| Coverage Policy Manual | |
| Policy #: | 2022045 |
| Category: | Surgery |
| Initiated: | November 2022 |
| Last Review: | November 2023 |
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| Axillary Reverse Mapping for Prevention of Breast Cancer-Related Lymphedema | |
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| Description: |
Surgery and radiotherapy for breast cancer can lead to lymphedema and are some of the most common causes of secondary lymphedema. Lymphedema is associated with a significant impact on quality of life, and there is no cure for lymphedema. Axillary reverse mapping, also called reverse lymphatic mapping, has been developed with the intent of sparing axillary lymph nodes and lymphatics during breast cancer surgery, minimizing disruption and potentially reducing the risk of subsequent lymphedema development.
Lymphedema
Lymphedema is an accumulation of fluid due to a disruption of lymphatic drainage. Lymphedema can be caused by congenital or inherited abnormalities in the lymphatic system (primary lymphedema) but is most often caused by acquired damage to the lymphatic system (secondary lymphedema). Breast cancer treatment is one of the most common causes of secondary lymphedema. Specific treatment-associated risk factors associated with lymphedema development include:
The risk of breast cancer-related lymphedema is also increased in overweight or obese individuals, and in those with postoperative infections. Studies have suggested that Black breast cancer survivors are nearly 2.2 times more likely to develop breast cancer-related lymphedema compared to White breast cancer survivors (Dean, 2016). These observations may be linked to racial disparities with regards to access to treatment and the types of treatments received. Black women are more likely than White women to undergo axillary lymph node dissection, which is associated with greater morbidity than the less invasive sentinel lymph node biopsy. While this may be explained in part by Black individuals having a higher likelihood of being diagnosed with more aggressive tumors, there is evidence that even when adjusting for stage and grade of tumors, Black women are more likely to undergo axillary lymph node dissection, putting Black women at greater risk of breast cancer-related lymphedema. Additionally, Black breast cancer survivors, on average, have higher body mass indexes than White breast cancer survivors, which could contribute to the development of lymphedema in this setting as well.
Development of lymphedema may take months or years following breast cancer treatment, and the true prevalence of breast cancer-related lymphedema is unclear (McLaughlin, 2020). Systematic reviews have found lymphedema rates up to 13% in individuals undergoing sentinel lymph node biopsy (SNLB) and as high as 77% in those undergoing axillary lymph node dissection (ANLD) (Shao, 2019) The addition of radiation therapy to SNLB or ANLD may also increase risk of lymphedema. A prospective study of 1,815 individuals published in 2020 found a5-year cumulative incidence of breast cancer-related lymphedema of 9.5%, which ranged widely from 8% to 30% when stratified according to type of treatment. The lowest incidence of lymphedema was found among those undergoing SLNB only (8%), increasing to 11% for SNLB + regional lymph node radiation, 25% for ANLD only, and 30% for ANLD + RLNR (Naoum, 2020). While SNLB was associated with a lower lymphedema risk, some risk remains, particularly for those with multiple positive axillary nodes for whom the standard for care is ANLD with or without radiation.
Early and ongoing treatment of lymphedema is necessary. Conservative therapy may consist of several features depending on the severity of the lymphedema. Patients are educated on the importance of self-care including hygiene practices to prevent infection, maintaining ideal body weight through diet and exercise, and limb elevation. Compression therapy consists of repeatedly applying padding and bandages or compression garments. Manual lymphatic drainage is a light pressure massage performed by trained physical therapists or patients designed to move fluid from obstructed areas into functioning lymph vessels and lymph nodes. Complete decongestive therapy is a multiphase treatment program involving all of the previously mentioned conservative treatment components at different intensities. Pneumatic compression pumps may also be considered as an adjunct to conservative therapy or as an alternative to self-manual lymphatic drainage in patients who have difficulty performing self-manual lymphatic drainage. Inpatients with more advanced lymphedema after fat deposition and tissue fibrosis have occurred, palliative surgery using reductive techniques such as liposuction may be performed.
