Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 11/2012

01-10-2012 | Breast Oncology

Relationship Between the Lymphatic Drainage of the Breast and the Upper Extremity: A Postmortem Study

Authors: David Pavlista, MD, PhD, Oldrich Eliska, MD, DSc

Published in: Annals of Surgical Oncology | Issue 11/2012

Login to get access

Abstract

Background

This anatomic study details the lymphatic drainage of the upper extremity (UE) and breast, as well as its course in the axilla and its relation to axillary reverse mapping. Two aspects important for breast cancer surgery were followed: connection between the lymphatics of the UE and breast, and the possible cause of lymphedema of the UE after sentinel node (SN) biopsy.

Methods

Patent blue dye was injected bilaterally in 23 cadavers with no history of breast carcinoma to simultaneously visualize the lymphatics of the UE and breast. After visualization and dissection of the lymphatic vessels and nodes, a record of their routes was made. A scheme of superficial UE and breast lymphatics was constructed.

Results

After application of color contrast to the UE, 2–4 main afferent collectors were shown. As opposed to cranial and medial collectors, caudal collectors diverged from the axillary vein and entered the caudal axilla. In five (10.8 %) cases, the caudal collector entered a node, which was considered to be the SN of the breast. In six (13 %) cases, the SN of the breast and SNs of the UE were found in close proximity (up to 1.5 cm).

