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

Abstract

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.

The intercostobrachial nerve as a sensory donor for hand reinnervation in brachial plexus reconstruction is a feasible technique and may be useful for restoring sensation

“…In this study, the average diameter of the ICBN at its origin in the second intercostal space was 2.1 ± 0.7 mm, similar to the result of 1.89 ± 0.44 mm described by Zhu et al 14 . Furthermore, the distance between the origin and its apparent branching point was 23.8 ± 17.9 mm, values also similar to those obtained by other authors 14,29 .…”

“…Some authors have reported the absence of ICBN in up to 6% of subjects 10,14,27 , but the present study confirmed the presence of ICBN in all of the dissections. The ICBN was identified as a single trunk at its origin in 93.3% of the cases dissected.…”

“…The ICBN was identified as a single trunk at its origin in 93.3% of the cases dissected. The description of this pattern ranged from 74% to 81.3% in other studies 8,10,14,28 . In this study, the average diameter of the ICBN at its origin in the second intercostal space was 2.1 ± 0.7 mm, similar to the result of 1.89 ± 0.44 mm described by Zhu et al 14 .…”

“…The intercostobrachial nerve (ICBN) arises from the second intercostal nerve as its lateral cutaneous branch 6 , and the axilla and posteromedial aspect of the arm has been related as its cutaneous area of innervation 7 . This nerve has been described in anatomical and clinical studies of axillary approaches to metastatic cancer, lymph node clearance, breast cancer and plastic surgery 8,9,10,11,12,13,14 . The use of the ICBN as a donor nerve for brachial plexus injury was once described by Hattori et al 15 , but in association with ICNs and with no anatomical background study.…”

Predictors of persistent pain after breast cancer surgery: a systematic review and meta-analysis of observational studies

“…Preliminary evidence suggests that sentinel lymph node biopsy, rather than standard axillary treatment, 66 may reduce the risk of chronic pain after breast cancer surgery. Moreover, preservation of intercostobrachial nerves during axillary lymph node dissection reduces the incidence of postmastectomy pain syndrome after surgery 67,68 and reduces the risk of sensory deficits after axillary clearance. 69 Accordingly, the American Society of Clinical Oncology now recommends sentinel lymph node biopsy for patients with early-stage breast cancer, followed by dissection only if the biopsy result is positive, 70 because this approach is associated with less pain and equivalent rates of axillary relapse compared with axillary dissection.…”