Gebruers Nick, Tjalma Wiebren A A
Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, Universiteitsplein 1, 2610 Wilrijk, Belgium.
Faculty of Medicine and Health Sciences, Universiteitsplein 1, 2610 Wilrijk, Belgium; Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium.
Eur J Obstet Gynecol Reprod Biol. 2016 May;200:117-22. doi: 10.1016/j.ejogrb.2016.03.014. Epub 2016 Mar 17.
Breast cancer is the most common malignancy in women worldwide. Fortunately, the overall survival is good. Therefore it is important to focus on the morbidities related to breast cancer treatment. One of the most dreaded morbidities is lymphedema. In 2007 the Axillary Reverse Mapping (ARM) was introduced to limit the invasiveness in the axilla during breast cancer surgery. It is hypothesized that ARM is able to limit the incidence of breast cancer related lymphedema (BCRL) considerably. This systematic review aims to answer the following research questions: (1) which approaches for ARM are described? (2) Is ARM surgical feasible and oncological safe? (3) Does ARM decrease the incidence of lymphedema after sentinel lymph node biopsy (SLNB) and axillary lymph node dissection (ALND)? In total 27 papers were retrieved using four electronic databases (PubMed, Web of Science, Medline and Cochrane clinical trials; assessed until May 13, 2015. The level of evidence of these studies was low (mostly level 3). Therefore the conclusions are that the ARM procedure is feasible although ARM-node rates have a broad range. Additionally, from a theoretical point there is a clear benefit from ARM in terms of lymphedema prevention. From a practical point there is little scientific data to support this due to the lack of studies; and especially because of the different methods and definitions for lymphedema used in the different studies.
乳腺癌是全球女性中最常见的恶性肿瘤。幸运的是，总体生存率良好。因此，关注与乳腺癌治疗相关的发病率很重要。最可怕的发病率之一是淋巴水肿。2007年引入了腋窝反向映射（ARM）技术，以在乳腺癌手术期间限制腋窝的侵袭性。据推测，ARM能够显著降低乳腺癌相关淋巴水肿（BCRL）的发生率。本系统评价旨在回答以下研究问题：（1）描述了哪些ARM方法？（2）ARM手术是否可行且肿瘤学安全？（3）ARM是否能降低前哨淋巴结活检（SLNB）和腋窝淋巴结清扫（ALND）后淋巴水肿的发生率？通过四个电子数据库（PubMed、科学网、Medline和Cochrane临床试验；截至2015年5月13日进行评估）共检索到27篇论文。这些研究的证据水平较低（大多为3级）。因此得出的结论是，尽管ARM淋巴结检出率范围较广，但ARM手术是可行的。此外，从理论上讲，ARM在预防淋巴水肿方面有明显益处。从实际角度来看，由于缺乏研究，尤其是因为不同研究中使用的淋巴水肿方法和定义不同，几乎没有科学数据支持这一点。
