Fanning James E, Chen Angela, Thomson Sarah, Tillotson Elizabeth, Fleishman Aaron, Parker John A, Donohoe Kevin, Singhal Dhruv
Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Department of Nuclear Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Breast Cancer Res Treat. 2025 Jun 25. doi: 10.1007/s10549-025-07748-w.
The lateral upper arm lymphatic pathway is theorized as a route of superficial lymphatic drainage protective against breast cancer-related lymphedema (BCRL) after axillary lymph node dissection (ALND). This study describes lymph nodes draining the lateral upper arm pathway.
Healthy female volunteers underwent bilateral ICG lymphography and nuclear lymphoscintigraphy. Nuclear tracer was injected over the cephalic vein in the upper arm. Lymph nodes with tracer uptake were recorded as deltopectoral, Station 1 (Axillary Levels I or II and Interpectoral), or Station 2 (Axillary Level III, Infraclavicular, Supraclavicular Levels IV or Vb, and Cervical Level Va).
72 arms of 36 volunteers were included. Functional drainage to deltopectoral lymph nodes was observed in 38% (27/72) of arms. Drainage to Station 1, Station 2, and neither station was observed in 96% (69/72), 36% (26/72), and 3% (2/72) of arms, respectively. No differences were observed between arms with or without deltopectoral lymph nodes draining to Station 1 lymph nodes (93% vs 98%, p = 0.286) or neither station (4% vs 2%, p = 0.711), respectively. A significant difference was observed between arms with or without deltopectoral lymph nodes draining to Station 2 lymph nodes (52% vs 27%, p = 0.031).
Deltopectoral lymph node drainage is significantly correlated with Station 2 lymph node drainage. As Station 2 lymph nodes are preserved in an ALND, the presence of deltopectoral lymph node drainage represents an important potential protective biomarker for BCRL development.
上臂外侧淋巴通路被认为是腋窝淋巴结清扫术（ALND）后预防乳腺癌相关淋巴水肿（BCRL）的一条浅表淋巴引流途径。本研究描述了引流上臂外侧通路的淋巴结。
健康女性志愿者接受双侧吲哚菁绿淋巴造影和核素淋巴闪烁显像。将核素示踪剂注射到上臂的头静脉上方。摄取示踪剂的淋巴结记录为三角胸肌淋巴结、第1站（腋窝Ⅰ或Ⅱ级及胸肌间）或第2站（腋窝Ⅲ级、锁骨下、锁骨上Ⅳ或Ⅴb级及颈Ⅴa级）。
纳入36名志愿者的72只手臂。38%（27/72）的手臂观察到向三角胸肌淋巴结的功能性引流。分别有96%（69/72）、36%（26/72）和3%（2/72）的手臂观察到向第1站、第2站的引流以及无引流至任何一站。向第1站淋巴结引流或不引流至任何一站的有或无三角胸肌淋巴结的手臂之间未观察到差异（93%对98%，p = 0.286）或（4%对2%，p = 0.711）。向第2站淋巴结引流的有或无三角胸肌淋巴结的手臂之间观察到显著差异（52%对27%，p = 0.031）。
三角胸肌淋巴结引流与第2站淋巴结引流显著相关。由于在ALND中保留第2站淋巴结，三角胸肌淋巴结引流的存在代表了BCRL发生的一个重要潜在保护生物标志物。
