Less is more: transmammary axillary lymph node evaluation: an initial clinical experience

Background: Standard axillary node dissection has the potential to cause a significant amount of morbidity. Sentinel lymph node biopsy has considerably decreased this rate of morbidity; however, data recently presented, based on ACOSOG Z-10, suggest that even this less invasive technique can have a lymphedema rate as high as 7%. The transmammary axillary lymph node evaluation procedure (TANE) removes the sentinel node via the breast incision, thus eliminating the axillary incision. This may decrease morbidity, including lymphedema, dyesthesias, pain, and loss of range of motion, and it will also improve cosmetic outcome. Methods: This is a prospective observational study to determine if it is feasible to perform both the partial mastectomy and sentinel lymph node biopsy via a single incision. All patients were consented for a partial mastectomy and sentinel lymph node biopsy. The partial mastectomy was performed in the standard fashion. The sentinel lymph node biopsy was performed via the same incision either before or after the breast specimen was removed. The sentinel lymph node biopsy was then performed in the standard fashion. Results: The TANE method was attempted in 44 patients from June 2005 to March 2006 and was successful in 43, for a rate of 97.73%. The mean age of the patients was 57.6 years, with a range of 34 to 82 years. The average tumor size was 1.57 cm, with a range of 0.4 cm to 4.5 cm. The TANE procedure was performed most often in patients with tumors located in the upper outer quadrant (79.54%). There were no perioperative complications. Conclusion: Our prospective study showed that this is a feasible procedure for sentinel lymph node biopsy and axillary lymph node dissection. The number of sentinel and axillary nodes obtained was within the standard published norms. Our technical success rate was 97.33%, and we did not have any perioperative complications. In this pilot study, there was the cosmetic benefit of only 1 incision. Future studies will examine if the TANE procedure can objectively decrease morbidity compared to a separate axillary incision.