Axillary Reverse Mapping
Axillary reverse mapping (ARM), involves intravenous administration of blue dye, fluorescence (i.e., indocyanine green), or radioisotopes to allow for visualization of the lymphatic drainage pathways of the arm and breast. This visualization is intended to distinguish and enable preservation of axillary lymph nodes and lymphatics in individuals undergoing SLNB and/or ANLD. It is believed that because the axilla and breast have mostly separate drainage pathways, the risk of lymphedema is reduced by avoiding the removal of lymph nodes and lymphatics that only drain the axilla identified through ARM. In the event that ARM reveals that the axillary nodes cannot be spared, for example due to crossover of sentinel and axillary nodes, lymphatic physiologic microsurgery has been explored as a method to preserve the axillary nodes, though evidence is limited.
Regulatory Status
Axillary reverse mapping for lymphedema is adjunctive to a surgical procedure and, as such, is not subject to regulation by the U.S.Food and Drug Administration (FDA). Mapping agents used to visualize lymphatic pathways (e.g. isosulfan blue, indocyanine green) may be subject to FDA regulation (DA, 2022).
Coding
There is no specific code for axillary reverse mapping (ARM). This procedure may be billed with CPT 38999.
38999 Unlisted procedure, hemic or lymphatic system
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Policy/ Coverage: |
Effective March 1, 2023
Does Not Meet Primary Coverage Criteria Or Is Investigational For Contracts Without Primary Coverage Criteria
Axillary reverse mapping/reverse lymphatic mapping performed during sentinel lymph node biopsy to prevent lymphedema in individuals who are being treated for breast cancer does not meet member benefit certificate primary coverage criteria that there be scientific evidence of effectiveness in improving health outcomes.
For members with contracts without primary coverage criteria, axillary reverse mapping/reverse lymphatic mapping performed during sentinel lymph node biopsy to prevent lymphedema in individuals who are being treated for breast cancer is considered investigational. Investigational services are specific contract exclusions in most member benefit certificates of coverage.
Axillary reverse mapping/reverse lymphatic mapping performed during axillary lymph node dissection to prevent lymphedema in individuals who are being treated for breast cancer does not meet member benefit certificate primary coverage criteria that there be scientific evidence of effectiveness in improving health outcomes.
For members with contracts without primary coverage criteria, axillary reverse mapping/reverse lymphatic mapping performed during axillary lymph node dissection to prevent lymphedema in individuals who are being treated for breast cancer is considered investigational. Investigational services are specific contract exclusions in most member benefit certificates of coverage.
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| Rationale: |
The purpose of axillary reverse mapping (ARM) simultaneous to breast cancer surgery is to prevent lymphedema in individuals who are being treated for breast cancer. The National Lymphedema Network has issued a set of lymphedema risk reduction practices (National Lymphedema Network Medical Advisory Committee, 2022).
Pre-treatment, these include patient education and arm and weight measurements. Post-treatment prevention measures include appropriate skin care; monitoring of activity/exercise level; avoiding limb constriction; use of well-fitting compression clothing, particularly during strenuous activity and air travel; and avoiding extreme temperatures. However, most recommendations are based on clinical opinion and direct evidence on lymphedema prevention is limited. A 2011 systematic review of preventive measures for lymphedema found strong scientific evidence only for the recommendations to maintain a normal body weight or avoid weight gain and to participate in a supervised exercise regimen (Cemal, 2011).
A subsequent 2016 review of the evidence for lifestyle-related breast cancer lymphedema risk factors that included air travel, ipsilateral arm blood pressure measurements, skin puncture, extreme temperatures, and skin infections found mostly low-level or inconclusive evidence of association (Asdourian, 2016).
