The Feasibility and Oncological Safety of Axillary Reverse Mapping in Patients with Breast Cancer: A Systematic Review and Meta-Analysis of Prospective Studies
Identifieur interne : 000834 ( Pmc/Curation ); précédent : 000833; suivant : 000835The Feasibility and Oncological Safety of Axillary Reverse Mapping in Patients with Breast Cancer: A Systematic Review and Meta-Analysis of Prospective Studies
Auteurs : Chao Han [République populaire de Chine] ; Ben Yang [République populaire de Chine] ; Wen-Shu Zuo [République populaire de Chine] ; Gang Zheng [République populaire de Chine] ; Li Yang [République populaire de Chine] ; Mei-Zhu Zheng [République populaire de Chine]Source :
- PLoS ONE [ 1932-6203 ] ; 2016.
Abstract
The axillary reverse mapping (ARM) technique has recently been developed to prevent lymphedema by preserving the arm lymphatic drainage during sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND) procedures. The objective of this systematic review and meta-analysis was to evaluate the feasibility and oncological safety of ARM.
We searched Medline, Embase, Web of science, Scopus, and the Cochrane Library for relevant prospective studies. The identification rate of ARM nodes, the crossover rate of SLN-ARM nodes, the proportion of metastatic ARM nodes, and the incidence of complications were pooled into meta-analyses by the random-effects model.
A total of 24 prospective studies were included into meta-analyses, of which 11 studies reported ARM during SLNB, and 18 studies reported ARM during SLNB. The overall identification rate of ARM nodes was 38.2% (95% CI 32.9%-43.8%) during SLNB and 82.8% (78.0%-86.6%) during ALND, respectively. The crossover rate of SLN-ARM nodes was 19.6% (95% CI 14.4%-26.1%). The metastatic rate of ARM nodes was 16.9% (95% CI 14.2%-20.1%). The pooled incidence of lymphedema was 4.1% (95% CI 2.9–5.9%) for patients undergoing ARM procedure.
The ARM procedure was feasible during ALND. Nevertheless, it was restricted by low identification rate of ARM nodes during SLNB. ARM was beneficial for preventing lymphedema. However, this technique should be performed with caution given the possibility of crossover SLN-ARM nodes and metastatic ARM nodes. ARM appeared to be unsuitable for patients with clinically positive breast cancer due to oncological safety concern.
Url:
DOI: 10.1371/journal.pone.0150285
PubMed: 26919589
PubMed Central: 4769133
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">The Feasibility and Oncological Safety of Axillary Reverse Mapping in Patients with Breast Cancer: A Systematic Review and Meta-Analysis of Prospective Studies</title><author><name sortKey="Han, Chao" sort="Han, Chao" uniqKey="Han C" first="Chao" last="Han">Chao Han</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>Department of Surgery II, Breast Cancer Center, Shandong Cancer Hospital and Institute, Jinan, Shandong, China</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Surgery II, Breast Cancer Center, Shandong Cancer Hospital and Institute, Jinan, Shandong</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff002"><addr-line>School of Medicine and life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan, Shandong, China</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>School of Medicine and life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan, Shandong</wicri:regionArea></affiliation></author><author><name sortKey="Yang, Ben" sort="Yang, Ben" uniqKey="Yang B" first="Ben" last="Yang">Ben Yang</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>Department of Surgery II, Breast Cancer Center, Shandong Cancer Hospital and Institute, Jinan, Shandong, China</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Surgery II, Breast Cancer Center, Shandong Cancer Hospital and Institute, Jinan, Shandong</wicri:regionArea></affiliation></author><author><name sortKey="Zuo, Wen Shu" sort="Zuo, Wen Shu" uniqKey="Zuo W" first="Wen-Shu" last="Zuo">Wen-Shu Zuo</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>Department of Surgery II, Breast Cancer Center, Shandong Cancer Hospital and Institute, Jinan, Shandong, China</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Surgery II, Breast Cancer Center, Shandong Cancer Hospital and Institute, Jinan, Shandong</wicri:regionArea></affiliation></author><author><name sortKey="Zheng, Gang" sort="Zheng, Gang" uniqKey="Zheng G" first="Gang" last="Zheng">Gang