Superficial and functional imaging of the tricipital lymphatic pathway: a modern reintroduction

Friedman, Rosie; Bustos, Valeria P.; Pardo, Jaime; Tillotson, Elizabeth; Donohoe, Kevin J.; Chatterjee, Abhishek; Ciucci, José Luis; Singhal, Dhruv

doi:10.1007/s10549-022-06777-z

Cited by 8 publications

(7 citation statements)

References 25 publications

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“…Along the forearm, fluid infiltration was most frequently seen along the ulnar aspect. The ulnar lymphatic channel is less likely to have a connection to the lateral upper arm pathway and is associated more with the tricipital lymphatic pathway, a compensatory route of lymphatic drainage 11–13 . However, the tricipital channel is less frequently observed, as shown in both in cadaveric dissections and in vivo 11,14 .…”

Section: Discussionmentioning

confidence: 99%

“…The lymphatic channel is less likely to have a connection to the lateral upper arm pathway and is associated more with the tricipital lymphatic pathway, a compensatory route of lymphatic drainage. [11][12][13] However, the tricipital channel is less frequently observed, as shown in both in cadaveric dissections and in vivo. 11,14 We therefore propose that compromised or unfavorable anatomic variations of the tricipital pathway may lead to edema at the ulnar forearm.…”

Section: Discussionmentioning

confidence: 99%

“…[11][12][13] However, the tricipital channel is less frequently observed, as shown in both in cadaveric dissections and in vivo. 11,14 We therefore propose that compromised or unfavorable anatomic variations of the tricipital pathway may lead to edema at the ulnar forearm. Gravity dependence has been postulated to play a role.…”

Section: Discussionmentioning

confidence: 99%

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Fluid Distribution Patterns in Early-Stage Upper Extremity Lymphedema

Friedman¹,

Lee

Kinney³

et al. 2023

Ann Plast Surg

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Introduction Magnetic resonance imaging (MRI) stage 1 (early stage) upper extremity lymphedema is characterized by fluid infiltration in the subcutaneous tissues that does not exceed 50% of the extremity circumference at any level. The spatial fluid distribution in these cases has not been detailed and may be important to help determine the presence and location of compensatory lymphatic channels. The aim of this study is to determine whether there was a pattern of distribution of fluid infiltration in patients with early-stage lymphedema that could correspond to known lymphatic pathways in the upper extremity. Methods A retrospective review identified all patients with MRI stage 1 upper extremity lymphedema who were evaluated at a single lymphatic center. Using a standardized scoring system, a radiologist graded the severity of fluid infiltration at 18 anatomical locations. A cumulative spatial histogram was then created to map out regions where fluid accumulation occurred most and least frequently. Results Eleven patients with MRI stage 1 upper extremity lymphedema were identified between January 2017 and January 2022. The mean age was 58 years and the mean BMI was 30 m/kg2. One patient had primary lymphedema and the remaining 10 had secondary lymphedema. The forearm was affected in nine cases, and fluid infiltration was predominantly concentrated along the ulnar aspect, followed by the volar aspect, while the radial aspect was completely spared. Within the upper arm, fluid was primarily concentrated distally and posteriorly, and occasionally medially. Conclusions In patients with early-stage lymphedema, fluid infiltration is concentrated along the ulnar forearm and the posterior distal upper arm, which aligns with the tricipital lymphatic pathway. There is also sparing of fluid accumulation along the radial forearm in these patients, suggesting a more robust lymphatic drainage along this region, possibly due to a connection to the lateral upper arm pathway.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Fluid Distribution Patterns in Early-Stage Upper Extremity Lymphedema

Friedman¹,

Lee

Kinney³

et al. 2023

Ann Plast Surg

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“…24 Singhal et al also suggested that variances in the anatomy of the arm lymphatic system may be a contributing factor for BCRL. [25][26][27] For any reconstructive efforts attempting to restore defects caused by surgical ablation of cancerous lesions, oncological safety remains the highest priority. [28][29][30][31] ILR, or LYMPHA, a surgical procedure combining axillary reverse mapping 32,33 and lymphovenous anastomosis, 34 is proposed to restore the disrupted lymphatic drainage during ALND.…”

Section: Discussionmentioning

confidence: 99%

Is Immediate Lymphatic Reconstruction on Breast Cancer Patients Oncologically Safe? A Preliminary Study

