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. 2023 Jul 22;28(1):20.
doi: 10.1007/s10911-023-09545-x.

Non-Linear Lymphatic Anatomy in Breast Cancer Patients Prior to Axillary Lymph Node Dissection: A Risk Factor For Lymphedema Development

JacqueLyn R Kinney  1 , Rosie Friedman  1 , Erin Kim  1 , Elizabeth Tillotson  1 , Kathy Shillue  1 , Bernard T Lee  1 , Dhruv Singhal  2
Affiliations

Non-Linear Lymphatic Anatomy in Breast Cancer Patients Prior to Axillary Lymph Node Dissection: A Risk Factor For Lymphedema Development

JacqueLyn R Kinney et al. J Mammary Gland Biol Neoplasia. .

Abstract

Immediate lymphatic reconstruction (ILR) at the time of axillary lymph node dissection (ALND) has become increasingly utilized for the prevention of breast cancer related lymphedema. Preoperative indocyanine green (ICG) lymphography is routinely performed prior to an ILR procedure to characterize baseline lymphatic anatomy of the upper extremity. While most patients have linear lymphatic channels visualized on ICG, representing a non-diseased state, some patients demonstrate non-linear patterns. This study aims to determine potential inciting factors that help explain why some patients have non-linear patterns, and what these patterns represent regarding the relative risk of developing postoperative breast cancer related lymphedema in this population. A retrospective review was conducted to identify breast cancer patients who underwent successful ILR with preoperative ICG at our institution from November 2017-June 2022. Among the 248 patients who were identified, 13 (5%) had preoperative non-linear lymphatic anatomy. A history of trauma or surgery of the affected limb and an increasing number of sentinel lymph nodes removed prior to ALND appeared to be risk factors for non-linear lymphatic anatomy. Furthermore, non-linear anatomy in the limb of interest was associated with an increased risk of postoperative lymphedema development. Overall, non-linear lymphatic anatomy on pre-operative ICG lymphography appears to be a risk factor for developing ipsilateral breast cancer-related lymphedema. Guided by the study's findings, when breast cancer patients present with baseline non-linear lymphatic anatomy, our institution has implemented a protocol of prophylactically prescribing compression sleeves immediately following ALND.

Keywords: Breast cancer related lymphedema; Immediate lymphatic reconstruction; Lymph node biopsy; Lymphatic anatomy; Prevention; Trauma.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Linear and Non-Linear Lymphatic Anatomy Demonstrated Immediately Prior to Axillary Lymph Node Dissection with Pre-operative Indocyanine Green (ICG) Lymphography. A Linear lymphatic anatomy on ICG lymphography, B Non-linear lymphatic anatomy on ICG lymphography. Note: Figures were obtained from patients treated at the sponsoring institution. Permissions to utilize their study contents for the purpose of research and publication were obtained. Animated images were developed for the use of this study using Canva, an online design software
Fig. 2
Fig. 2
Demonstration of the Various Types of Upper Extremity Lymphatic Drainage as it would be Visualized with Indocyanine Green (ICG) Lymphography. A Diffuse patterning, B Stardust patterning, C Splash patterning, D Linear lymphatic patterning. Note: Figures were created for the use of this publication in Adobe Photoshop
Fig. 3
Fig. 3
All Reported Trauma History in Patients Receiving Upper Extremity ICG Lymphography Prior to Ipsilateral Axillary Lymph Node Dissection. Note: Designed with Canva, an online software, for the purpose of this publication
See this image and copyright information in PMC

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