Pasko, J.L., Garreau, J., Carl, A., Ansteth, M., Glissmeyer, M., & Johnson, N. (2015). Axillary reverse lymphatic mapping reduces patient perceived incidence of lymphedema after axillary dissection in breast cancer. American Journal of Surgery, 209, 890–895. 

DOI Link

Study Purpose

To retrospectively examine how axillary reverse lymphatic mapping (ARM) affects patients perceived incidence of lymphedema compared to patients who did not receive ARM

Intervention Characteristics/Basic Study Process

A retrospective review of 46 patients with breast cancer who had greater than 10 lymph nodes removed were recruited and surveyed to determine which patients identified as having lymphedema and whether they required treatment or therapy for it. Patients were also asked if they underwent the ARM procedure.

Sample Characteristics

  • N = 46   
  • MEAN AGE = 57 years  
  • FEMALES: 100%
  • CURRENT TREATMENT: Not applicable
  • KEY DISEASE CHARACTERISTICS: Patients with breast cancer with axillary node dissection

Setting

  • SITE: Retrospective (not applicable)
  • SETTING TYPE: Retrospective (not applicable)
  • LOCATION: Portland, Oregon

Phase of Care and Clinical Applications

  • PHASE OF CARE: Late effects and survivorship 
  • APPLICATIONS: Palliative care 

Study Design

  • Retrospective review

Measurement Instruments/Methods

A survey was created and sent to all women who qualified for the study from the Community Hospital Tumor Registry in Portland, Oregon.

Results

Twenty-two patients reported undergoing the ARM procedure compared to 24 patients who did not undergo the ARM procedure. Of the 22 who did, 39% reported having lymphedema compared with 50% of the non-ARM patients. Eighteen percent of the ARM group reported requiring a compression sleeve for treatment of lymphedema compared to 45.8% of women in the non-ARM group.

Conclusions

The incidence of patient perceptions of lymphedema and the use of compression sleeves were lower in the ARM group than in the non-ARM group.

Limitations

  • Small sample (< 100)
  • Baseline sample/group differences of import
  • Risk of bias (no control group)
  • Risk of bias (no random assignment) 
  • Risk of bias (no appropriate attentional control condition)  
  • Risk of bias (sample characteristics)
  • Unintended interventions or applicable interventions not described that would influence results 
  • Selective outcomes reporting
  • Measurement/methods not well described
  • Measurement validity/reliability questionable 
  • Findings not generalizable
  • Fifty-seven percent of patients contacted for the retrospective study did not complete the survey.

 

Nursing Implications

The effect of using the ARM procedure to decrease lymphedema cannot be ascertained from this study.