Abstract
The intercostobrachial nerve (ICBN), which usually originates from the lateral cutaneous branch of the second intercostal nerve, innervates areas of the axilla, lateral chest, and medial arm. It is at risk for injury during operative procedures that are often used in the management of breast cancer and such injury has been associated with postoperative sensory loss and neuropathic pain, decreasing the quality of life.PubMed, Excerpta Medica Database (EMBASE), ScienceDirect, Google Scholar, China National Knowledge Infrastructure (CNKI), Scientific Electronic Library Online (SciELO), Biosciences Information Service (BIOSIS), and Web of Science were searched comprehensively. Data concerning the prevalence, branching, origin and communications of the ICBN were extracted and pooled into a meta-analysis.A total of 16 studies (1,567 axillas) reported data indicating that the ICBN was present in 98.4% of person. It most often (90.6%) originated from fibers at the T2 spinal level and commonly coursed in two branching patterns: as a single trunk in 47.0% of cases and as a bifurcating pattern in 42.2%. In the latter cases, the bifurcation was usually unequal (63.4%). Additionally, the ICBN presented with anastomosing communication to the brachial plexus in 41.3% of cases.The ICBN is a prevalent and variable structure at significant risk for injury during operative procedures of the axilla. In view of the postoperative pain and paresthesia experienced by patients following injury, surgeons need to exercise caution and aim to preserve the ICBN when possible. Ultimately, careful dissection and knowledge of ICBN anatomy could allow postoperative complications to be reduced and patient's quality of life increased.
Highlights
BackgroundThe intercostobrachial nerve (ICBN) is a nerve classically originating from the lateral cutaneous branch of the second intercostal nerve [1]
The proximity and course of the ICBN in relation to the axilla poses a danger of iatrogenic injury resulting from common procedures such as axillary lymph node dissection (ALND), sentinel lymph node biopsy (SLNB) and mastectomy [2,4]
Breast cancer is the most common malignancy in women worldwide, affecting nearly one in eight in both the United States and Europe [1, 5,6]. Procedures such as ALND, SLNB, and/or mastectomy are utilized in a significant portion of breast cancer cases for purposes ranging from diagnosis, staging, to resection [1, 7,8]
Summary
BackgroundThe intercostobrachial nerve (ICBN) is a nerve classically originating from the lateral cutaneous branch of the second intercostal nerve [1]. The ICBN, in its historically portrayed course, exits the second intercostal space and traverses the axilla to terminally branch in the region of the medial arm [1]. Breast cancer is the most common malignancy in women worldwide, affecting nearly one in eight in both the United States and Europe [1, 5,6]. Procedures such as ALND, SLNB, and/or mastectomy are utilized in a significant portion of breast cancer cases for purposes ranging from diagnosis, staging, to resection [1, 7,8].
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