Axillary Arch May Affect Axillary Lymphadenectomy

Karanlık, Hasan; Fathalizadeh, Alisan; İlhan, Mehmet; Serin, Kürşat Rahmi; Kurul, Sidika

doi:10.1159/000357307

Cited by 16 publications

(14 citation statements)

References 9 publications

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“…In particular, old age, high BMI, and use of only a single SLN mapping technique with a vital dye or radioisotope are factors that increase SLN identification failure [ 2 , 3 , 4 ]. However, according to some reports, in addition to the previously mentioned factors, the axillary arch muscle is also a factor that may reduce the SLN identification rate during SLNB [ 5 , 6 , 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical Significance of the Axillary Arch in Sentinel Lymph Node Biopsy

2014

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PurposeThe 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.MethodsWe 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.ResultsOf 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.ConclusionThe 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.

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Section: Introductionmentioning

confidence: 99%

Clinical Significance of the Axillary Arch in Sentinel Lymph Node Biopsy

2014

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“…The prevalence of axillary arch in cadaveric dissection in Japanese, Turkish and Bulgarian populations is 9.1%, 1.9% and 3.6% respectively [5][6][7]. On the other hand, it has been recognized in only 0.25% of patients during axillary surgical procedures [8]. The difference in prevalence in anatomical and surgical reports may be due to a failure to identify or report the variation when observed during surgery, whereas the specific aim of cadaveric studies is to identify anatomical anomalies [8].…”

Section: Discussionmentioning

confidence: 99%

“…Most patients, similarly to the one described here, are asymptomatic. However, entrapment of the axillary neurovascular bundle by an axillary arch during arm movements has been described, and may cause circulatory insufficiency, chronic pain or paraesthesia [8]. The simple division of the arch is curative in such situations [9].…”

Section: Discussionmentioning

confidence: 99%

Axillary arch: Clinical significance in breast cancer patients

Lamichhane¹,

Agrawal²,

Mukhopadhyay³

et al. 2017

IJCRI

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International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations. Case Report: A 55-year-old female presented with a 3x3 cm carcinoma in the superomedial quadrant of the right breast, with no palpable regional lymph nodes. She underwent breast conservation surgery with axillary nodal clearance. During axillary dissection, an unusual muscle slip was identified crossing the axilla, connecting the anterior border of latissimus dorsi to the posterior surface of pectoralis major, anterior to the axillary artery, vein and brachial plexus. IJCRI publishes Review Conclusion:Preoperative knowledge is essential to identify such unusual anatomy and to appropriately tackle it to avoid surgical complications and adequate axillary lymph node clearance.

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“…Moreover, the LAA presence can obscure clinical examination when palpable, as it can misguide towards a diagnosis of an axillary mass or lymphadenopathy [41,45]. Finally, arm movement in the presence of a LAA may cause entrapment of the neurovascular bundle, leading to circulatory deficiency, chronic pain and paraesthesia [38,42].…”

Section: Clinical Significancementioning

confidence: 99%

Accessory muscles of the anterior thoracic wall and axilla. Cadaveric, surgical and radiological incidence and clinical significance during breast and axillary surgery

et al. 2019

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Background: The present study aims to summarise the accessory muscles of the anterior thoracic wall and axilla that can be encountered during breast and axillary surgery and record their incidence and clinical significance. Moreover, the laterality of the atypical muscles is highlighted and possible gender dimorphism is referred. Accessory anterior thoracic wall muscles include: Langer's axillary arch, sternalis muscle, chondrocoracoideus, chondroepitrochlearis, chondrofascialis, pectoralis minimus, pectoralis quartus and pectoralis intermedius. Materials and methods: The anatomical, surgical and radiological literature has been reviewed and an anatomical study on 48 Greek adult cadavers was performed. Results: Literature review revealed the existence of accessory muscles of the anterior thoracic wall and axilla that have a significant incidence that can be considered high and may, therefore, have clinical significance. For the most common of these muscles, which are axillary arch (Langer's) and sternalis muscle, the cadaveric incidence is 10.30% and 7.67%, respectively. In the current cadaveric study, accessory thoracic wall muscles were identified in two cadavers; namely a bilateral sternalis muscle (incidence 2.08%) extending both to the anterior and posterior surface of the sternum and a left-sided chondrocoracoideus muscle (of Wood) (incidence 2.08%). Conclusions: Despite the fact that accessory anterior thoracic wall and axillary muscles are considered to be rare, it is evident that the incidence of at least some of them is high enough to encounter them in clinical practice. Thus, clinicians' awareness of these anatomical structures is advisable. (Folia Morphol 2019; 78, 3: 606-616)

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Axillary Arch May Affect Axillary Lymphadenectomy

Cited by 16 publications

References 9 publications

Clinical Significance of the Axillary Arch in Sentinel Lymph Node Biopsy

Clinical Significance of the Axillary Arch in Sentinel Lymph Node Biopsy

Axillary arch: Clinical significance in breast cancer patients

Accessory muscles of the anterior thoracic wall and axilla. Cadaveric, surgical and radiological incidence and clinical significance during breast and axillary surgery

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