Lin,

Kuan,

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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Background: In breast cancer patients receiving axillary lymph node dissection (ALND), immediate lymphatic reconstruction (ILR) with lymphovenous anastomosis is an emerging technique for reducing the risk of arm lymphedema. However, the oncologic safety of surgically diverting lymphatic ducts directly into venules in a node-positive axilla is still a concern of inadvertently inducing metastasis of remaining cancer cells. This study aimed to assess the oncologic safety of ILR. Methods: From January 2020 to January 2022, 95 breast cancer patients received ALND, and 45 of them also received ILR. Patients with recurrent cancer, with follow-up less than 12 months, and with missed data were excluded. Variables were compared between ILR and non-ILR groups, and the outcome of interest was the rate of distant recurrence after follow-up for at least 1 year. Results: Thirty-four patients in the ILR group and 32 patients in the non-ILR group fulfilled the inclusion criteria for analysis. No statistically significant difference was noted between groups in terms of age, body mass index, type of breast surgery, pathologic cancer staging, histologic type and grade of breast cancer, molecular subtypes, frequency of axillary lymph node metastasis, or adjuvant therapy. For the patients receiving follow-up for at least 1 year, no statistically significant difference was found in terms of distant recurrence rates between ILR and non-ILR groups (P = 0.44). Conclusion: For breast cancer patients receiving ALND, ILR with lymphovenous anastomosis is oncologically safe, within an average follow-up period of 21 months.

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“…3,10 In the early 20 th century, a comprehensive compendium of human lymphatic anatomy, "Anatomy of the human lymphatic system," was published by Rouvière and Tobias (1938). 11 Despite continued important work in the modern era on lymphatic anatomy including that by Kubik (1973), 12 Caplán (1977, 1981), 6,7 Leduc (1993), 13 Ciucci (199613 Ciucci ( , 200413 Ciucci ( , 2015, 6,7,14 Suami (2005, 2018), 15,16 Pan (2011), 17 and Singhal (2020, 2022), 18,19 no compendium of the entire human lymphatic system has been attempted since 1938.…”

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confidence: 99%

Mapping the Anatomy of the Human Lymphatic System

Bustos,

Wang,

Pardo

et al. 2024

J Reconstr Microsurg

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Background While substantial anatomical study has been pursued throughout the human body, anatomical study of the human lymphatic system remains in its infancy. For microsurgeons specializing in lymphatic surgery, a better command of lymphatic anatomy is needed to further our ability to offer surgical interventions with precision. In an effort to facilitate the dissemination and advancement of human lymphatic anatomy knowledge, our teams worked together to create a map. The aim of this paper is to present our experience in mapping the anatomy of the human lymphatic system. Methods Three steps were followed to develop a modern map of the human lymphatic system: (1) identifying our source material, which was “Anatomy of the human lymphatic system,” published by Rouvière and Tobias (1938), (2) choosing a modern platform, the Miro Mind Map software, to integrate the source material, and (3) transitioning our modern platform into The Human BioMolecular Atlas Program (HuBMAP). Results The map of lymphatic anatomy based on the Rouvière textbook contained over 900 data points. Specifically, the map contained 404 channels, pathways, or trunks and 309 lymph node groups. Additionally, lymphatic drainage from 165 distinct anatomical regions were identified and integrated into the map. The map is being integrated into HuBMAP by creating a standard data format called an Anatomical Structures, Cell Types, plus Biomarkers table for the lymphatic vasculature, which is currently in the process of construction. Conclusion Through a collaborative effort, we have developed a unified and centralized source for lymphatic anatomy knowledge available to the entire scientific community. We believe this resource will ultimately advance our knowledge of human lymphatic anatomy while simultaneously highlighting gaps for future research. Advancements in lymphatic anatomy knowledge will be critical for lymphatic surgeons to further refine surgical indications and operative approaches.

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Superficial and functional imaging of the tricipital lymphatic pathway: a modern reintroduction

Cited by 8 publications

References 25 publications

Fluid Distribution Patterns in Early-Stage Upper Extremity Lymphedema

Fluid Distribution Patterns in Early-Stage Upper Extremity Lymphedema

Is Immediate Lymphatic Reconstruction on Breast Cancer Patients Oncologically Safe? A Preliminary Study

Mapping the Anatomy of the Human Lymphatic System

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