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DOI: 10.1055/s-0040-1722648
Breast Cancer-Related Lymphedema: Magnetic Resonance Imaging Evidence of Sparing Centered Along the Cephalic Vein
Funding This study received support from a RSNA R&E Resident Research Grant RR1820.![](https://www.thieme-connect.de/media/jrm/202106/lookinside/thumbnails/10-1055-s-0040-1722648_200186-1.jpg)
Abstract:
Background A distinct pattern of edema distribution is seen in breast cancer-related lymphedema. The area of edema sparing has not been characterized in relation to anatomy. Specifically, alternate lymphatic pathways are known to travel adjacent to the cephalic vein. Our study aims to define the location of edema sparing in the arm relative to the cephalic vein.
Methods A retrospective review of patients who underwent magnetic resonance imaging (MRI) between March 2017 and September 2018 was performed. Variables including patient demographics, arm volumes, and MRI data were extracted. MRIs were reviewed to define the amount of sparing, or angle of sparing, and the deviation between the center of sparing and the cephalic vein, or angle of deviation.
Results A total of 34 consecutive patients were included in the analysis. Five patients demonstrated circumferential edema (no sparing) and 29 patients demonstrated areas of edema sparing. Advanced age (69.7 vs. 57.6 years) and greater excess arm volume (40.4 vs. 20.8%) correlated with having circumferential edema without sparing (p = 0.003). In 29 patients with areas of edema sparing, the upper arm demonstrated the greatest angle of sparing (183.2 degrees) and the narrowest in the forearm (99.9 degrees; p = 0.0032). The mean angle of deviation to the cephalic vein measured 3.2, –0.1, and –5.2 degrees at the upper arm, elbow, and forearm, respectively.
Conclusion Our study found that the area of edema sparing, when present, is centered around the cephalic vein. This may be explained by the presence of the Mascagni-Sappey (M-S) pathway as it is located alongside the cephalic vein. Our findings represent a key springboard for additional research to better elucidate any trends between the presence of the M-S pathway, areas of sparing, and severity of lymphedema.
Publication History
Received: 08 May 2020
Accepted: 23 November 2020
Article published online:
31 January 2021
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References
- 1 Kim G, Smith MP, Donohoe KJ, Johnson AR, Singhal D, Tsai LL. MRI staging of upper extremity secondary lymphedema: correlation with clinical measurements. Eur Radiol 2020; 30 (08) 4686-4694
- 2 Mascagni P. Vasorum lymphaticorum corporis humani. Historia & Iconographia. Senis: Carli P, ed. 1787
- 3 Sappey PC. Anatomie, physiologie, pathologie de vaisseaux lymphatiques. Adrain Delahaye. 1874
- 4 Johnson AR, Bravo MG, James TA, Suami H, Lee BT, Singhal D. The all but forgotten mascagni-sappey pathway: learning from immediate lymphatic reconstruction. J Reconstr Microsurg 2020; 36 (01) 28-31
- 5 Kubik S. The role of the lateral upper arm bundle and the lymphatic watersheds in the formation of collateral pathways in lymphedema. Acta Biol Acad Sci Hung 1980; 31 (1-3): 191-200
- 6 Leduc A, Caplan I, Leduc O. Lymphatic drainage of the upper limb. Substitution lymphatic pathways. Eur J Lymph 1993; 4: 11-18
- 7 Johnson AR, Kimball S, Epstein S. et al. Lymphedema incidence after axillary lymph node dissection: quantifying the impact of radiation and the lymphatic microsurgical preventive healing approach. Ann Plast Surg 2019; 82 (4S, Suppl 3): S234-S241
- 8 Suami H, Scaglioni MF. Anatomy of the lymphatic system and the lymphosome concept with reference to lymphedema. Semin Plast Surg 2018; 32 (01) 5-11
- 9 Stanton AW, Northfield JW, Holroyd B, Mortimer PS, Levick JR. Validation of an optoelectronic limb volumeter (Perometer). Lymphology 1997; 30 (02) 77-97
- 10 Suami H. Lymphosome concept: anatomical study of the lymphatic system. J Surg Oncol 2017; 115 (01) 13-17
- 11 Stanton AW, Svensson WE, Mellor RH, Peters AM, Levick JR, Mortimer PS. Differences in lymph drainage between swollen and non-swollen regions in arms with breast-cancer-related lymphoedema. Clin Sci (Lond) 2001; 101 (02) 131-140
- 12 Lin C-H, Ali R, Chen SC. et al. Vascularized groin lymph node transfer using the wrist as a recipient site for management of postmastectomy upper extremity lymphedema. Plast Reconstr Surg 2009; 123 (04) 1265-1275
- 13 Cheng M-H, Chen SC, Henry SL, Tan BK, Lin MC, Huang JJ. Vascularized groin lymph node flap transfer for postmastectomy upper limb lymphedema: flap anatomy, recipient sites, and outcomes. Plast Reconstr Surg 2013; 131 (06) 1286-1298
- 14 Gharb BB, Rampazzo A, Spanio di Spilimbergo S, Xu ES, Chung KP, Chen HC. Vascularized lymph node transfer based on the hilar perforators improves the outcome in upper limb lymphedema. Ann Plast Surg 2011; 67 (06) 589-593
- 15 Coriddi M, Khansa I, Stephens J, Miller M, Boehmler J, Tiwari P. Analysis of factors contributing to severity of breast cancer-related lymphedema. Ann Plast Surg 2015; 74 (01) 22-25
- 16 Suami H, Koelmeyer L, Mackie H, Boyages J. Patterns of lymphatic drainage after axillary node dissection impact arm lymphoedema severity: a review of animal and clinical imaging studies. Surg Oncol 2018; 27 (04) 743-750
- 17 Johnson AR, Granoff MD, Suami H, Lee BT, Singhal D. Real-time visualization of the Mascagni-Sappey pathway utilizing ICG lymphography. Cancers (Basel) 2020; 12 (05) 1195