Lymph drainage of the upper limb and mammary region to the axilla: anatomical study in stillborns

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dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.authorCUADRADO, Guilherme de Arruda
dc.contributor.authorANDRADE, Mauro Figueiredo Carvalho de
dc.contributor.authorAKAMATSU, Flavia Emi
dc.contributor.authorJACOMO, Alfredo Luiz
dc.date.accessioned2018-07-05T17:48:50Z
dc.date.available2018-07-05T17:48:50Z
dc.date.issued2018
dc.description.abstractPurpose We studied the lymphatic drainage of the upper limb and mammary region directing to the axilla to investigate whether independent pathways can be observed or whether anastomoses and shared drainage occur between them. This analysis aimed to assess the safety of axillary reverse mapping (ARM) in breast cancer treatment and to understand the development of lymphedema after sentinel lymph node biopsy (SLNB) alone. Methods Seven unfixed stillborn fetuses were injected with a modified Gerota mass in the peri-areolar area, palm and dorsum of the hands, formalin fixed, and then submerged in 10% hydrogen peroxide solution. Microsurgical dissection was then performed on the subcutaneous cellular tissue of the upper limb, axillary region, and anterior thorax to expose the lymphatic vessels and lymph nodes. Results The dye injected into the upper limb reached either the lateral axillary group, known to be exclusively responsible for upper limb drainage, or the anterior group, which is typically related to breast drainage. There was great proximity among the pathways and lymph nodes. Communicating lymphatic vessels among these groups of lymph nodes were also found in all studied cases. Discussion Lymphedema remains a challenging morbidity in breast cancer treatment. ARM and SLNB aim to avoid unnecessary damage to the lymphatic drainage of the upper limb. However, our anatomical study suggests that ARM may have potential oncological risks because preserved lymph nodes may harbor malignant cells due their proximity, overlapping drainage pathways, and connecting lymph vessels among lymph nodes.
dc.description.indexMEDLINE
dc.identifier.citationBREAST CANCER RESEARCH AND TREATMENT, v.169, n.2, p.251-256, 2018
dc.identifier.doi10.1007/s10549-018-4686-1
dc.identifier.eissn1573-7217
dc.identifier.issn0167-6806
dc.identifier.urihttps://observatorio.fm.usp.br/handle/OPI/26807
dc.language.isoeng
dc.publisherSPRINGER
dc.relation.ispartofBreast Cancer Research and Treatment
dc.rightsrestrictedAccess
dc.rights.holderCopyright SPRINGER
dc.subjectLymphedema
dc.subjectBreast
dc.subjectUpper extremity
dc.subjectCancer
dc.subjectAnatomy
dc.subject.otherbreast-cancer patients
dc.subject.othernode biopsy
dc.subject.otherlymphadenectomy
dc.subject.othersafety
dc.subject.otherimpact
dc.subject.othermri
dc.subject.otherarm
dc.subject.wosOncology
dc.titleLymph drainage of the upper limb and mammary region to the axilla: anatomical study in stillborns
dc.typearticle
dc.type.categoryoriginal article
dc.type.versionpublishedVersion
dspace.entity.typePublication
hcfmusp.citation.scopus3
hcfmusp.contributor.author-fmusphcGUILHERME DE ARRUDA CUADRADO
hcfmusp.contributor.author-fmusphcMAURO FIGUEIREDO CARVALHO DE ANDRADE
hcfmusp.contributor.author-fmusphcFLAVIA EMI AKAMATSU JACOMO
hcfmusp.contributor.author-fmusphcALFREDO LUIZ JACOMO
hcfmusp.description.beginpage251
hcfmusp.description.endpage256
hcfmusp.description.issue2
hcfmusp.description.volume169
hcfmusp.origemWOS
hcfmusp.origem.pubmed29380209
hcfmusp.origem.scopus2-s2.0-85041098889
hcfmusp.origem.wosWOS:000431884900006
hcfmusp.publisher.cityNEW YORK
hcfmusp.publisher.countryUSA
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