Main findings

• The purpose of axillary reverse mapping (ARM) is to differentiate the lymphatics and lymph nodes of the arm from those of the breast during axillary surgery, to enable preservation of the arm lymphatics.
• Arm circumference was measured at a level 10cm proximal to the medial epicondyle before surgery and 6 months after surgery.
• Out of 24 participants with ARM, stained lymphatics were visualized in 18 (75.0%), and stained lymph nodes were visualized in 20 (83.3%).
• the mean number of axillary nodes removed during ALND was 13.4 per person in the study group and 17.4 in the control group; the difference between these means was statistically significant. Although the quantity of retrieved lymph nodes in the ARM group was less than the number of resected nodes with classic axillary dissection, there was no statistically significant difference between the number of harvested nodes and the number of nodes that were positive for malignancy.
• The 4.2% incidence of lymphedema in the study group was not significantly different from the 16.7% incidence in the control group. This lack of significance may be the result of the small number of patients included in the study.
• Limitatation was the small sample size.
• ARM is a minimally invasive technique that can be readily added to ALND and that can help prevent arm lymphedema. The use of ARM for LAD mapping and avoidance of excision of arm lymphatics and nodes was associated with a lower incidence of arm lymphedema than classic ALND surgery in this study population.