Diagnosis of lymphedema is based on history and physical examination, although imaging may also be used. Symptoms that may indicate lymphedema include chronic swelling, atrophic skin changes, and recurrent infections. Objective outcomes of interest include a reduction in limb circumference and/or volume and reduction in the rates of infections (eg, cellulitis, lymphangitis). Volume is measured using different methods; eg, tape measurements with geometry formulas, perometry, and water displacement. Bioimpedance spectroscopy may be used to detect changes in tissue fluid accumulation.
The International Society of Lymphology categorizes lymphedema stage and severity as follows (Executive Committee of the International Society of Lymphology, 2020):
Stage Severity
0: A subclinical, usually asymptomatic condition with -----
impaired lymph transport
1: Edema that resolves with limb elevation, usually Mild: <20% increase in extremity volume
within 24 hours
2: Pitting edema that is unresolved with limb elevation Moderate: 20% to 40% increase in
extremity volume
3: Changes in skin character and thickness, with Severe: >40% increase in extremity
excess fat deposits and fibrosis volume
Duration of follow-up of a year or more is needed to accurately assess lymphedema risk since development of lymphedema can occur 3 or more years following breast cancer surgery.
Axillary Reverse Mapping in Sentinel Lymph Node Biopsy
Systematic Reviews
A 2017 systematic review conducted by Parks et al designed to assess comparative, clinical trial evidence comparing SLNB+ ARM versus SLNB alone failed to identify any studies meeting inclusion criteria (Parks, 2017). The review authors concluded that a large RCT specifically comparing SLNB + ARM to SLNB alone should be performed before ARM could be utilized in routine clinical practice.
Two systematic reviews conducted by Wijaya et al and Han et al assessed ARM in individuals undergoing SLNB or axillary lymph node dissection (ALND) and conducted subgroup analyses limited to those individuals who underwent SLNB (Wijaya, 2020; Han, 2016). The reviews included a similar set of prospective, nonrandomized, single-arm studies.
The reviews found similar lymphedema rates among individuals who underwent ARM during SLNB. Pooled sentinel lymph node identification rates were also similar and low, potentially because ARM-visualized lymphatics draining the upper extremity may be located deeper than the sentinel lymph nodes.(Han, 2016). In comparison, the sentinel lymph node identification rate in individuals undergoing ARM and ALND was 82% in the Wijaya review and 83% in the Han review (Wijaya, 2020; Han, 2016). The crossover rate between sentinel and ARM nodes was slightly higher in the Han review (19.6%) than the Wijaya et al review (12%) (Han, 2016; Wijaya, 2020), For identification and crossover of sentinel lymph nodes, heterogeneity was high in both reviews. Identification and crossover rates were similar in subgroup analyses stratified according to mapping agent used or study geographic area, but heterogeneity remained high.
The evidence in these systematic reviews has numerous limitations. All included studies were uncontrolled, single-arm studies, so conclusions cannot be drawn about the comparative effectiveness of ARM + SLNB versus SLNB without ARM. Study duration ranged widely from less than one year to nearly 4 years, and neither review reported the mean or median duration across studies. To accurately identify lymphedema development, duration of follow-up of over one year and potentially over 3 years may be needed and as such, studies with shorter follow-up may underestimate the true prevalence of lymphedema. Finally, health outcomes such as quality of life were not reported.
Nonrandomized Studies
The largest nonrandomized, single-arm study included in the reviews described above was conducted by Tummel et al (Tummel, 2017). The study was conducted in the United States and included 654 individuals enrolled from 2007 to 2013, of whom 492 underwent ARM +SLNB. ARM was accomplished through split mapping, that is, technetium injection was used to identify sentinel lymph nodes, and isosulfan blue dye was used to identify axillary lymph nodes and lymphatics. ARM identified axillary lymphatics in 138 individuals(29.2%), which were spared in 107 of these individuals (77.5%). After a mean 26 months follow-up, lymphedema rates ranged from0.8% to 3.4%, depending on lymphedema definition. Specifically, among individuals who underwent ARM and SLNB, lymphedema rate was 0.8% (3/350) based on arm volumetric measure and 2.5% (9/350) based on subjective patient report, resulting in a total rate of 3.4%. Lymphedema rates were similar when stratified according to individuals in whom ARM successfully identified lymph nodes and lymphatics (1.2%; 1/79) and those who did not have ARM-identified lymph nodes and lymphatics (1.7%; 5/291). There were no instances of axillary recurrence in individuals with ARM-identified and preserved nodes. This study is primarily limited by its single-arm, uncontrolled design, and comparative evidence is needed to accurately determine the net health benefit of ARM in SLNB.
