Relationship between the lymphatic drainage of the breast and the upper extremity: a postmortem study.

BACKGROUND: This anatomic study details the lymphatic drainage of the upper extremity (UE) and breast, as well as its course in the axilla and its relation to axillary reverse mapping. Two aspects important for breast cancer surgery were followed: connection between the lymphatics of the UE and breast, and the possible cause of lymphedema of the UE after sentinel node (SN) biopsy. METHODS: Patent blue dye was injected bilaterally in 23 cadavers with no history of breast carcinoma to simultaneously visualize the lymphatics of the UE and breast. After visualization and dissection of the lymphatic vessels and nodes, a record of their routes was made. A scheme of superficial UE and breast lymphatics was constructed. RESULTS: After application of color contrast to the UE, 2-4 main afferent collectors were shown. As opposed to cranial and medial collectors, caudal collectors diverged from the axillary vein and entered the caudal axilla. In five (10.8%) cases, the caudal collector entered a node, which was considered to be the SN of the breast. In six (13%) cases, the SN of the breast and SNs of the UE were found in close proximity (up to 1.5 cm). CONCLUSIONS: Lymphatic drainage of the UE and breast are closely related in the caudal part of the axilla. SN groups for the UE and breast share connections in 24% of cases, which could explain lymphedema after surgery if damaged. Additional studies are needed to further improve our understanding of the lymphatic drainage of the UE and breast.

Localization of the sentinel node of the upper outer breast quadrant in the axillary quadrants.

BACKGROUND: Sentinel node (SN) biopsy is associated with much less morbidity than axillary dissection. In patients with early breast cancer, lymphatic mapping and SN biopsy accurately stage the axillary nodes. Both currently available lymphatic mapping agents, radiocolloid and blue dye, have some limitations that may make perioperative or preoperative SN identification difficult. In such cases, exact knowledge of the topography of the axilla and the most probable location of the SN may be crucial. METHODS: In 12 fresh female cadavers with no history of breast carcinoma, injections of patent blue dye were used to visualize the SNs in the axillary quadrants and their lymphatic collectors from the upper outer quadrant of the breast, which is the most common location of breast cancer. The axilla was divided into quadrants with regard to the intersection of the thoracoepigastric vein and the third intercostobrachial nerve. RESULTS: All SNs were located within a circle of 2-cm radius of this intersection in the fatty tissue at the clavipectoral fascia. In most cases, the SN was located in the fatty tissue near the clavipectoral fascia in the lower ventral quadrant of the axilla (n = 14, 58%). In seven cases (29%), the SN was located in the upper ventral quadrant, in two cases (8%) in the upper dorsal quadrant, and in one case in the lower dorsal quadrant. CONCLUSIONS: The results of this anatomical study may facilitate SN biopsy in patients with breast cancer.