Seyednejad, N., Kuusk, U., & Wiseman, S.M. (2014). Axillary reverse lymphatic mapping in breast cancer surgery: A comprehensive review. Expert Review of Anticancer Therapy, 14, 771–781.
STUDY PURPOSE: To evaluate the literature with the reported use of identifying arm and breast lymphatics using the axillary reverse mapping (ARM) procedure, and the utility of using ARM with sentinel lymph node biopsy (SLNB) and axillary lymph node dissection (ALND), as well as the oncologic safety of its use, by reviewing ARM lymph node metastasis and the convergence of SLN and ARM nodes
TYPE OF STUDY: General review/\"semi\" systematic
PHASE OF CARE: Diagnostic
The identification rates of ARM nodes and lymphatics during ALND ranged from 17%–91% and for SLNB, 38%–50%. The applicability in the clinical setting is questionable, given the low rates of ARM/lymphatics identification during both procedures. The broad ranges in ARM/lymphatic identification necessitates improvement in the procedure through standardization of procedure protocols. Metastatic involvement was reported higher in ARM nodes in patients with cancer burden that is extensive in the axilla (0%–43%) and in patients with SLN/ARM node convergence (up to 64%); therefore, further study to understand the connectivity of breast and arm lymphatics is necessary to improve the rate of clinical applicability with the ARM procedure. The outcome measure of lymphedema incidence with or without the ARM procedure varied with no conclusive evidence. Length of follow-up, small follow-up samples, and differences in lymphedema measures and definitions made the outcome measure relative to lymphedema incidence unattainable.
The implications for nursing would be in the area of patient education, if and when the ARM procedure becomes a standard of care. For the present, nurses need to be knowledgeable of clinical trials involving ARM.