Axillary Reverse Mapping in Axillary Lymph Node Dissection
Systematic Reviews
Two systematic reviews of ARM in individuals undergoing ALND have included RCTs and nonrandomized studies. The study results are summarized below.
A systematic review and meta-analysis conducted by Guo et al (2021) included 5 RCTs of ARM in individuals undergoing ALND for treatment of breast cancer (Guo, 2021). The review found individuals who had ARM had a lower risk of breast cancer-related lymphedema(BCRL) of the arm compared with no ARM (4.7% vs. 18.8%; OR, 0.20; 95% CI, 0.13 to 0.29), but there was some heterogeneity present in the analysis (I2=38%). This finding was consistent in sensitivity analyses that stratified studies according to study setting(single center or multicenter), mapping agent (blue dye alone and in combination with fluorescence or a radioisotope), and measurement of arm lymphedema (volumetric measurement or arm circumference measurement). When stratified according to duration of follow-up, odds ratios for ARM versus no ARM and risk of BCRL were 0.70 (95% CI, 0.32 to 1.51) at 6 months, 0.18 (95%CI, 0.10 to 0.33) at 6 to 12 months, and 0.23 (95% CI, 0.15 to 0.36) at 20 months follow-up, based on 3 studies included in analyses at each time point. Oncological safety, based on rate of metastatic ARM nodes, was not significantly different between ARM and no ARM groups based on analysis of 2 studies (1% vs. 0%). Other outcome measures such as quality of life were not reported. The review’s findings were heavily influenced by one study, conducted in China that accounted for 82% of the total review population(1354/1659) (Yuan, 2019). Risk of bias among the included studies was assessed using Cochrane Collaboration criteria, and all of the included studies were judged to have low or moderate risk of bias. The review is limited by the inclusion of a small number of RCTs with results dominated by 1 trial, and heterogeneity among the included studies in terms of outcome assessment and duration of follow-up.
A 2020 systematic review and meta-analysis conducted by Wijaya et al included 29 studies, 4 of which were RCTs included in the Guo systematic review discussed above, and the remaining studies were prospective, nonrandomized studies (Wijaya, 2020). Based on a pooled analysis of 27 studies, ARM was associated with an 82% (95% CI, 77% to 87%; I2=88%) identification rate of axillary lymph nodes and lymphatics, and a crossover rate between ARM and sentinel lymph nodes of 12% (95% CI, 6% to 19%; I2=94%) in pooled analysis of 11 studies. Subgroup analyses could not account for the heterogeneity of either of these findings. The prevalence of lymphedema was 14% (95% CI, 5% to 26%; I2=93%) in a pooled analysis of 6 studies, and preservation of visualized ARM lymph nodes and lymphatics was associated with a lower risk of lymphedema when compared with resection of ARM nodes (OR, 0.27; 95%CI, 0.20 to 0.36; I2=31%).
In terms of oncological safety, the review found the pooled rate of metastatic ARM nodes was 13% (95% CI, 10% to 17%; I2=75%) in an analysis of 27 studies. When comparing metastatic rate according to breast cancer stage, the review found individuals with stagespN0-1 had a significantly lower risk of ARM metastasis than those with pN2-3 disease (OR, 0.11; 95% CI, 0.05 to 0.25; I2=23.4%)based on analysis of 6 studies. Analysis of 5 studies did not find a significant association between preoperative neoadjuvant chemotherapy and rate of ARM node metastasis (OR, 1.20; 95% CI, 0.74 to 1.94; I2=49.4%), suggesting that neoadjuvant chemotherapy may not reduce the risk of metastatic ARM nodes.
