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Real-Time Visualization of the Mascagni-Sappey Pathway Utilizing ICG Lymphography
Background: Anatomic variations in lymphatic drainage pathways of the upper arm may have an important role in the pathophysiology of lymphedema development. The Mascagni–Sappey (M–S) pathway, initially described in 1787 by Mascagni and then again in 1874 by Sappey, is a lymphatic drainage pathway of...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7281680/ https://www.ncbi.nlm.nih.gov/pubmed/32397246 http://dx.doi.org/10.3390/cancers12051195 |
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author | Johnson, Anna Rose Granoff, Melisa D. Suami, Hiroo Lee, Bernard T. Singhal, Dhruv |
author_facet | Johnson, Anna Rose Granoff, Melisa D. Suami, Hiroo Lee, Bernard T. Singhal, Dhruv |
author_sort | Johnson, Anna Rose |
collection | PubMed |
description | Background: Anatomic variations in lymphatic drainage pathways of the upper arm may have an important role in the pathophysiology of lymphedema development. The Mascagni–Sappey (M–S) pathway, initially described in 1787 by Mascagni and then again in 1874 by Sappey, is a lymphatic drainage pathway of the upper arm that normally bypasses the axilla. Utilizing modern lymphatic imaging modalities, there is an opportunity to better visualize this pathway and its potential clinical implications. Methods: A retrospective review of preoperative indocyanine green (ICG) lymphangiograms of consecutive node-positive breast cancer patients undergoing nodal resection was performed. Lymphography targeted the M-S pathway with an ICG injection over the cephalic vein in the lateral upper arm. Results: In our experience, the M-S pathway was not visualized in 22% (n = 5) of patients. In the 78% (n = 18) of patients where the pathway was visualized, the most frequent anatomic destination of the channel was the deltopectoral groove in 83% of patients and the axilla in the remaining 17%. Conclusion: Our study supports that ICG injections over the cephalic vein reliably visualizes the M-S pathway when present. Further study to characterize this pathway may help elucidate its potential role in the prevention or development of upper extremity lymphedema. |
format | Online Article Text |
id | pubmed-7281680 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-72816802020-06-15 Real-Time Visualization of the Mascagni-Sappey Pathway Utilizing ICG Lymphography Johnson, Anna Rose Granoff, Melisa D. Suami, Hiroo Lee, Bernard T. Singhal, Dhruv Cancers (Basel) Article Background: Anatomic variations in lymphatic drainage pathways of the upper arm may have an important role in the pathophysiology of lymphedema development. The Mascagni–Sappey (M–S) pathway, initially described in 1787 by Mascagni and then again in 1874 by Sappey, is a lymphatic drainage pathway of the upper arm that normally bypasses the axilla. Utilizing modern lymphatic imaging modalities, there is an opportunity to better visualize this pathway and its potential clinical implications. Methods: A retrospective review of preoperative indocyanine green (ICG) lymphangiograms of consecutive node-positive breast cancer patients undergoing nodal resection was performed. Lymphography targeted the M-S pathway with an ICG injection over the cephalic vein in the lateral upper arm. Results: In our experience, the M-S pathway was not visualized in 22% (n = 5) of patients. In the 78% (n = 18) of patients where the pathway was visualized, the most frequent anatomic destination of the channel was the deltopectoral groove in 83% of patients and the axilla in the remaining 17%. Conclusion: Our study supports that ICG injections over the cephalic vein reliably visualizes the M-S pathway when present. Further study to characterize this pathway may help elucidate its potential role in the prevention or development of upper extremity lymphedema. MDPI 2020-05-08 /pmc/articles/PMC7281680/ /pubmed/32397246 http://dx.doi.org/10.3390/cancers12051195 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Johnson, Anna Rose Granoff, Melisa D. Suami, Hiroo Lee, Bernard T. Singhal, Dhruv Real-Time Visualization of the Mascagni-Sappey Pathway Utilizing ICG Lymphography |
title | Real-Time Visualization of the Mascagni-Sappey Pathway Utilizing ICG Lymphography |
title_full | Real-Time Visualization of the Mascagni-Sappey Pathway Utilizing ICG Lymphography |
title_fullStr | Real-Time Visualization of the Mascagni-Sappey Pathway Utilizing ICG Lymphography |
title_full_unstemmed | Real-Time Visualization of the Mascagni-Sappey Pathway Utilizing ICG Lymphography |
title_short | Real-Time Visualization of the Mascagni-Sappey Pathway Utilizing ICG Lymphography |
title_sort | real-time visualization of the mascagni-sappey pathway utilizing icg lymphography |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7281680/ https://www.ncbi.nlm.nih.gov/pubmed/32397246 http://dx.doi.org/10.3390/cancers12051195 |
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