Anatomic-surgical study of intercostobrachial nerve (ICBN) course in axilla during I. and II. level of axilla clearance in breast cancer and malignant melanoma
Authors:
O. Kubala 1; J. Prokop 1; P. Jelínek 1; P. Ostruszka 1; J. Tošenovský 2; P. Ihnát 1; P. Zonča 1
Authors‘ workplace:
Chirurgická klinika LF Ostravské univerzity a FN Ostrava
přednosta: Doc. MUDr. P. Zonča, Ph. D. FRCS
1; Fakulta metalurgie a materiálového inženýrství, Katedra kontroly a řízení jakosti
VŠB – Technická univerzita Ostrava, vedoucí katedry: Prof. Ing. J. Plura, CSc.
2
Published in:
Rozhl. Chir., 2013, roč. 92, č. 6, s. 320-329.
Category:
Original articles
Overview
Introduction:
The aim of this paper is to offer results of anatomic study of axillary course of intercostobrachial nerve (ICBN) and the effort of its saving in primary axilla clearance (PE), secondary clearance (SE) after previous positive sentinel nodes detection (SLN) and in re-clearance (RE) after previous axilla clearance in breast cancer and malignant melanoma. The correlation between possibility of ICBN saving and anatomic variant of ICBN and type of previous surgery was observed.
Material and methods:
A total of 113 surgeries with the effort of description and preservation of ICBN were done between September 2007 and August 2011. Patients were divided into three groups according to type of surgery: primary clearance (PE), secondary clearance (SE) and re-clearance (RE). Results have been statistically tested using licensed statistical software Statgraphics.
Results:
ICBN was found in 107 patients (94.7%), it wasn’t found in six cases. There were eight different types of ICBN branching. Two most frequent variants formed majority of cases – 87 out of 107 (81.3%). The successful preservation of intact ICBN was in 86 patients (76.1%). ICBN was interrupted or not found in 10 patients (8.8%), partial injury of ICBN branches was detected in 17 cases (15.0%). If the most frequent variant of ICBN branching was present, the nerve was not injured in 42 out of 45 cases (93.3%). Statistical testing showed that non-standard anatomical branches are associated with higher risk of perioperative injury. The risk of injury was lowest in PE (21.6%) and the highest in RE (42.9%). The difference wasn’t statistically significant because of low number of re-clearance cases in our study.
Conclusion:
The anatomy of ICBN in axilla is variable. The standard variant of ICBN course is the most frequent (the trunk coming out of second intercostal space; no branches in axillary course). If other variants are present, there is significantly higher risk of perioperative injury. ICBN preservation is possible also after previous axilla clearance. Preparation is more difficult and the risk of injury is increasing with the degree of previous surgery radicality.
Key words:
intercostobrachial nerve (ICBN) – anatomy – injury
Sources
1. Alex JC, Krag DN. Gamma-probe-guided localisation of lymph nodes. Surg Oncol 1993;2:137–143.
2. Benson JR, Wishart GC. Role of axillary clearence for patiens with sentinel node-positive early breast cancer. Br J Surg 2011; 98:1499–1500.
3. Coufal O, Fait V, a kol. Chirurgická léčba karcinomu prsu. 1. vyd. Praha, Grada Publishing, 2011; ISBN 978-80-247-3641-9.
4. Coufal O, Fait V, Foltinová V, Vrtělová P, Gabrielová L, Chrenko V. Chirurgická léčba karcinomu prsu v MOÚ. Rozhl Chir 2007;86:540–547.
5. Del Bianco P, Zavagno G, Burelli P, Scalco G, Barutta L, Carraro P, et al. Morbidity comparison of sentinel lymph node biopsy versus conventional axillary lymph node dissection for breast cancer patiens: Results of the sentinella-GIVOM Italian randomised clinical trial. Eur J Surg Oncol 2008;34:508–513.
6. Ferreira BP, Pimentel MD, Santos LC, di Flora W, Gobbi H. Morbidity after sentinel node biopsy and axillary dissection in breast cancer. Rev Assoc Med Bras 2008;54:517–521.