The studies included in the review had numerous limitations, including unclear and/or inadequate duration of follow-up, lack of adjustment for confounding variables, and varying methods of diagnosing lymphedema. The review is also limited by including a mix of randomized and nonrandomized studies with limited subgroup analysis according to study design, and pooled estimates generally demonstrating high heterogeneity that could not be accounted for in subgroup analyses.
Randomized Controlled Trials
As noted above, the RCT reported by Yuan et al contributed data from 1,354 individuals included in both the Guo et al and Wijaya et al, systematic reviews and is described below as it is the largest RCT of ARM for ANLD published to date (Yuan, 2019; Guo, 2021; Wijaya, 2020).
Yuan et al (2019) randomized 1,354 individuals undergoing ALND with ARM (n=689) or standard ALND without ARM (n=665) (Yuan, 2019). Of the 689 individuals randomized to the ALND + ARM group, 131 were excluded from the analysis due to lack of visualization of either arm sentinel lymph nodes (n=116) or lymphatics (n=13), resulting in an axillary lymphatic system identification rate of 81% (558/689) with ARM. An additional 15 individuals in the ALND + ARM group and 17 individuals in the standard ALND group were lost to follow-up, resulting in 543 and 648 individuals available for analysis, respectively. After a median 37 months follow-up, the rate of objective and subjective lymphedema was lower in the ALND + ARM group than the standard ALND group. Rates of local, regional, and distant cancer recurrence were generally similar in both groups. However, axillary recurrence was twice as likely in the ANLD + ARM group compared with the standard ANLD group (2.9% vs. 1.4%; p=.03), and the rate of ARM node metastasis in the ALND + ARM group was 7% (38/558).
Summary
For individuals with breast cancer undergoing SLNB who receive ARM, the evidence includes nonrandomized studies and systematic reviews of those studies. Relevant outcomes are symptoms, change in disease status, morbid events, quality of life, and treatment-related morbidity. Evidence from 2 systematic reviews found ARM identified axillary lymphatics in about 38% of individuals undergoing SLNB, with lymphedema rates of 2% to 3% in individuals who underwent ARM during SLNB. Other outcomes such as quality of life were not reported. The systematic reviews had numerous limitations, including unclear mean duration of follow-up and inclusion of only single-arm, uncontrolled studies. Evidence from well-designed RCTs or controlled cohort studies is needed to determine the net health benefit of ARM in SLNB. The evidence is insufficient to determine that the technology results in an improvement in the net health outcome.
For individuals with breast cancer undergoing ALND who receive ARM, the evidence includes RCTs, nonrandomized studies, and systematic reviews of those studies. Relevant outcomes are symptoms, change in disease status, morbid events, quality of life, and treatment-related morbidity. Pooled evidence from a systematic review of 5 RCTs showed a lower risk of lymphedema with Arm compared with no ARM (OR, 0.20; 95% CI, 0.13 to 0.29), and another systematic review of RCTs and nonrandomized studies found a pooled lymphedema prevalence of 14% and lower risk of lymphedema with ARM and preserved axillary lymph nodes compared with resected lymph nodes (OR, 0.27; 95% CI, 0.20 to 0.36). In the same review, ARM was associated with an 82% identification rate of axillary lymph nodes and lymphatics, and a crossover rate between ARM and sentinel lymph nodes of 12%. Other health outcomes, including quality of life, were not reported. The safety of ARM in ALND has not been established, and the rate of metastatic Arm nodes was 13% based on pooled analysis of 27 studies in one systematic review. ARM in ALND was also associated with a lower risk of lymphedema in the largest RCT conducted to date, which was also included in the systematic reviews, but oncological safety could not be determined and the trial also had important study relevance and design limitations. The evidence is insufficient to determine that the technology results in an improvement in the net health outcome.
