Fanning James E, Givant Madeleine, Chen Angela, Thomson Sarah, Tillotson Elizabeth, Fleishman Aaron, Donohoe Kevin, Singhal Dhruv
Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis St, Suite 5A, Boston, MA, 02215, USA.
Department of Nuclear Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Breast Cancer. 2025 Jul 15. doi: 10.1007/s12282-025-01742-2.
The lateral upper arm (LUA) pathway is a route of superficial lymphatic drainage that bypasses the axilla by draining to the deltopectoral, clavicular, and cervical lymph nodes. Despite the fact that anatomic variations of the LUA pathway have been implicated in breast cancer-related lymphedema (BCRL) risk after axillary lymph node dissection (ALND), the incidence of the LUA pathway variations in the healthy population has never been reported.
Healthy female volunteers underwent bilateral lymphatic mapping of the upper extremities with indocyanine green (ICG) lymphography. ICG was injected in six standard sites in the hand/wrist and upper arm. Major anatomic variations of the LUA pathway were recorded including bundle phenotype (long, short, or absent), proximal visualization sites, and forearm pathway continuation to the long bundle phenotype.
90 arms of 45 volunteers were included. The LUA pathway was present in 99% of arms and a long-versus-short bundle phenotype was observed in 71% versus 28% of arms. When the long bundle was present, it was formed by continuity with the forearm posterior radial channel alone (47%), posterior ulnar channel alone (34%), or both channels (19%). The LUA pathway was traced proximally to the deltopectoral groove in 89% of arms and to the axilla in 11% of arms.
We observed similar proportions of arms with long and short bundle phenotypes in comparison to our previous report of the LUA pathway in breast cancer patients with nodal disease. Defining the incidence of the LUA pathway with its variations in the general population is important as variations in this pathway may have implications for an individual's risk of developing BCRL.
上臂外侧（LUA）途径是一条浅表淋巴引流途径，通过引流至三角胸肌、锁骨和颈部淋巴结绕过腋窝。尽管LUA途径的解剖变异与腋窝淋巴结清扫术（ALND）后乳腺癌相关淋巴水肿（BCRL）的风险有关，但健康人群中LUA途径变异的发生率从未被报道过。
健康女性志愿者接受了使用吲哚菁绿（ICG）淋巴造影术对双侧上肢进行淋巴绘图。ICG被注射到手/腕和上臂的六个标准部位。记录LUA途径的主要解剖变异，包括束状表型（长、短或无）、近端可视化部位以及前臂途径延续至长束状表型。
纳入了45名志愿者的90只手臂。99%的手臂存在LUA途径，71%的手臂观察到长束状与短束状表型。当存在长束时，它仅由与前臂桡侧后通道连续形成（47%）、仅由尺侧后通道连续形成（34%）或由两个通道连续形成（19%）。89%的手臂LUA途径可追踪至三角胸肌沟近端，11%的手臂可追踪至腋窝。
与我们之前关于有淋巴结疾病的乳腺癌患者LUA途径的报告相比，我们观察到长束状和短束状表型的手臂比例相似。确定LUA途径及其在一般人群中的变异发生率很重要，因为该途径的变异可能对个体发生BCRL的风险有影响。