7. Fait V, Coufal O, Gatěk J. Chirurgie karcinomu v České republice. Rozhl Chir 2010;89:229–230.
8. Giuliano AE, Haigh PI, Brennan MB, Hansen NM, Kelley MC, Ye W, et al. Prospective observational study of sentinel lymphadenectomy without further axillary dissection in patiens with sentinel node-negative breast cancer. J Clin Oncol 2000;18: 2553–2559.
9. Kotoč J, Kotočová K, Gatěk J, Duben J, Vážan P, Bakala J. Mikrometastáza v sentinelové uzlině – nutnost disekce axilárních uzlin. Prakt Lék 2009;89:587–590.
10. Krag DN, Anderson SJ, Julian TB, Brown AM, Harlow SP, Ashikaga T, et al. Technical outcomes of sentinel-lymph-node resection and conventional axillary-lymph-node dissection in patients with clinically node-negative breast cancer: results from the NSABP B-32 randomized phase III trial. Lancet Oncol 2007;8: 881–888.
11. Langer I, Guller U, Berlacz G, Koechli OR, Schaer G, Fehr MK, et al. Morbidity of sentinel lymph node biopsy (SLN) alone versus SLN and completion axillary lymph node dissection after breast cancer surgery: a prospective Swiss multicenter study on 659 patients. Ann Surg 2007;245:452–461.
12. Mansel RE, Fallowfield L, Kissin M, Goyal A, Newcombe RG, Dixon JM, et al. Randomized multicenter trial of sentinel node biopsy versus standard axillary treatment in operable breast cancer: the ALMANAC trial. J Natl Cancer Inst 2006;98:599–609.
13. Motomura K, Inaji H, Komoike Y, Kasugai T, Nagumo S, Noguchi S, Koyama H. Sentinel node biopsy in breast cancer patients with clinically negative lymph-nodes. Breast Cancer 1999;6: 259–262.
14. Schijven MP, Vingerhoets AJ, Rutten HJ, Nieuwenhuijzen GA, Roumen RM, van Bussel ME, et al. Comparison of morbidity between axillary lymph node dissection and sentinel node biopsy. Eur J Surg Oncol 2003;29:341–350.
15. Silberman AW, McVay C, Cohen JS, Altura JF, Brackert S, Sarna GP, et al. Comparative morbidity of axillary lymph node dissection and the sentinel lymph node technique: implications for patients with breast cancer. Ann Surg 2004;240:1–6.
16. Veronesi U, Paganelli G, Viale G, Luini A, Zurrida S, Galimberti V, et al. A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer. N Engl J Med 2003;349:546–553.
17. Albertini JJ, Cruse CW, Rapaport D, et al. Intraoperative radio-lympho-scintigraphy improves sentinel lymph node identification for patiens with melanoma. Ann Surg 1996; 223:217–224.
18. Cole DJ, Baron PL. Surgical management of patients with intermediate thickness melanoma: current role of elective lymph node dissection. Semin Oncol 1996;23:719–724.
19. Fait V, Chrenko J, Žaloudík J. Sentinelová lymfadenektomie u kožního maligního melanomu – krátkodobé výsledky a prognostický význam. Rozhl Chir 1998;77:466–473.
20. Morton DL. Sentinel lymphadenectomy for patients with clinical stage I melanoma. J Surg Oncol 1997;66:267–269.
21. Morton DL, Thompson J, Cochran AJ, et al. Sentinel-node biopsy or nodal observation in melanoma. N Engl J Med 2006; 355:1307–1317.
22. Thompson JF, McCarthy WH, Bosch CM, et al. Sentinel lymph node status as an indicator of the presence of metastatic melanoma in regional lymph nodes. Melanoma Res 1995;5:255–260.
23. Thompson JF, Niewind P, Uren FR, Bosch CM, Howman-Giles R, Vrouenraets BC. Single-dose isotope injection for both preoperative lymphoscintigraphy and intraoperative sentinel lymph node identification in melanoma patiens. Melanoma Res 1997;7:500–506.