Zheng</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>Department of Surgery II, Breast Cancer Center, Shandong Cancer Hospital and Institute, Jinan, Shandong, China</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Surgery II, Breast Cancer Center, Shandong Cancer Hospital and Institute, Jinan, Shandong</wicri:regionArea></affiliation></author><author><name sortKey="Yang, Li" sort="Yang, Li" uniqKey="Yang L" first="Li" last="Yang">Li Yang</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>Department of Surgery II, Breast Cancer Center, Shandong Cancer Hospital and Institute, Jinan, Shandong, China</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Surgery II, Breast Cancer Center, Shandong Cancer Hospital and Institute, Jinan, Shandong</wicri:regionArea></affiliation></author><author><name sortKey="Zheng, Mei Zhu" sort="Zheng, Mei Zhu" uniqKey="Zheng M" first="Mei-Zhu" last="Zheng">Mei-Zhu Zheng</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>Department of Surgery II, Breast Cancer Center, Shandong Cancer Hospital and Institute, Jinan, Shandong, China</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Surgery II, Breast Cancer Center, Shandong Cancer Hospital and Institute, Jinan, Shandong</wicri:regionArea></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">26919589</idno><idno type="pmc">4769133</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4769133</idno><idno type="RBID">PMC:4769133</idno><idno type="doi">10.1371/journal.pone.0150285</idno><date when="2016">2016</date><idno type="wicri:Area/Pmc/Corpus">000834</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000834</idno><idno type="wicri:Area/Pmc/Curation">000834</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000834</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">The Feasibility and Oncological Safety of Axillary Reverse Mapping in Patients with Breast Cancer: A Systematic Review and Meta-Analysis of Prospective Studies</title><author><name sortKey="Han, Chao" sort="Han, Chao" uniqKey="Han C" first="Chao" last="Han">Chao Han</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>Department of Surgery II, Breast Cancer Center, Shandong Cancer Hospital and Institute, Jinan, Shandong, China</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Surgery II, Breast Cancer Center, Shandong Cancer Hospital and Institute, Jinan, Shandong</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff002"><addr-line>School of Medicine and life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan, Shandong, China</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>School of Medicine and life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan, Shandong</wicri:regionArea></affiliation></author><author><name sortKey="Yang, Ben" sort="Yang, Ben" uniqKey="Yang B" first="Ben" last="Yang">Ben Yang</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>Department of Surgery II, Breast Cancer Center, Shandong Cancer Hospital and Institute, Jinan, Shandong, China</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Surgery II, Breast Cancer Center, Shandong Cancer Hospital and Institute, Jinan, Shandong</wicri:regionArea></affiliation></author><author><name sortKey="Zuo, Wen Shu" sort="Zuo, Wen Shu" uniqKey="Zuo W" first="Wen-Shu" last="Zuo">Wen-Shu Zuo</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>Department of Surgery II, Breast Cancer Center, Shandong Cancer Hospital and Institute, Jinan, Shandong, China</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Surgery II, Breast Cancer Center, Shandong Cancer Hospital and Institute, Jinan, Shandong</wicri:regionArea></affiliation></author><author><name sortKey="Zheng, Gang" sort="Zheng, Gang" uniqKey="Zheng G" first="Gang" last="Zheng">Gang Zheng</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>Department of Surgery II, Breast Cancer Center, Shandong Cancer Hospital and Institute, Jinan, Shandong, China</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Surgery II, Breast Cancer Center, Shandong Cancer Hospital and Institute, Jinan, Shandong</wicri:regionArea></affiliation></author><author><name sortKey="Yang, Li" sort="Yang, Li" uniqKey="Yang L" first="Li" last="Yang">Li Yang</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>Department of Surgery II, Breast Cancer Center, Shandong Cancer Hospital and Institute, Jinan, Shandong, China</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Surgery II, Breast