Division of Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Division of Radiation Oncology, Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
J Surg Oncol. 2021 Mar;123(4):846-853. doi: 10.1002/jso.26343. Epub 2020 Dec 17.
This study characterizes the physiological drainage of the normal upper extremity using single-photon emission computed tomography/computed tomography (SPECT/CT) lymphoscintigraphy axillary reverse lymphatic mapping (ARM).
A consecutive series of patients assessed with SPECT/CT lymphoscintigraphy ARM of the upper extremity were included. Anatomical localization of the axillary sentinel lymph nodes (SLN) was completed in normal axillae in relation to consistent anatomic landmarks. Retrospective case note analysis was performed to collect patient demographic data.
A total of 169 patients underwent SPECT/CT lymphoscintigraphy, and imaging of 182 normal axillae was obtained. All patients (100%) had an axillary SLN identified: 19% had a single contrast-enhanced SLN in the axilla and the remainder had multiple. The SLN(s) of the upper extremity was located in the upper outer quadrant (UOQ) of the axilla in 97% of cases (177 axillae). When the SLN(s) was found in the UOQ of the axilla, second-tier lymph nodes were found predominantly in the upper inner quadrant (50% of cases).
The upper extremity SLN(s) is located in a constant region of the axilla. This study provides the most complete investigation to date and results can be directly applied clinically to ARM techniques and adjuvant radiation planning.
本研究通过单光子发射计算机断层扫描/计算机断层扫描（SPECT/CT）淋巴闪烁显像腋窝逆向淋巴作图（ARM）对正常上肢的生理引流进行了描述。
本研究纳入了一系列连续评估上肢 SPECT/CT 淋巴闪烁显像 ARM 的患者。在正常腋窝中，通过与一致的解剖学标志相关联，完成腋窝前哨淋巴结（SLN）的解剖定位。通过回顾性病历分析收集患者的人口统计学数据。
共 169 例患者接受了 SPECT/CT 淋巴闪烁显像，获得了 182 例正常腋窝的图像。所有患者（100%）均识别出腋窝 SLN：19%的患者在腋窝中仅有单个增强对比的 SLN，其余患者有多个。上肢的 SLN 位于腋窝的外上象限（UOQ），占 97%（177 个腋窝）。当 SLN 位于腋窝的 UOQ 时，第二级淋巴结主要位于内上象限（50%的病例）。
上肢 SLN 位于腋窝的一个固定区域。本研究提供了迄今为止最完整的调查结果，其结果可直接应用于 ARM 技术和辅助放疗计划。
