%0 Journal Article
%T Intercostobrachial Nerves as a Novel Anatomic Landmark for Dividing the Axillary Space in Lymph Node Dissection
%A Jianyi Li
%A Yang Zhang
%A Wenhai Zhang
%A Shi Jia
%A Xi Gu
%A Yan Ma
%A Dan Li
%J ISRN Oncology
%D 2013
%R 10.1155/2013/279013
%X Purpose. Our aim was to assess the feasibility of using the intercostobrachial nerves (ICBNs) as a possible new anatomic landmark for axillaries lymph node dissection in breast cancer patients. Background Data Summary. The preservation of ICBN is now an accepted procedure in this type of dissection; however, it could be improved further to reduce the number of postoperative complications. The axillary space is divided into lower and upper parts by the ICBN¡ªa thorough investigation of the metastasis patterns in lymph nodes found in this area could supply new information leading to such improvements. Methods. Seventy-two breast cancer patients, all about to undergo lymph node dissection and with sentinel lymph nodes identified, were included in this trial. The lymph nodes were collected in two groups, from lower and upper axillary spaces, relative to the intercostobrachial nerves. The first group was further subdivided into sentinel (SLN) and nonsentinel (non-SLN) nodes. All lymph nodes were tested to detect macro- and micrometastasis. Results. All the sentinel lymph nodes were found under the intercostobrachial nerves; more than 10 lymph nodes were located in that space. Moreover, when lymph nodes macrometastasize or micrometastasize above the intercostobrachial nerves, we also observe metastasis-positive nodes under the nerves; when the lower group nodes show no metastasis, the upper group is also metastasis free. Conclusions. Our results show that the intercostobrachial nerves are good candidates for a new anatomic landmark to be used in lymph node dissection procedure. 1. Introduction The axillary lymph node (ALN) status represents one of the most important prognostic factors in breast cancer patients and determines, among other parameters, the type of subsequent adjuvant treatment [1, 2]. Lymph nodes in axillary space are traditionally divided into 3 groups by pectoralis minor (level I, level II, and level III), according to the rule of lymph nodes metastasis [3]. It is the accepted basic principle for axillary lymph node dissection (ALND) of breast cancer that lymph nodes should be extracted from level I to level III, step by step [4]. The postoperative risk of arm lymphedema increases with the increasing axillary space level during the dissection [5]. On the other hand, the necessity of intercostobrachial nerves (ICBNs) preservation is now accepted by the surgeons and has become the standard procedure in such dissections, reducing the postoperative skin numbness and loss of feeling in the upper arm [6]. The ICBN is nearly parallel to the axillary
%U http://www.hindawi.com/journals/isrn.oncology/2013/279013/