Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
J Reconstr Microsurg. 2021 Jul;37(6):519-523. doi: 10.1055/s-0040-1722648. Epub 2021 Jan 31.
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.
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.
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 ( = 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; = 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.
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.
乳腺癌相关淋巴水肿的水肿分布模式明显不同。水肿未受累区与解剖结构的关系尚未确定。具体来说，已知替代的淋巴通路沿着头静脉走行。我们的研究旨在确定手臂中相对于头静脉的水肿未受累区的位置。
对 2017 年 3 月至 2018 年 9 月期间接受磁共振成像（MRI）检查的患者进行回顾性研究。提取变量包括患者人口统计学资料、手臂体积和 MRI 数据。对 MRI 进行回顾，以确定受累量或受累角度，以及未受累区中心与头静脉之间的偏差或偏差角度。
共有 34 例连续患者纳入分析。5 例患者表现为环状水肿（无未受累区），29 例患者表现为水肿未受累区。高龄（69.7 岁 vs. 57.6 岁）和更大的过量手臂体积（40.4% vs. 20.8%）与无未受累区的环状水肿相关（ = 0.003）。在 29 例存在水肿未受累区的患者中，上臂的受累角度最大（183.2 度），前臂的受累角度最小（99.9 度； = 0.0032）。头静脉处的平均偏差角度分别为上臂 3.2 度、肘 0.1 度和前臂-5.2 度。
本研究发现，存在水肿未受累区时，其位于头静脉周围。这可能是由于 Mascagni-Sappey（M-S）通路的存在，因为它位于头静脉旁边。我们的发现为进一步研究提供了关键的基础，以更好地阐明 M-S 通路的存在、未受累区和淋巴水肿严重程度之间的任何趋势。
