Gennaro, M., Maccauro, M., Sigari, C., Casalini, P., Bedodi, L., Conti, A. R., . . . Bombardieri, E. (2013). Selective axillary dissection after axillary reverse mapping to prevent breast cancer–related lymphoedema. European Journal of Surgical Oncology, 39, 1341–1345.

DOI Link

Study Purpose

To assess the occurrence of breast cancer–related lymphedema (BCRL) and the feasibility of selective axillary dissection (SAD) after axillary reverse mapping (ARM)

Intervention Characteristics/Basic Study Process

ARM was performed on 60 patients undergoing SAD. Patients received follow-up after 6–36 months and were assessed for BCRL.

Sample Characteristics

  • N = 60    
  • KEY DISEASE CHARACTERISTICS: Patients with axillary nodal involvement, diagnosed by positive sentinel lymph node biopsy or preoperative needle biopsy, scheduled for axillary lymph node dissection 
  • OTHER KEY SAMPLE CHARACTERISTICS: All patients received three intradermal injections of Tc-labeled nanocolloid, and lymphoscintigraphy was performed one hour later. Operations were completed by the same surgeon, and SAD was completed up to Berg’s level III, with identification and preservation of the arm’s lymphatic hot spot when feasible.

Setting

  • SITE: Single site 
  • SETTING TYPE: Inpatient 
  • LOCATION: Milan, Italy

Phase of Care and Clinical Applications

  • PHASE OF CARE: Active antitumor treatment

Study Design

The intervention group participated in the SAD intervention, and the control group usually had axillary lymph node dissection. 

Measurement Instruments/Methods

  • T test
  • Chi-square
  • Fisher’s exact test

Results

SAD was successful in 45 of 60 patients. Four of 45 patients in the intervention group and five of 15 patients in the control group developed lymphedema (p = .072). 

Conclusions

BCRL with SAD technique after median follow-up of 16 months had 33% the rate of lymphedema occurence than conventional ALND. SAD technique requires a separate surgery from sentinel lymph node biopsy. Authors concede there may be a learning curve to this technique, and further research is needed to determine appropriate patient selection.

Limitations

  • Small sample (< 100)
  • Risk of bias (no blinding)
  • Findings not generalizable
  • Other limitations/explanation:  Relatively short follow-up to determine development of BCRL

Nursing Implications

New surgical techniques may result in lowering patient morbidity but does not eliminate the possibility of patients developing BCRL. Education should continue to be provided to all patients regarding early identification of signs and symptoms of BCRL.