Supplemental Information
The purpose of the following information is to provide reference material. Inclusion does not imply endorsement or alignment with the evidence review conclusions.
American Society of Breast Surgeons
The 2022 American Society of Breast Surgeons consensus guideline on axillary management of patients with in-situ and invasive breast cancer indicates that axillary reverse mapping (ARM) is one of several promising techniques for prevention of lymphedema, but also states "well-designed prospective studies with uniform criteria for patient selection, procedure, and outcome assessment are needed." The guideline recommends considering ARM if it is readily available when axillary lymph node dissection (ALND) is required (American Society of Breast Surgeons, 2022).
The American Society of Breast Surgeons also published recommendations from an expert panel in 2017 that included prevention of breast cancer-related lymphedema (McLaughlin, 2017). The panel stated that "emerging data on preventive surgical strategies with ARM and LYMPHA are promising and should be explored further with appropriate patients."
American Association of Plastic Surgeons
In 2017, the American Association of Plastic Surgeons sponsored a conference to create consensus statements and recommendations for surgical treatment and prevention of upper and lower extremity lymphedema. The 2021 publication of the consensus recommendations did not include any recommendations specific to the use of ARM, but the following general statement was included within the text of the publication: "mapping of the lymphatics is encouraged when harvesting lymph nodes adjacent to the limbs such as reverse lymphatic mapping to avoid lymphatics draining the limb and to minimize the risk of donor-site lymphedema (Chang, 2021)."
Ongoing and Unpublished Clinical Trials
Some currently unpublished trials that might influence this review are listed below.
Ongoing
NCT05040685
Axillary Reverse Mapping (ARM): Validation of Surgical Technique in Breast Cancer Surgery
Planned Enrollment: 30
Completion Date: Dec 2022
NCT03428581
Preventing Lymphedema in Patients Undergoing Axillary Lymph Node Dissection Via Axillary Reverse Mapping and Lympho-venous Bypass
Planned Enrollment: 264
Completion Date: Feb 2023
NCT05094102
Intraoperative Evaluation of Axillary Lymphatics for Breast Cancer Patients Undergoing Axillary Surgery
Planned Enrollment: 25
Completion Date: Mar 2023
NCT03927027
ARM: Axillary Reverse Mapping - A Prospective Trial to Study Rates of Lymphedema and Regional Recurrence After Sentinel Lymph Node Biopsy and Sentinel Lymph Node Biopsy Followed by Axillary Lymph Node Dissection With and Without Axillary Reverse Mapping
Planned Enrollment: 516
Completion Date: Jan 2024
NCT04446494
Identification and Preservation of Arm Lymphatics (DEPART) in Axillary Dissection for Breast Cancer to Reduce Arm Lymphedema Events: A Multicenter Randomized Clinical Trial
Planned Enrollment: 1200
Completion Date: Sep 2025
Unpublished
NCT03333226
Axillary Reverse Mapping (ARM). Identification of the Arm Lymphatic Pathways in Breast Cancer Surgery to Prevent Breast Cancer Related Lymphedema (BCRL): a Randomized Clinical Trial.
Planned Enrollment: 300
Completion Date: Dec 2020 (last updated Jan 2018)
2023 Update
Annual policy review completed with a literature search using the MEDLINE database through October 2023. No new literature was identified that would prompt a change in the coverage statement.
