The AAPS 102nd Annual Meeting

Forearm Lymphatic Drainage to the Deltopectoral Lymph Nodes is Correlated with a Long-Bundle Lateral Upper Arm Pathway

James E. Fanning, BS1; Rosie Friedman, BS1; Aaron Fleishman, MPH1; Yuma Fuse, MD1; Kevin Donohoe, MD2; Dhruv Singhal, MD1

1. Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

2. Department of Nuclear Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

Background

•Variations of upper extremity lymphatic anatomy may explain an individual’s predisposition for developing breast cancer-related lymphedema (BCRL) after axillary lymph node dissection (ALND)

•The lateral upper arm pathway is hypothesized to be a protective drainage route avoiding the axilla

•Drainage to deltopectoral lymph nodes suggests a path of lymphatic drainage that may avoid the axillary regions commonly subject to ALND

•We correlated deltopectoral lymph node drainage with ICG pattern of the lateral upper arm pathway

Methods

•Thirty-two (32) healthy female volunteers underwent bilateral SPECT/CT lymphoscintigraphy of the upper extremities with hand and wrist injections

•Volunteers were included if they demonstrated deltopectoral lymph node drainage (tracer uptake)

•We then analyzed the lateral upper arm pathway channel on ICG lymphography in these volunteers

•ICG patterns were recorded as short-bundle (present in upper arm only), long-bundle (present in forearm and upper arm), or absent

Results

•Functional drainage to the deltopectoral lymph nodes was seen in 20% (13/64) of arms

•Of these 13 arms, 12 (92%) demonstrated a long-bundle of the lateral upper pathway in comparison to 73% (47/64) of the cohort

Discussion and Conclusion

•A long-bundle lateral upper arm pathway enables protective drainage from the hand and forearm to the deltopectoral lymph nodes

•Future investigation of lymphatic anatomy and drainage may help predict BCRL risk after ALND

The AAPS 102nd Annual Meeting

Collateralization Of Forearm Lymphatic Drainage Is Afforded By A Long-Bundle Lateral Upper Arm Pathway: Novel Insights From Combined ICG Lymphography And Lymphoscintigraphy

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