Anatomy of the lymphatics of the upper limb and anterior upper torso, and their prospective relationship

H. Suami, W. R. Pan, G. I. Taylor

Research output: Contribution to journalMeeting abstract


Introduction: Lymphoscintigraphy has become a routine examination for identifying the sentinel lymph node in various cancer patients. Despite increasing clinical information, the anatomy of the lymphatics has not been fully understood. Current understanding of the pattern of lymph drainage is still largely dependent on the anatomical studies of Sappey performed in the nineteenth century. The aim of this study was to reappraise the gross anatomy of the lymphatic system in the upper limb and breast region, and their relationship using human cadavers. Methods: 19 upper limbs, 12 anterior upper torsos and 3 forequarters fresh human cadaver specimens were studied. The technique used hydrogen peroxide to identify lymphatic vessels and inflate them. The individual channels were injected with a radio opaque lead oxide mixture and recorded on radiographs. Each channel was meticulously dissected under the surgical microscope and its course traced in relation to its nodes. Results: On the upper limb studies, most of the superficial lymph vessels, especially on the anterior side, flowed into one dominant lymph node in the axillary region. However, it is in the posterior side that there is the possibility of vessels bypassing the main node and going straight into the 2ⁿᵈ tier nodes. Kinmonth mentioned the presence of this node as the large central arm collecting gland using lymphangiography examination in vivo¹⁾. On the anterior upper torso studies, the superficial lymphatic pathways showed no significant difference between male and female. Most of them passed over and some through breast parenchyma. We found perforating lymph vessels that coursed beside the branches of the internal mammary vessels, draining into the ipsilateral internal mammary lymphatics. On the forequarter studies, the main node identified on the upper limb studies also covered a wide range of the anterior upper torso. Conclusion: We have demonstrated by radiography and by dissection of the lymphatic system of the upper limb and anterior torso and their relationship. These anatomical findings are discordant with some of the current knowledge based on previous studies and demand a closer examination by clinicians.
Original languageEnglish
Pages (from-to)4-5
Number of pages2
Journal6th Biennial International Sentinel Node Society Meeting : abstracts
Publication statusPublished - 2008
Externally publishedYes
EventBiennial International Sentinel Node Society Meeting (6th: 2008) - Sydney, Australia
Duration: 18 Feb 200820 Feb 2008


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