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The subclavian artery transitions into the axillary artery as it exits the chest and enters the axillary region. This artery is critical for supplying blood to the shoulder area, including the head of the humerus, through the humeral circumflex arteries. As the vessel continues into the upper arm or brachium, it becomes the brachial artery. This artery plays a key role in vascularizing the brachial region and bifurcates at the elbow into several branches. These branches include the deep...
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Collateralization of the upper extremity lymphatic system after axillary lymph node dissection.

James E Fanning1, David K V Chung2,3, Hayley M Reynolds4

  • 1Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.

Journal of Surgical Oncology
|September 24, 2024
PubMed
Summary

Axillary lymph node dissection (ALND) significantly alters arm lymphatic drainage patterns. Post-ALND patients show increased drainage to Levels II/III axillary, epitrochlear, and brachial nodes, impacting cancer staging.

Keywords:
anatomyaxillary lymph node dissectionbreast cancerlymphaticlymphedemamelanomaupper extremity

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Area of Science:

  • Oncology
  • Nuclear Medicine
  • Surgical Oncology

Background:

  • Axillary lymph node dissection (ALND) can disrupt normal arm lymphatic drainage.
  • Understanding these lymphatic changes is crucial for managing recurrent breast cancer and upper extremity skin cancers, including melanoma.

Purpose of the Study:

  • To investigate and compare lymphatic drainage patterns in patients who underwent ALND versus control patients with upper extremity cutaneous melanoma.
  • To identify potential alternative sites of lymphatic metastasis after ALND.

Main Methods:

  • Utilized a single-institution lymphoscintigraphy database (2008-2023) of upper extremity cutaneous melanoma patients.
  • Compared sentinel lymph node (SLN) drainage patterns between 22 ALND patients and 912 matched control patients without lymphedema.

Main Results:

  • ALND patients showed significantly reduced Level I axillary SLN drainage (27% vs. 98% in controls).
  • Increased drainage to Level II (27% vs. 3%), Level III (32% vs. 1%), epitrochlear (32% vs. 9%), and brachial nodes (23% vs. 4%) was observed in ALND patients compared to controls.
  • These differences were statistically significant (p < 0.001 for most comparisons).

Conclusions:

  • Prior ALND leads to distinct alterations in functional lymphatic drainage pathways in the arm.
  • Level II and III axillary, epitrochlear, and brachial lymph nodes are potential sites for metastatic disease in patients with a history of ALND and should be considered in cancer staging and treatment planning.