Cancer Center, Shandong Cancer Hospital and Institute, Jinan, Shandong</wicri:regionArea></affiliation></author><author><name sortKey="Zheng, Mei Zhu" sort="Zheng, Mei Zhu" uniqKey="Zheng M" first="Mei-Zhu" last="Zheng">Mei-Zhu Zheng</name><affiliation wicri:level="1"><nlm:aff id="aff001"><addr-line>Department of Surgery II, Breast Cancer Center, Shandong Cancer Hospital and Institute, Jinan, Shandong, China</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Surgery II, Breast Cancer Center, Shandong Cancer Hospital and Institute, Jinan, Shandong</wicri:regionArea></affiliation></author></analytic><series><title level="j">PLoS ONE</title><idno type="eISSN">1932-6203</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="sec001"><title>Objective</title><p>The axillary reverse mapping (ARM) technique has recently been developed to prevent lymphedema by preserving the arm lymphatic drainage during sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND) procedures. The objective of this systematic review and meta-analysis was to evaluate the feasibility and oncological safety of ARM.</p></sec><sec id="sec002"><title>Methods</title><p>We searched Medline, Embase, Web of science, Scopus, and the Cochrane Library for relevant prospective studies. The identification rate of ARM nodes, the crossover rate of SLN-ARM nodes, the proportion of metastatic ARM nodes, and the incidence of complications were pooled into meta-analyses by the random-effects model.</p></sec><sec id="sec003"><title>Results</title><p>A total of 24 prospective studies were included into meta-analyses, of which 11 studies reported ARM during SLNB, and 18 studies reported ARM during SLNB. The overall identification rate of ARM nodes was 38.2% (95% CI 32.9%-43.8%) during SLNB and 82.8% (78.0%-86.6%) during ALND, respectively. The crossover rate of SLN-ARM nodes was 19.6% (95% CI 14.4%-26.1%). The metastatic rate of ARM nodes was 16.9% (95% CI 14.2%-20.1%). The pooled incidence of lymphedema was 4.1% (95% CI 2.9–5.9%) for patients undergoing ARM procedure.</p></sec><sec id="sec004"><title>Conclusions</title><p>The ARM procedure was feasible during ALND. Nevertheless, it was restricted by low identification rate of ARM nodes during SLNB. ARM was beneficial for preventing lymphedema. However, this technique should be performed with caution given the possibility of crossover SLN-ARM nodes and metastatic ARM nodes. ARM appeared to be unsuitable for patients with clinically positive breast cancer due to oncological safety concern.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Gradishar, Wj" uniqKey="Gradishar W">WJ Gradishar</name></author><author><name sortKey="Anderson, Bo" uniqKey="Anderson B">BO Anderson</name></author><author><name sortKey="Balassanian, R" uniqKey="Balassanian R">R Balassanian</name></author><author><name sortKey="Blair, Sl" uniqKey="Blair S">SL Blair</name></author><author><name sortKey="Burstein, Hj" uniqKey="Burstein H">HJ Burstein</name></author><author><name sortKey="Cyr, A" uniqKey="Cyr A">A Cyr</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Desantis, C" uniqKey="Desantis C">C DeSantis</name></author><author><name sortKey="Ma, J" uniqKey="Ma J">J Ma</name></author><author><name sortKey="Bryan, L" uniqKey="Bryan L">L Bryan</name></author><author><name sortKey="Jemal, A" 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Endo</name></author><author><name sortKey="Shimizu, K" uniqKey="Shimizu K">K Shimizu</name></author><author><name sortKey="Yoshimizu, N" uniqKey="Yoshimizu N">N Yoshimizu</name></author><author><name sortKey="Nakajima, K" uniqKey="Nakajima K">K Nakajima</name></author><author><name sortKey="Nosaka, K" uniqKey="Nosaka K">K Nosaka</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Schunemann, E" uniqKey="Schunemann E">E Schunemann</name></author><author><name sortKey="Doria, Mt" uniqKey="Doria M">MT Doria</name></author><author><name sortKey="Silvestre, Jb" uniqKey="Silvestre J">JB Silvestre</name></author><author><name sortKey="Gasperin, P" uniqKey="Gasperin P">P Gasperin</name></author><author><name sortKey="Cavalcanti, Tc" uniqKey="Cavalcanti T">TC Cavalcanti</name></author><author><name sortKey="Budel, Vm" uniqKey="Budel V">VM Budel</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Beek, Ma" uniqKey="Beek M">MA 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article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">PLoS