The lymphatic anatomy of the breast and its implications for sentinel lymph node biopsy

A human cadaver study

Hiroo Suami*, Wei Ren Pan, G. Bruce Mann, G. Ian Taylor

*Corresponding author for this work

Research output: Contribution to journalArticle

154 Citations (Scopus)
79 Downloads (Pure)

Abstract

Background: Current understanding of the lymphatic system of the breast is derived mainly from the work of the anatomist Sappey in the 1850s, with many observations made during the development and introduction of breast lymphatic mapping and sentinel node biopsy contributing to our knowledge. Methods: Twenty four breasts in 14 fresh human cadavers (5 male, 9 female) were studied. Lymph vessels were identified with hydrogen peroxide and injected with a lead oxide mixture and radiographed. The specimens were cross sectioned and radiographed to provide three dimensional images. Lymph (collecting) vessels were traced from the periphery to the first-tier lymph node. Results: Lymph collecting vessels were found evenly spaced at the periphery of the anterior upper torso draining radially into the axillary lymph nodes. As they reached the breast some passed over and some through the breast parenchyma, as revealed in the cross-section studies. The pathways showed no significant difference between male and female specimens. We found also perforating lymph vessels that coursed beside the branches of the internal mammary vessels, draining into the ipsilateral internal mammary lymphatics. In some studies one sentinel node in the axilla drained almost the entire breast. In most more than one sentinel node was represented. Conclusion: These anatomical findings are discordant with our current knowledge based on previous studies and demand closer examination by clinicians. These anatomical studies may help explain the percentage of false-negative sentinel node biopsy studies and suggest the peritumoral injection site for accurate sentinel lymph node detection.

Original languageEnglish
Pages (from-to)863-871
Number of pages9
JournalAnnals of Surgical Oncology
Volume15
Issue number3
DOIs
Publication statusPublished - Mar 2008
Externally publishedYes

Bibliographical note

Copyright the Author(s) 2008. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

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