009367:Neoplasm Staging; D011379:Prognosis; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*