One</journal-id><journal-id journal-id-type="iso-abbrev">PLoS ONE</journal-id><journal-id journal-id-type="publisher-id">plos</journal-id><journal-id journal-id-type="pmc">plosone</journal-id><journal-title-group><journal-title>PLoS ONE</journal-title></journal-title-group><issn pub-type="epub">1932-6203</issn><publisher><publisher-name>Public Library of Science</publisher-name><publisher-loc>San Francisco, CA USA</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">26919589</article-id><article-id pub-id-type="pmc">4769133</article-id><article-id pub-id-type="doi">10.1371/journal.pone.0150285</article-id><article-id pub-id-type="publisher-id">PONE-D-15-28409</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Pathology and Laboratory Medicine</subject><subj-group><subject>Signs and Symptoms</subject><subj-group><subject>Edema</subject><subj-group><subject>Lymphedema</subject></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Biology and Life Sciences</subject><subj-group><subject>Anatomy</subject><subj-group><subject>Musculoskeletal System</subject><subj-group><subject>Limbs (Anatomy)</subject><subj-group><subject>Arms</subject></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Anatomy</subject><subj-group><subject>Musculoskeletal System</subject><subj-group><subject>Limbs (Anatomy)</subject><subj-group><subject>Arms</subject></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Research and Analysis Methods</subject><subj-group><subject>Mathematical and Statistical Techniques</subject><subj-group><subject>Statistical Methods</subject><subj-group><subject>Meta-Analysis</subject></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Physical Sciences</subject><subj-group><subject>Mathematics</subject><subj-group><subject>Statistics (Mathematics)</subject><subj-group><subject>Statistical Methods</subject><subj-group><subject>Meta-Analysis</subject></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Physical Sciences</subject><subj-group><subject>Materials Science</subject><subj-group><subject>Materials by Attribute</subject><subj-group><subject>Pigments</subject><subj-group><subject>Dyes</subject><subj-group><subject>Fluorescent Dyes</subject></subj-group></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Oncology</subject><subj-group><subject>Cancer Detection and Diagnosis</subject><subj-group><subject>Lymphatic Mapping</subject></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Oncology</subject><subj-group><subject>Basic Cancer Research</subject><subj-group><subject>Metastasis</subject></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Oncology</subject><subj-group><subject>Cancers and Neoplasms</subject><subj-group><subject>Breast Tumors</subject><subj-group><subject>Breast Cancer</subject></subj-group></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Oncology</subject></subj-group></subj-group></article-categories><title-group><article-title>The Feasibility and Oncological Safety of Axillary Reverse Mapping in Patients with Breast Cancer: A Systematic Review and Meta-Analysis of Prospective Studies</article-title><alt-title alt-title-type="running-head">Axillary Reverse Mapping in Breast Cancer</alt-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Han</surname><given-names>Chao</given-names></name><xref ref-type="aff" rid="aff001"><sup>1</sup></xref><xref ref-type="aff" rid="aff002"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Yang</surname><given-names>Ben</given-names></name><xref ref-type="aff" rid="aff001"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Zuo</surname><given-names>Wen-Shu</given-names></name><xref ref-type="aff" rid="aff001"><sup>1</sup></xref><xref ref-type="corresp" rid="cor001">*</xref></contrib><contrib contrib-type="author"><name><surname>Zheng</surname><given-names>Gang</given-names></name><xref ref-type="aff" rid="aff001"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Yang</surname><given-names>Li</given-names></name><xref ref-type="aff" rid="aff001"><sup>1</sup></xref></contrib><contrib contrib-type="author"><name><surname>Zheng</surname><given-names>Mei-Zhu</given-names></name><xref ref-type="aff" rid="aff001"><sup>1</sup></xref></contrib></contrib-group><aff id="aff001"><label>1</label><addr-line>Department of Surgery II, Breast Cancer Center, Shandong Cancer Hospital and Institute, Jinan, Shandong, China</addr-line></aff><aff id="aff002"><label>2</label><addr-line>School of Medicine and life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan, Shandong, China</addr-line></aff><contrib-group><contrib contrib-type="editor"><name><surname>Liu</surname><given-names>Xiaoan</given-names></name><role>Editor</role><xref ref-type="aff" rid="edit1"></xref></contrib></contrib-group><aff id="edit1"><addr-line>The First Affiliated Hospital with Nanjing Medical University, CHINA</addr-line></aff><author-notes><fn fn-type="conflict" id="coi001"><p><bold>Competing Interests: </bold>The authors have declared that no competing interests exist.