Is dissection of the internerve tissue during axillary lymphadenectomy forbreast cancer necessary?

Aims: The study evaluates the necessity of dissecting the tissue between th e long thoracic and thoracodorsal nerves (internerve tissue) during axillar y dissection in breast cancer surgery. By reviewing the lymph node yield an d the metastatic rate in the internerve tissue, we examine whether the inte rnerve tissue could be left in situ to minimize the risk of nerve injury. Methods: A prospective study was conducted on 30 consecutive women undergoi ng axillary lymphadenectomy for breast cancer. The internerve tissue remain ing was excised separately after a routine axillary dissection and was exam ined by the same pathologist. Results: Twenty (67%) of 30 internerve specimens contained lymph nodes; the internerve nodes were positive for carcinoma in three cases (10%). In one case the lymph node in the internerve tissue was the only metastatic node i n the axilla. Conclusions: There is a significant incidence of lymph nodes (67%) and axil lary node metastases (10%) in the tissue lying between the long thoracic an d thoracodorsal nerves. Therefore excision of this internerve tissue is str ongly recommended in order to optimize decision making regarding adjuvant t reatment and oucome in women with operable breast cancer.