Surgical Oncology Unit, General Surgery Department, Faculty of Medicine, Tanta University, Tanta, Egypt
10.21608/asjs.2025.412874.1227
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.
Farag, K., Moussa, H., Mlees, M., & El Sherpiny, W. (2025). The Role of Axillary Reverse Mapping in Reducing Lymphedema in Patients with Early Breast Cancer: A Prospective Randomized Study. Ain Shams Journal of Surgery, 18(4), 348-354. doi: 10.21608/asjs.2025.412874.1227
MLA
Kerolos Naem Fayez Farag; Hossam Ramadan Moussa; Mohamed Ali Mlees; Waleed Yusif El Sherpiny. "The Role of Axillary Reverse Mapping in Reducing Lymphedema in Patients with Early Breast Cancer: A Prospective Randomized Study", Ain Shams Journal of Surgery, 18, 4, 2025, 348-354. doi: 10.21608/asjs.2025.412874.1227
HARVARD
Farag, K., Moussa, H., Mlees, M., El Sherpiny, W. (2025). 'The Role of Axillary Reverse Mapping in Reducing Lymphedema in Patients with Early Breast Cancer: A Prospective Randomized Study', Ain Shams Journal of Surgery, 18(4), pp. 348-354. doi: 10.21608/asjs.2025.412874.1227
VANCOUVER
Farag, K., Moussa, H., Mlees, M., El Sherpiny, W. The Role of Axillary Reverse Mapping in Reducing Lymphedema in Patients with Early Breast Cancer: A Prospective Randomized Study. Ain Shams Journal of Surgery, 2025; 18(4): 348-354. doi: 10.21608/asjs.2025.412874.1227
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