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Clinical Significance of the Axillary Arch in Sentinel Lymph Node Biopsy
길원호,이정언,남석진 한국유방암학회 2014 Journal of breast cancer Vol.17 No.3
Purpose: The axillary arch is an anomalous muscle that is not infrequentlyencountered during axillary sentinel lymph node biopsy(SLNB) of breast cancer patients. In this study, we aimed toinvestigate how often the axillary arch is found during SLNB andwhether it affects the intraoperative sentinel lymph node (SLN)identification rate. Methods: We retrospectively analyzed the correlationbetween the presence of the axillary arch and the SLNsampling failure rate during SLNB in 1,069 patients who underwentaxillary SLNB for invasive breast cancer. Results: Of 1,069patients who underwent SLNB, 79 patients (7.4%) had the axillaryarch present. The SLNB failure rate was high when the patient’sbody mass index was ≥25 (p=0.026), when a single SLNmapping technique was used (p=0.012), and when the axillaryarch was present (p<0.001). These three factors were also foundto be statistically significant by multivariate analysis, and of thesethree factors, presence of the axillary arch most significantly increasedthe SLNB failure rate (hazard ratio, 10.96; 95% confidenceinterval, 4.42–27.21; p<0.001). Additionally, if the axillaryarch was present, the mean operative time of SLNB was 20.8minutes, compared to 12.5 minutes when the axillary arch wasnot present (p<0.001). If the axillary arch was present, the SLNwas often located in a high axillary region (67%) rather than in ageneral low axillary location. Conclusion: The axillary arch wasfound to be a significant factor affecting intraoperative SLN failurerate. It is necessary to keep in mind that carefully checkingthe high axillar region during SLNB in breast cancer patients withthe axillary arch is important for reducing SLN sampling failure.