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| References: |
American Society of Breast Surgeons.(2022) Consensus Guideline on Axillary Management for Patients with In-Situ and Invasive Breast Cancer: A Concise Overview. 2022. Accessed September 21, 2022. Asdourian MS, Skolny MN, Brunelle C, et al.(2016) Precautions for breast cancer-related lymphoedema: risk from air travel, ipsilateral arm blood pressure measurements, skin puncture, extreme temperatures, and cellulitis. Lancet Oncol. Sep 2016; 17(9): e392-405. PMID 27599144 Boneti C, Korourian S, Diaz Z, et al.(2009) Scientific Impact Award: Axillary reverse mapping (ARM) to identify and protect lymphatics draining the arm during axillary lymphadenectomy. Am J Surg. Oct 2009; 198(4): 482-7. PMID 19800452 Casabona F, Bogliolo S, Valenzano Menada M, et al.(2009) Feasibility of axillary reverse mapping during sentinel lymph node biopsyin breast cancer patients. Ann Surg Oncol. Sep 2009; 16(9): 2459-63. PMID 19506954 Cemal Y, Pusic A, Mehrara BJ.(2011) Preventative measures for lymphedema: separating fact from fiction. J Am Coll Surg. Oct 2011;213(4): 543-51. PMID 21802319 Chang DW, Dayan J, Greene AK, et al.(2021) Surgical Treatment of Lymphedema: A Systematic Review and Meta-Analysis of Controlled Trials. Results of a Consensus Conference. Plast Reconstr Surg. Apr 01 2021; 147(4): 975-993. PMID 33761519 Connor C, McGinness M, Mammen J, et al.(2013) Axillary reverse mapping: a prospective study in women with clinically node negative and node positive breast cancer. Ann Surg Oncol. Oct 2013; 20(10): 3303-7. PMID 23975287 Coriddi M, Dayan J, Sobti N, et al.(2020) Systematic Review of Patient-Reported Outcomes following Surgical Treatment of Lymphedema. Cancers (Basel). Feb 29 2020; 12(3). PMID 32121343 Dean LT, Kumar A, Kim T, et al.(2016) Race or Resource? BMI, Race, and Other Social Factors as Risk Factors for Interlimb Differences among Overweight Breast Cancer Survivors with Lymphedema. J Obes. 2016; 2016: 8241710. PMID 27433356 Deng H, Chen L, Jia W, et al.(2011) Safety study of axillary reverse mapping in the surgical treatment for breast cancer patients. J Cancer Res Clin Oncol. Dec 2011; 137(12): 1869-74. PMID 21935615 Executive Committee of the International Society of Lymphology.(2020) The diagnosis and treatment of peripheral lymphedema: 2020Consensus Document of the International Society of Lymphology. Lymphology. 2020; 53(1): 3-19. PMID 32521126 Guo X, Jiao D, Zhu J, et al.(2021) The effectiveness of axillary reverse mapping in preventing breast cancer-related lymphedema: a meta-analysis based on randomized controlled trials. Gland Surg. Apr 2021; 10(4): 1447-1459. PMID 33968696 Han C, Yang B, Zuo WS, et al.(2016) The Feasibility and Oncological Safety of Axillary Reverse Mapping in Patients with Breast Cancer: A Systematic Review and Meta-Analysis of Prospective Studies. PLoS One. 2016; 11(2): e0150285. PMID 26919589 Han JW, Seo YJ, Choi JE, et al.(2012) The efficacy of arm node preserving surgery using axillary reverse mapping for preventing lymphedema in patients with breast cancer. J Breast Cancer. Mar 2012; 15(1): 91-7. PMID 22493634 Kuusk U, Seyednejad N, McKevitt EC, et al.(2014) Axillary reverse mapping in breast cancer: a Canadian experience. J Surg Oncol. Dec 2014; 110(7): 791-5. PMID 25053441 Ma X, Wen S, Liu B, et al.(2019) Relationship between Upper Extremity Lymphatic Drainage and Sentinel Lymph Nodes in Patients with Breast Cancer. J Oncol. 2019; 2019: 8637895. PMID 31057616 McLaughlin SA, DeSnyder SM, Klimberg S, et al.