Conclusions

Lymphatic drainage of the UE and breast are closely related in the caudal part of the axilla. SN groups for the UE and breast share connections in 24 % of cases, which could explain lymphedema after surgery if damaged. Additional studies are needed to further improve our understanding of the lymphatic drainage of the UE and breast.
Literature
1.
Swenson KK, Nissen MJ, Ceronsky C, Swenson L, Lee MW, Tuttle TM. Comparison of side effects between sentinel lymph node and axillary lymph node dissection for breast cancer. Ann Surg Oncol. 2002;9:745–53.PubMedCrossRef
2.
Gerber L, Lampert M, Wood C, et al. Comparison of pain, motion, and edema after modified radical mastectomy vs. local excision with axillary dissection and radiation. Breast Cancer Res Treat. 1992;21:139–45.PubMedCrossRef
3.
4.
Thompson M, Korourian S, Henry-Tillman R, et al. Axillary reverse mapping (ARM): a new concept to identify and enhance lymphatic preservation. Ann Surg Oncol. 2007;14:1890–5.PubMedCrossRef
5.
Wilke LG, McCall LM, Posther KE, et al. Surgical complications associated with sentinel lymph node biopsy: results from a prospective international cooperative group trial. Ann Surg Oncol. 2006;13:491–500.PubMedCrossRef
6.
Casabona F, Bogliolo S, Valenzano Menada M, Sala P, Villa G, Ferrero S. Feasibility of axillary reverse mapping during sentinel lymph node biopsy in breast cancer patients. Ann Surg Oncol. 2009;16:2459–63.PubMedCrossRef
7.
Klimberg VS. A new concept toward the prevention of lymphedema: axillary reverse mapping. J Surg Oncol. 2008;97:563–4.PubMedCrossRef
8.
9.
Ponzone R, Mininanni P, Cassina E, Sismondi P. Axillary reverse mapping in breast cancer: can we spare what we find? Ann Surg Oncol. 2008;15:390–1.PubMedCrossRef
10.
Suami H, Pan WR, Mann GB, Taylor GI. The lymphatic anatomy of the breast and its implications for sentinel lymph node biopsy: a human cadaver study. Ann Surg Oncol. 2008;15:863–71.PubMedCrossRef
11.
Suami H, Taylor GI, Pan WR. The lymphatic territories of the upper limb: anatomical study and clinical implications. Plast Reconstr Surg. 2007;119:1813–22.PubMedCrossRef
12.
Cruikshank C. The anatomy of the absorbing vessels of the human body. London: G. Nicol, 1786.
13.
Sappey C. Anatomie, physiologie, pathologie des vaisseaux lymphatiques consideres chez l’homme at les vertebres. Paris: A. Delahaye and E. Lecrosnier, 1874.
14.
Delamere G, Poirier P, Cuneo B. The lymphatics. In: Charpy PP, ed. A trearise of human anatomy. Westminster: Archibald Constable, 1903.
15.
Borgstein PJ, Meijer S, Pijpers RJ, van Diest PJ. Functional lymphatic anatomy for sentinel node biopsy in breast cancer: echoes from the past and the periareolar blue method. Ann Surg. 2000;232:81–9.PubMedCrossRef
16.
Kett K, Szilágyi K, Anga B, Kett AG, Királyfalvi K. Axillary lymph drainage as a prognostic factor of survival in breast cancer. Lymphology. 2002;35:161–70.PubMed
17.
Kelley MC, Hansen N, McMasters KM. Lymphatic mapping and sentinel lymphadenectomy for breast cancer. Am J Surg. 2004;188:49–61.PubMedCrossRef
18.
McMasters KM, Tuttle TM, Carlson DJ, et al. Sentinel lymph node biopsy for breast cancer: a suitable alternative to routine axillary dissection in multi-institutional practice when optimal technique is used. J Clin Oncol. 2000;18:2560–6.PubMed
19.
Pecha V, Kolarik D, Kozevnikova R, et al. Sentinel lymph node biopsy in breast cancer patients treated with neoadjuvant chemotherapy. Cancer. doi:10.​1002/​cncr.​26102.
20.
Suami H, Pan WR, Taylor GI. Changes in the lymph structure of the upper limb after axillary dissection: radiographic and anatomical study in a human cadaver. Plast Reconstr Surg. 2007;120:982–91.PubMedCrossRef
21.
Gerota D. Zur Technik der Lymphgefassinjektion—Eine neue Injektionsmasse fuer Lymphgefasse—Polychrome Injektion. Anat Anz. 1896;12:216–24.
22.
Boneti C, Korourian S, Diaz Z, et al. Scientific Impact Award. Axillary reverse mapping (ARM) to identify and protect lymphatics draining the arm during axillary lymphadenectomy. Am J Surg. 2009;198:482–7.PubMedCrossRef
23.
Rubio I, Cebrecos I, Peg V, et al. Extensive nodal involvement increases the positivity of blue nodes in the axillary reverse mapping procedure in patients with breast cancer. J Surg Oncol. doi:10.​1002/​jso.​23048.
24.
Ponzone R, Cont N, Maggiorotto F, et al. Extensive nodal disease may impair axillary reverse mapping in patients with breast cancer. J Clin Oncol. 2009;33:5547–51.CrossRef
25.
Clough KB, Nasr R, Nos C, Vieira M, Inguenault C, Poulet B. New anatomical classification of the axilla with implications for sentinel node biopsy. Br J Surg. 2010;97:1659–65.PubMedCrossRef
26.
Bedrosian I, Babiera GV, Mittendorf EA, et al. A phase I study to assess the feasibility and oncologic safety of axillary reverse mapping in breast cancer patients. Cancer. 2010;116:2543–8.PubMed
27.
Schrenk P, Rieger R, Shamiyeh A, Wayand W. Morbidity following sentinel lymph node biopsy versus axillary lymph node dissection for patients with breast carcinoma. Cancer. 2000;88:608–14.PubMedCrossRef
Metadata
Title
Relationship Between the Lymphatic Drainage of the Breast and the Upper Extremity: A Postmortem Study
Authors
David Pavlista, MD, PhD
Oldrich Eliska, MD, DSc
Publication date
01-10-2012
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 11/2012
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-012-2363-x

Other articles of this Issue 11/2012

Annals of Surgical Oncology 11/2012 Go to the issue

SSO Special Article

Sentinel Lymph Node Biopsy for Melanoma: American Society of Clinical Oncology and Society of Surgical Oncology Joint Clinical Practice Guideline

Hepatobiliary Tumors

Definition of T3/4 and Regional Lymph Nodes in Gallbladder Cancer: Which Is More Valid, the UICC or the Japanese Staging System?

Breast Oncology

Clinical Outcomes of Breast-Conserving Surgery in Patients Using a Modified Method for Cavity Margin Assessment

Endocrine Tumors

Is There a Role for Unstimulated Thyroglobulin Velocity in Predicting Recurrence in Papillary Thyroid Carcinoma Patients with Detectable Thyroglobulin after Radioiodine Ablation?

Bone and Soft Tissue Sarcomas

Presentation and Management of Gastrointestinal Stromal Tumors of the Duodenum: A Multi-Institutional Analysis

Healthcare Policy and Outcomes

A Society in Transition: Presidential Remarks at the 65th Annual SSO Cancer Symposium