Axillary Reverse Mapping (ARM) Technique
Axillary Reverse Mapping (ARM) Technique
The purpose of this pilot study is to compare a new surgical technique (axillary reverse
 mapping) to standard axillary surgery in patients diagnosed with invasive or in situ breast
 cancer.
Lymphedema is a major chronic morbidity that occurs in patients undergoing treatment for
 breast cancer (BC). Surgery for BC includes axillary surgery with either sentinel lymph node
 biopsy (SLNB) or axillary lymph node dissection (ALND). Lymphedema occurs due to removal or
 disruption of lymphatic drainage of the arm that overlaps with drainage of the breast. The
 risk of lymphedema increases significantly with adjuvant radiation. Axillary reverse mapping
 (ARM) is a technique where blue dye is injected into the upper arm at surgery, allowing
 direct visualization of arm lymphatics and nodes during either SLNB or ALND. This allows
 preservation of arm lymphatics unless there is suspicion of metastatic disease in ARM
 lymphatics or if the ARM node is/are also the sentinel lymph node. Studies to date have
 largely been observational cohort studies, and mainly with low risk patients undergoing SLNB
 only. There is only one published randomized controlled trial, and this included only
 patients undergoing modified radical mastectomy.Our proposal is a prospective randomized
 pilot study. The study population includes patients undergoing axillary surgery (SLNB with
 mastectomy or ALND with either BCS or mastectomy or completion ALND after positive SLNB). The
 intervention group will undergo ARM; the control will undergo standard surgical treatment.
 Both groups will undergo standardized baseline and postoperative arm measurements and
 patients will complete symptom and quality of life questionnaires. The purpose is to
 determine the feasibility of the ARM technique, its accuracy in identifying and sparing arm
 lymphatics, and its ability to reduce the risk of lymphedema.
Inclusion Criteria: women diagnosed with invasive breast cancer or ductal carcinoma in situ
 receiving the following treatment:

 1. mastectomy and sentinel lymph node biopsy

 2. breast conserving surgery or mastectomy and axillary lymph node dissection

 3. completion axillary lymph node dissection after positive sentinel lymph node biopsy

 4. cases receiving neo-adjuvant therapy (chemotherapy or hormonal therapy) who are having
 axillary lymph node dissection as part of their surgical treatment -

 Exclusion Criteria:

 1. males with breast cancer

 2. women less than 18 years of age

 3. known allergic reaction to patent blue dye

 4. pregnant

 5. previous radiation therapy to affected side

 6. clinical N2/N3 disease -