Patterns of lymphatic drainage after axillary node dissection impact arm lymphoedema severity: a review of animal and clinical imaging studies

Research output: Contribution to journalReview articleResearchpeer-review

Abstract

Upper extremity lymphoedema after axillary node dissection is an iatrogenic disease particularly associated with treatment for breast or skin cancer. Anatomical studies and lymphangiography in healthy subjects identified that axillary node dissection removes a segment of the lymphatic drainage pathway running from the upper limb to the sub-clavicular vein, creating a surgical break. It is reasonable to infer that different patterns of lymphatic drainage may occur in the upper limb following surgery and contribute to the various presentations of lymphoedema from none to severe. Firstly, we reviewed animal imaging studies that investigated the repair of lymphatic drainage pathways from the limb after lymph node dissection. Secondly, we examined clinical imaging studies of lymphatic drainage pathways after axillary node dissection, including lymphangiography, lymphoscintigraphy and indocyanine green fluorescence lymphography. Finally, based on the gathered data, we devised a set of general principles for the restoration of lymphatic pathways after surgery. Lymphoscintigraphy shows that restoration of the original lymphatic pathway to the axilla after its initial disruption by nodal dissection was not uncommon and may prevent lymphoedema. We found that regenerated lymphatic vessels and dermal backflow (the reflux of lymph to the skin) contributed to either restoration of the original pathway or rerouting of the lymphatic pathway to other regional nodes. Variation in the lymphatic drainage pathway and the mechanisms of fluid drainage itself are the foundation of new lymphatic drainage patterns considered to be significant in determining the severity with which lymphoedema develops.

LanguageEnglish
Pages743-750
Number of pages8
JournalSurgical Oncology
Volume27
Issue number4
DOIs
Publication statusPublished - 1 Dec 2018

Fingerprint

Lymphedema
Dissection
Drainage
Arm
Lymphography
Upper Extremity
Lymphoscintigraphy
Iatrogenic Disease
Skin
Axilla
Lymphatic Vessels
Indocyanine Green
Skin Neoplasms
Lymph
Clinical Studies
Lymph Node Excision
Veins
Healthy Volunteers
Extremities
Fluorescence

Keywords

  • Anatomy
  • Axillary node dissection
  • Imaging
  • Lymphangiography
  • Lymphedema
  • Lymphoscintigraphy

Cite this

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title = "Patterns of lymphatic drainage after axillary node dissection impact arm lymphoedema severity: a review of animal and clinical imaging studies",
abstract = "Upper extremity lymphoedema after axillary node dissection is an iatrogenic disease particularly associated with treatment for breast or skin cancer. Anatomical studies and lymphangiography in healthy subjects identified that axillary node dissection removes a segment of the lymphatic drainage pathway running from the upper limb to the sub-clavicular vein, creating a surgical break. It is reasonable to infer that different patterns of lymphatic drainage may occur in the upper limb following surgery and contribute to the various presentations of lymphoedema from none to severe. Firstly, we reviewed animal imaging studies that investigated the repair of lymphatic drainage pathways from the limb after lymph node dissection. Secondly, we examined clinical imaging studies of lymphatic drainage pathways after axillary node dissection, including lymphangiography, lymphoscintigraphy and indocyanine green fluorescence lymphography. Finally, based on the gathered data, we devised a set of general principles for the restoration of lymphatic pathways after surgery. Lymphoscintigraphy shows that restoration of the original lymphatic pathway to the axilla after its initial disruption by nodal dissection was not uncommon and may prevent lymphoedema. We found that regenerated lymphatic vessels and dermal backflow (the reflux of lymph to the skin) contributed to either restoration of the original pathway or rerouting of the lymphatic pathway to other regional nodes. Variation in the lymphatic drainage pathway and the mechanisms of fluid drainage itself are the foundation of new lymphatic drainage patterns considered to be significant in determining the severity with which lymphoedema develops.",
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Patterns of lymphatic drainage after axillary node dissection impact arm lymphoedema severity : a review of animal and clinical imaging studies. / Suami, Hiroo; Koelmeyer, Louise; Mackie, Helen; Boyages, John.

In: Surgical Oncology, Vol. 27, No. 4, 01.12.2018, p. 743-750.

Research output: Contribution to journalReview articleResearchpeer-review

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