J Breast Cancer.  2014 Sep;17(3):244-249. 10.4048/jbc.2014.17.3.244.

Clinical Significance of the Axillary Arch in Sentinel Lymph Node Biopsy

• Kil WH
• Lee JE
• Nam SJ

• KMID: 2286351
• DOI: http://doi.org/10.4048/jbc.2014.17.3.244

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 > or =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.

Keyword

Axillary arch; Breast neoplasms; Sentinel lymph node biopsy

MeSH Terms

Body Mass Index
Breast Neoplasms
Humans
Lymph Nodes
Multivariate Analysis
Operative Time
Retrospective Studies
Sentinel Lymph Node Biopsy*

Figure

• 

  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.

• 

  Figure 2 The illustration for the relationship between the axillary arch and the location of sentinel lymph nodes (SLNs). The yellow-dotted circle shown in the back and top of the axillary arch is the high axillary group of the SLN, and the blue-dotted circle is the low axillary group. PM=pectoralis muscle; LD=latissimus dorsi; AA=axillary arch.

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