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Clinical significance of the axillary arch in sentinel lymph node biopsy.

Kil WH, Lee JE, Nam SJ - J Breast Cancer (2014)

Bottom Line: These three factors were also found to be statistically significant by multivariate analysis, and of these three factors, presence of the axillary arch most significantly increased the SLNB failure rate (hazard ratio, 10.96; 95% confidence interval, 4.42-27.21; p<0.001).If the axillary arch was present, the SLN was often located in a high axillary region (67%) rather than in a general low axillary location.The axillary arch was found to be a significant factor affecting intraoperative SLN failure rate.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

ABSTRACT

Purpose: The axillary arch is an anomalous muscle that is not infrequently encountered during axillary sentinel lymph node biopsy (SLNB) of breast cancer patients. In this study, we aimed to investigate how often the axillary arch is found during SLNB and whether it affects the intraoperative sentinel lymph node (SLN) identification rate.

Methods: We retrospectively analyzed the correlation between the presence of the axillary arch and the SLN sampling failure rate during SLNB in 1,069 patients who underwent axillary SLNB for invasive breast cancer.

Results: Of 1,069 patients who underwent SLNB, 79 patients (7.4%) had the axillary arch present. The SLNB failure rate was high when the patient's body mass index was ≥25 (p=0.026), when a single SLN mapping technique was used (p=0.012), and when the axillary arch was present (p<0.001). These three factors were also found to be statistically significant by multivariate analysis, and of these three factors, presence of the axillary arch most significantly increased the SLNB failure rate (hazard ratio, 10.96; 95% confidence interval, 4.42-27.21; p<0.001). Additionally, if the axillary arch was present, the mean operative time of SLNB was 20.8 minutes, compared to 12.5 minutes when the axillary arch was not present (p<0.001). If the axillary arch was present, the SLN was often located in a high axillary region (67%) rather than in a general low axillary location.

Conclusion: The axillary arch was found to be a significant factor affecting intraoperative SLN failure rate. It is necessary to keep in mind that carefully checking the high axillar region during SLNB in breast cancer patients with the axillary arch is important for reducing SLN sampling failure.

No MeSH data available.


Related in: MedlinePlus

The relationship between axillary arch and the location of sentinel lymph nodes (SLNs). (A) The findings of chest computed tomography for the location of SLN in a 58-year-old breast cancer patient with axillary arch; the SLN (white arrow) can be seen located in the top of the axillary arch (yellow arrows). (B) The SLN (thick arrow) can be seen located above the axillary arch, and the lymphatic flow (thin arrows) colored with dye is found to flow into the SLN at the top of the axillary arch.PM=pectoralis muscle; LD=latissimus dorsi; AA=axillary arch.
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Figure 1: The relationship between axillary arch and the location of sentinel lymph nodes (SLNs). (A) The findings of chest computed tomography for the location of SLN in a 58-year-old breast cancer patient with axillary arch; the SLN (white arrow) can be seen located in the top of the axillary arch (yellow arrows). (B) The SLN (thick arrow) can be seen located above the axillary arch, and the lymphatic flow (thin arrows) colored with dye is found to flow into the SLN at the top of the axillary arch.PM=pectoralis muscle; LD=latissimus dorsi; AA=axillary arch.

Mentions: All axillary arches were identified during SLNB. If there was a suspected axillary arch during preoperative computed tomography, the presence of the axillary arch was carefully investigated during SLNB (Figure 1A). In addition, we also counted the number of patients in which the axillary arch was accidewntally found during SLNB (Figure 1B). Consequently, we found the axillary arch in 79 of 1,069 patients (7.4%).


Clinical significance of the axillary arch in sentinel lymph node biopsy.

Kil WH, Lee JE, Nam SJ - J Breast Cancer (2014)

The relationship between axillary arch and the location of sentinel lymph nodes (SLNs). (A) The findings of chest computed tomography for the location of SLN in a 58-year-old breast cancer patient with axillary arch; the SLN (white arrow) can be seen located in the top of the axillary arch (yellow arrows). (B) The SLN (thick arrow) can be seen located above the axillary arch, and the lymphatic flow (thin arrows) colored with dye is found to flow into the SLN at the top of the axillary arch.PM=pectoralis muscle; LD=latissimus dorsi; AA=axillary arch.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4197354&req=5

Figure 1: The relationship between axillary arch and the location of sentinel lymph nodes (SLNs). (A) The findings of chest computed tomography for the location of SLN in a 58-year-old breast cancer patient with axillary arch; the SLN (white arrow) can be seen located in the top of the axillary arch (yellow arrows). (B) The SLN (thick arrow) can be seen located above the axillary arch, and the lymphatic flow (thin arrows) colored with dye is found to flow into the SLN at the top of the axillary arch.PM=pectoralis muscle; LD=latissimus dorsi; AA=axillary arch.
Mentions: All axillary arches were identified during SLNB. If there was a suspected axillary arch during preoperative computed tomography, the presence of the axillary arch was carefully investigated during SLNB (Figure 1A). In addition, we also counted the number of patients in which the axillary arch was accidewntally found during SLNB (Figure 1B). Consequently, we found the axillary arch in 79 of 1,069 patients (7.4%).

Bottom Line: These three factors were also found to be statistically significant by multivariate analysis, and of these three factors, presence of the axillary arch most significantly increased the SLNB failure rate (hazard ratio, 10.96; 95% confidence interval, 4.42-27.21; p<0.001).If the axillary arch was present, the SLN was often located in a high axillary region (67%) rather than in a general low axillary location.The axillary arch was found to be a significant factor affecting intraoperative SLN failure rate.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

ABSTRACT

Purpose: The axillary arch is an anomalous muscle that is not infrequently encountered during axillary sentinel lymph node biopsy (SLNB) of breast cancer patients. In this study, we aimed to investigate how often the axillary arch is found during SLNB and whether it affects the intraoperative sentinel lymph node (SLN) identification rate.

Methods: We retrospectively analyzed the correlation between the presence of the axillary arch and the SLN sampling failure rate during SLNB in 1,069 patients who underwent axillary SLNB for invasive breast cancer.

Results: Of 1,069 patients who underwent SLNB, 79 patients (7.4%) had the axillary arch present. The SLNB failure rate was high when the patient's body mass index was ≥25 (p=0.026), when a single SLN mapping technique was used (p=0.012), and when the axillary arch was present (p<0.001). These three factors were also found to be statistically significant by multivariate analysis, and of these three factors, presence of the axillary arch most significantly increased the SLNB failure rate (hazard ratio, 10.96; 95% confidence interval, 4.42-27.21; p<0.001). Additionally, if the axillary arch was present, the mean operative time of SLNB was 20.8 minutes, compared to 12.5 minutes when the axillary arch was not present (p<0.001). If the axillary arch was present, the SLN was often located in a high axillary region (67%) rather than in a general low axillary location.

Conclusion: The axillary arch was found to be a significant factor affecting intraoperative SLN failure rate. It is necessary to keep in mind that carefully checking the high axillar region during SLNB in breast cancer patients with the axillary arch is important for reducing SLN sampling failure.

No MeSH data available.


Related in: MedlinePlus