</p></fn><fn fn-type="con" id="contrib001"><p>Conceived and designed the experiments: CH BY WSZ. Performed the experiments: CH BY WSZ. Analyzed the data: CH BY GZ LY. Contributed reagents/materials/analysis tools: LY MZZ. Wrote the paper: CH BY WSZ.</p></fn><corresp id="cor001">* E-mail: <email>sdwenshu_z@126.com</email></corresp></author-notes><pub-date pub-type="epub"><day>26</day><month>2</month><year>2016</year></pub-date><pub-date pub-type="collection"><year>2016</year></pub-date><volume>11</volume><issue>2</issue><elocation-id>e0150285</elocation-id><history><date date-type="received"><day>29</day><month>6</month><year>2015</year></date><date date-type="accepted"><day>11</day><month>2</month><year>2016</year></date></history><permissions><copyright-statement>© 2016 Han et al</copyright-statement><copyright-year>2016</copyright-year><copyright-holder>Han et al</copyright-holder><license xlink:href="http://creativecommons.org/licenses/by/4.0/"><license-p>This is an open access article distributed under the terms of the <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">Creative Commons Attribution License</ext-link>, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</license-p></license></permissions><self-uri content-type="pdf" xlink:type="simple" xlink:href="pone.0150285.pdf"></self-uri><abstract><sec id="sec001"><title>Objective</title><p>The axillary reverse mapping (ARM) technique has recently been developed to prevent lymphedema by preserving the arm lymphatic drainage during sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND) procedures. The objective of this systematic review and meta-analysis was to evaluate the feasibility and oncological safety of ARM.</p></sec><sec id="sec002"><title>Methods</title><p>We searched Medline, Embase, Web of science, Scopus, and the Cochrane Library for relevant prospective studies. The identification rate of ARM nodes, the crossover rate of SLN-ARM nodes, the proportion of metastatic ARM nodes, and the incidence of complications were pooled into meta-analyses by the random-effects model.</p></sec><sec id="sec003"><title>Results</title><p>A total of 24 prospective studies were included into meta-analyses, of which 11 studies reported ARM during SLNB, and 18 studies reported ARM during SLNB. The overall identification rate of ARM nodes was 38.2% (95% CI 32.9%-43.8%) during SLNB and 82.8% (78.0%-86.6%) during ALND, respectively. The crossover rate of SLN-ARM nodes was 19.6% (95% CI 14.4%-26.1%). The metastatic rate of ARM nodes was 16.9% (95% CI 14.2%-20.1%). The pooled incidence of lymphedema was 4.1% (95% CI 2.9–5.9%) for patients undergoing ARM procedure.</p></sec><sec id="sec004"><title>Conclusions</title><p>The ARM procedure was feasible during ALND. Nevertheless, it was restricted by low identification rate of ARM nodes during SLNB. ARM was beneficial for preventing lymphedema. However, this technique should be performed with caution given the possibility of crossover SLN-ARM nodes and metastatic ARM nodes. ARM appeared to be unsuitable for patients with clinically positive breast cancer due to oncological safety concern.</p></sec></abstract><funding-group><funding-statement>The authors have no support or funding to report.</funding-statement></funding-group><counts><fig-count count="6"></fig-count><table-count count="3"></table-count><page-count count="16"></page-count></counts><custom-meta-group><custom-meta id="data-availability"><meta-name>Data Availability</meta-name><meta-value>All relevant data are within the paper and its Supporting Information files.</meta-value></custom-meta></custom-meta-group></article-meta><notes><title>Data Availability</title><p>All relevant data are within the paper and its Supporting Information files.</p></notes></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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