ARM-ICG in the prevention of lymphedema after surgical treatment of breast cancer

Abstract

Objective: To evaluate the effectiveness of Axillary Reverse Mapping (ARM) using indocyanine green (ICG) during axillary lymph node dissection (ALND) in breast cancer (BC) patients, aimed at preventing postoperative upper limb lymphedema. Materials and Methods: A prospective study included 128 female patients with invasive breast cancer who underwent surgical treatment at the University Hospital of Odesa National Medical University. The control groups underwent sentinel lymph node biopsy (SLNB) or standard ALND, whereas the study group underwent ARM-ICG with intraoperative visualization of upper limb lymphatic pathways. Lymphedema was assessed at 1, 3, 6, and 12 months postoperatively. Results: ARM-ICG provided clear visualization of lymphatic collectors in 94% of cases and reduced the rate of postoperative lymphedema to 5%, which was significantly lower than after conventional ALND (42.9%, p < 0.001). In the SLNB-only group, lymphedema occurred in 9.4% of patients. The use of ARM-ICG did not compromise oncologic radicality or increase the risk of residual disease. Conclusions: The application of ARM-ICG in surgical management of breast cancer effectively decreases the risk of postoperative lymphedema by preserving upper extremity lymphatic drainage without loss of oncologic control. The technique demonstrates high clinical relevance and may be recommended for routine inclusion in the comprehensive treatment of breast cancer patients.