24. Aitken DR, Minton JP. Complications associated with mastectomy. Surg Clin North Am 1983;63:1331–1352.
25. Paredes JP, Puente JL, Potel J. Variations in sensitivity after sectioning the intercostobrachial nerve. Am J Surg 1990;160: 525–528.
26. Temple WJ, Ketcham AS. Preservation of the intercostobrachial nerve during axillary dissection for breast cancer. Am J Surg 1985;150:585–588.
27. Torresan RZ, Cabello C, Conde DM, Brenelli HB. Impact of the preservation of the intercostobrachial nerve in axillary lymphadenectomy due to breast cancer. Breast J, 2003;9:389–392.
28. Abdullah TI, Iddon J, Barr L, Baildam AD, Bundred NJ. Prospective randomized controlled trial of preservation of the intercostobrachial nerve during axillary node clearence for breast cancer. Br J Surg 1998;85:1443–1445.
29. Cohen AM, Schaeffer N, Zu-Ying Chen, Wood WC. Early discharge after modified radical mastectomy. Am J Surg, 1986; 151:465–466.
30. Hermann RE, Esselstyn CB, Cooperman AM, Crile G. Mastectomía parcel sin radioterapia. Clin Quir Norteam 1984;6: 1125–1135.
31. Roses DF, Harris MN, Potter DA, Gumport SL. Total mastectomy with complete axillary dissection. Ann Surg 1981;194:4–8.
32. Freeman SR, Washington SJ, Pritchard T, Barr L, Baildam AD, Bundred NJ. Long term results of a randomised prospective study of preservation of the intercostobrachial nerve. Eur J Surg Oncol, 2003;29:213–215.
33. Maycock LA, Dillon P, Dixon JM. Morbidity related to intercostobrachial nerve damage following axillary surgery for breast cancer. Breast1998,7:209–212.
34. Cunnick GH, Upponi S, Wishart GC. Anatomical variants of the intercostobrachial nerve encountered during axillary dissection. Breast 2001;10:160–162.
35. Loukas M, Hullet J, Louis RG, Holdman S, Holdman D. The gross anatomy of the extrathoracic course of the intercostobrachial nerve. Clin Anat 2006;19:106–111.
36. Loukas M, Louis RG, Jr., Fogg QA, Hallner B, Gupta AA. An unusual innervation of pectoralis minor and major muscles from a branch of the intercostobrachial nerve. Clin Anat 2006;19: 347–349.
37. Loukas M, Louis RG, Jr., Wartmann CT. T2 contributions to the brachial plexus. Neurosurgery 2007;60(2 Suppl 1):13–18.
38. Murakami S, Ohtsuka A, Murakami T. Anterior intercostobrachial nerve penetrating the pectoralis minor or major muscle. Acta Med Okayama 2002;56:267–269.
39. OęRourke MGE, Tang TS, Allison SI, Wood W. The anatomy of the extrathoracic intercostobrachial nerve. Aust N Z J Surg 1999;69:860–864.
40. Clough KB, Nasr R, Nos C, Vieira M, Inguenault C, Poulet B. New anatomical classification of the axilla with implications for sentinel node biopsy. Br J Surg 2010;97:1659–1665.
41. Pavlišta D, Eliška O, Dušková M, Zikán M, Cibula D. Localization of the sentinel node of the upper outer breast quadrant in the axillary quadrants. Annals of Surg Oncology 2006;14:633–637.
42. Ivanović N, Granić M, Randelović T, Bilanović D, Dukanović B, Ristić N, Babić D. Functional effects of preserving the intercostobrachial nerve and the lateral thoracic vein during axillary dissection in breast cancer conservative surgery. Vojnosanit Pregl 2007;64:195–198.
43. Ivanović N, Granić M, Randjelović T, Todorović S. Fragmentation of axillary fibrofatty tissue during dissection facilitates preservativ of the intercostobrachial nerve and the lateral thoracic vein. Breast 2008;17:293–295.
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Perspectives in Surgery
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