The Epitrochlear and Humeral Lymphatic Pathway: Deep Lymphatic System Compensation After Axillary Lymph Node Dissection
Madeleine Givant, James E. Fanning, Angela Chen, Sarah Thomson, Kathleen Shillue, Aaron Fleishman, Caitlin M. Connolly, Kevin Donohoe, Dhruv SinghalABSTRACT
Background and Objectives
Superficial‐to‐deep lymphatic drainage has been proposed as a mechanism to reduce an individual's risk of developing breast cancer‐related lymphedema (BCRL). The epitrochlear‐humeral pathway provides superficial‐to‐deep lymphatic drainage and may be preferentially recruited when the superficial lymphatic system becomes inadequate. We evaluated the presence or absence of epitrochlear‐humeral lymph node drainage in breast cancer survivors post‐axillary lymph node dissection (ALND) who did not develop BCRL.
Methods
Female breast cancer survivors without BCRL after ALND underwent lymphatic mapping with ICG lymphography and SPECT/CT lymphoscintigraphy. The presence of epitrochlear and/or humeral drainage was recorded and compared between volunteers based on linear versus nonlinear patterns on ICG lymphography.
Results
Twenty‐five volunteers, a median of 13.0 years after ALND, met the inclusion criteria. Drainage to both the epitrochlear and humeral nodes was observed in 56% (14/25). Linear ICG patterns were present in 32% (8/25), while 68% (17/25) demonstrated nonlinear patterns. Epitrochlear and humeral drainage was observed in 38% (3/8) of volunteers with linear patterns compared with 65% (11/17) of those with nonlinear patterns.
Conclusions
Superficial‐to‐deep lymphatic drainage is common in breast cancer survivors without BCRL after ALND and may represent an important compensatory mechanism of the deep lymphatic system.