(2017) Considerations for Clinicians in the Diagnosis, Prevention, and Treatment of Breast Cancer-Related Lymphedema, Recommendations from an Expert Panel: Part 2: Preventive and Therapeutic Options. Ann Surg Oncol. Oct 2017; 24(10): 2827-2835. PMID 28766218 McLaughlin SA, Stout NL, Schaverien MV.(2020) Avoiding the Swell: Advances in Lymphedema Prevention, Detection, and Management. Am Soc Clin Oncol Educ Book. Mar 2020; 40: 1-10. PMID 32315238 Naoum GE, Roberts S, Brunelle CL, et al.(2020) Quantifying the Impact of Axillary Surgery and Nodal Irradiation on Breast Cancer-Related Lymphedema and Local Tumor Control: Long-Term Results From a Prospective Screening Trial. J Clin Oncol. Oct 102020; 38(29): 3430-3438. PMID 32730184 National Lymphedema Network Medical Advisory Committee.(2022) Lymphedema Risk Reduction Practices: Position Statement of the National Lymphedema Network. 2012. Accessed September 19, 2022. Noguchi M, Yokoi M, Nakano Y.(2010) Axillary reverse mapping with indocyanine fluorescence imaging in patients with breast cancer. J Surg Oncol. Mar 01 2010; 101(3): 217-21. PMID 20063370 Ochoa D, Korourian S, Boneti C, et al.(2014) Axillary reverse mapping: five-year experience. Surgery. Nov 2014; 156(5): 1261-8.PMID 25444319 Parks RM, Cheung KL.(2017) Axillary reverse mapping in N0 patients requiring sentinel lymph node biopsy - A systematic review of the literature and necessity of a randomised study. Breast. Jun 2017; 33: 57-70. PMID 28282588 Pusic AL, Cemal Y, Albornoz C, et al.(2013) Quality of life among breast cancer patients with lymphedema: a systematic review of patient-reported outcome instruments and outcomes. J Cancer Surviv. Mar 2013; 7(1): 83-92. PMID 23212603 Rubio IT, Cebrecos I, Peg V, et al.(2012) Extensive nodal involvement increases the positivity of blue nodes in the axillary reverse mapping procedure in patients with breast cancer. J Surg Oncol. Jul 01 2012; 106(1): 89-93. PMID 22258666 Sakurai T, Endo M, Shimizu K, et al.(2014) Axillary reverse mapping using fluorescence imaging is useful for identifying the risk group of postoperative lymphedema in breast cancer patients undergoing sentinel node biopsies. J Surg Oncol. May 2014; 109(6):612-5. PMID 24310418 Shao X, Sun B, Shen Y.(2019) Axillary reverse mapping (ARM): where to go. Breast Cancer. Jan 2019; 26(1): 1-10. PMID 29961238 Tummel E, Ochoa D, Korourian S, et al.(2017) Does Axillary Reverse Mapping Prevent Lymphedema After Lymphadenectomy?. Ann Surg. May 2017; 265(5): 987-992. PMID 27163955 U.S. Food and Drug Administration.(2022) Lymphazurin (Isosulfan Blue) Product Label. Accessed September 27, 2022. U.S. Food and Drug Administration.(2022) Spy Agent Green (Indocyanine Green for Injection) Product Label. Accessed September28, 2022. Wijaya WA, Peng J, He Y, et al.(2020) Clinical application of axillary reverse mapping in patients with breast cancer: A systematic review and meta-analysis. Breast. Oct 2020; 53: 189-200. PMID 32858404 Yuan Q, Wu G, Xiao SY, et al.(2019) Identification and Preservation of Arm Lymphatic System in Axillary Dissection for Breast Cancer to Reduce Arm Lymphedema Events: A Randomized Clinical Trial. Ann Surg Oncol. Oct 2019; 26(11): 3446-3454. PMID31240591 |
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Group specific policy will supersede this policy when applicable. This policy does not apply to the Wal-Mart Associates Group Health Plan participants or to the Tyson Group Health Plan participants.
CPT Codes Copyright © 2024 American Medical Association. |
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