Partial Lower Axillary Dissection for Patients with Clinically Node-negative Breast Cancer

Kodama, Hiroshi; Mise, Kazuyuki; Kan, Norimichi

doi:10.1177/030006051204000632

Cited by 13 publications

(9 citation statements)

References 29 publications

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“…Patients in the ALND group might have benefited from chemotherapy and radiotherapy. Our findings are consistent with a study by Kodama et al who compared overall 5-year survival rates in patients undergoing PALND and historical controls undergoing conventional dissection [ 16 ]. Thus, there is sufficient evidence to suggest that PALND can significantly prevent arm lymphedema with a satisfying DFS.…”

Section: Discussionsupporting

confidence: 93%

Partial axillary lymph node dissection inferior to the intercostobrachial nerves complements sentinel node biopsy in patients with clinically node-negative breast cancer

Song

Zhang

et al. 2015

BMC Surg

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BackgroundThe practice of breast cancer diagnosis and treatment in China varies to that in western developed countries. With the unavailability of radioactive tracer technique for sentinel lymph nodes biopsy (SLNB), using blue dye alone has been the only option in China. Also, the diagnosis of breast malignant tumor in most Chinese centres heavily relies on intraoperative instant frozen histology which is normally followed by sentinel lymph nodes mapping, SLNB and the potential breast and axillary operations in one consecutive session. This practice appears to cause a high false negative rate (FNR) for SLNB. The present study aimed to investigate the impact of the current practice in China on the accuracy of SLNB, and whether partial axillary lymph node dissection (PALND), dissection of lymph nodes inferior to the intercostobrachial nerve (ICBN), was a good complementary procedure following SLNB using blue dye.Methods289 patients with clinically node-negative breast cancer were identified and recruited. Tumorectomy, intraoperative instant frozen histological diagnosis, SLNB using methylene blue dye, and PALND or complete axillary node dissection (ALND) were performed in one consecutive operative session. The choice of SLNB only, SLNB followed by PALND or by ALND was based on the pre-determined protocol and preoperative choice by the patient. Clinical parameters were analyzed and survival analysis was performed.Results37 % patients with clinically negative nodes were found nodes positive. 59 patients with positive SLN underwent ALND, including 47 patients with up to two positive nodes which were all located inferior to the ICBN. 9 patients had failed SLNB and underwent PALND. Among them, 3 (33.3 %) patients were found to have one metastatic node. 149 patients showed negative SLNB but chose PALND. Among them, 30 (20.1 %), 14 (9.4) and 1 (0.7 %) patients were found to have one, two and three metastatic node(s), respectively. PALND detected 48 (30.4 %) patients who had either failed SLNB or negative SLNB to have additional positive nodes. All the patients with up to two positive nodes had their nodes located inferior to the ICBN. The FNR of SLNB was 43 %. The accuracy rate was 58 %. The follow-up ranged 12–33 months. The incidence of lymphedema for SLNB, PALND, and ALND was 0 %, 0 %, and 25.4 %, respectively (P < 0.005). The disease-free survivals for SLNB, PALND, and ALND groups were 95.8 %, 96.8 %, and 94.9 %, respectively (p > 0.05).ConclusionsUnder the circumstances of current practice in China, PALND is a good complementary procedure following SLNB in clinically node-negative breast cancer.

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Section: Discussionsupporting

confidence: 93%

Partial axillary lymph node dissection inferior to the intercostobrachial nerves complements sentinel node biopsy in patients with clinically node-negative breast cancer

Song

Zhang

et al. 2015

BMC Surg

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“…The pain is persistent in most cases and rarely resolves spontaneously or by conventional analgesia (McIntosh and Purushotham, 1998;Carpenter et al, 1999;Kodama et al, 2012). Why does ICBN damage cause ICBN syndrome?…”

Section: Discussionmentioning

confidence: 99%

“…Resection or damage to the intercostobrachial nerve (ICBN) during ALND would limit the activities of the upper limbs of patients after surgery and causes post-mastectomy pain syndrome, such as pain, numbness, and sensory disturbances in the lateral thoracic wall, axilla, and arms, which occur in 18-50% of patients (McIntosh and Purushotham, 1998;Carpenter et al, 1999;Bergmann et al, 2012;Kodama et al, 2012;Taira et al, 2014) and seriously reduces the postoperative quality of life for patients with breast cancer. Therefore, an increasing number of surgeons have considered improvements to surgical procedures to protect the ICBN during ALND.…”

Section: Introductionmentioning

confidence: 99%

Anatomical information for intercostobrachial nerve preservation in axillary lymph node dissection for breast cancer

Zhu¹,

Liu²,

Pl³

et al. 2014

Genet. Mol. Res.

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ABSTRACT. This study aimed to provide additional anatomical information for axillary lymph node dissection (ALND) through in vivo anatomy studies of intercostobrachial nerve (ICBN) preservation in order to provide theoretical and practical experience for clinicians. A total of 156 patients with breast cancer underwent ALND at the Department of Gynecology of Baotou Tumor Hospital between June 2009 and March 2010. The origin, destination, main source, length, branch type, and direction of ICBN in axilla were observed, as well as its relationship with adjacent major blood vessels and nerves within the axilla. There were 120 cases of single trunk, 23 cases of double trunks, 9 cases of multiple trunks, and 4 cases without trunks in 156 patients with ICBN preservation. The transverse diameter at the origin of the ICBN was 1.89 ± 0.44 mm with a length of 94.45 ± 12.08 mm; the distances were 77.19 ± 21.04 mm, 29.34 ± 6.73 mm, 90.04 ± 13.13 mm, and 28.63 ± 13.01 mm from origin to the inferior margin at the midpoint of the clavicle, inferior margin of the axillary vein, the bottom of axilla, and branch point, respectively. The identification, dissection, and preservation of ICBN was simple and easy in a modified radical mastectomy for breast cancer and breast-conserving surgery, which only took 10-20 min, but effectively reduced the incidence of post-mastectomy pain syndrome and significantly improved the quality of life for patients after surgery.

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“…Kodama et al 48 performed lower ALND without using either the ARM procedure or SLN biopsy to prevent arm lymphedema. In the lower ALND, axillary lymph nodes were partially dissected below the second ICBN.…”

Section: Oncological Safety Of Lower Alndmentioning

confidence: 99%

Is axillary reverse mapping feasible in breast cancer patients?

Noguchi

Miura

Morioka

et al. 2015

European Journal of Surgical Oncology (EJSO)

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Partial Lower Axillary Dissection for Patients with Clinically Node-negative Breast Cancer

Cited by 13 publications

References 29 publications

Partial axillary lymph node dissection inferior to the intercostobrachial nerves complements sentinel node biopsy in patients with clinically node-negative breast cancer

Partial axillary lymph node dissection inferior to the intercostobrachial nerves complements sentinel node biopsy in patients with clinically node-negative breast cancer

Anatomical information for intercostobrachial nerve preservation in axillary lymph node dissection for breast cancer

Is axillary reverse mapping feasible in breast cancer patients?

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