Breast Cancer Research and Treatment

, Volume 158, Issue 3, pp 421–432 | Cite as

Axillary reverse mapping in axillary surgery for breast cancer: an update of the current status

  • Martinus A. BeekEmail author
  • Paul D. Gobardhan
  • Ernst J. P. Schoenmaeckers
  • Elisabeth G. Klompenhouwer
  • Harm J. T. Rutten
  • Adri C. Voogd
  • Ernest J. T. Luiten


Axillary reverse mapping (ARM) is a technique by which the lymphatic drainage of the upper extremity that traverses the axillary region can be differentiated from the lymphatic drainage of the breast during axillary lymph node dissection (ALND). Adding this procedure to ALND may reduce upper extremity lymphedema by preserving upper extremity drainage. This review of the current literature on the ARM procedure discusses the feasibility, safety and relevance of this technique. A PubMed literature search was performed until 12 August 2015. A total of 31 studies were included in this review. The studies indicated that the ARM procedure adequately identifies the upper extremity lymph nodes and lymphatics in the axillary basin using blue dye or fluorescence. Preservation of ARM lymph nodes and corresponding lymphatics was proven to be oncologically safe in clinically node-negative breast cancer patients with metastatic lymph node involvement in the sentinel lymph node (SLN) who are advised to undergo a completion ALND. The ARM procedure is technically feasible with a high visualisation rate using blue dye or fluorescence. ALND combined with ARM can be regarded as a promising surgical refinement in order to reduce the incidence of upper extremity lymphedema in selected groups of patients.


Axillary reverse mapping Breast cancer Lymphedema 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Martinus A. Beek
    • 1
    Email author
  • Paul D. Gobardhan
    • 1
  • Ernst J. P. Schoenmaeckers
    • 1
  • Elisabeth G. Klompenhouwer
    • 2
  • Harm J. T. Rutten
    • 3
    • 4
  • Adri C. Voogd
    • 4
    • 5
  • Ernest J. T. Luiten
    • 1
  1. 1.Department of SurgeryAmphia HospitalBredaThe Netherlands
  2. 2.Department of RadiologyThe Netherlands Cancer InstituteAmsterdamThe Netherlands
  3. 3.Department of SurgeryCatharina HospitalEindhovenThe Netherlands
  4. 4.GROW: School of Oncology and Developmental BiologyMaastricht UniversityMaastrichtThe Netherlands
  5. 5.Department of ResearchNetherlands Comprehensive Cancer OrganisationUtrechtThe Netherlands

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