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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...

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Autores principales: Johnson, Anna Rose, Granoff, Melisa D., Suami, Hiroo, Lee, Bernard T., Singhal, Dhruv
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
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.
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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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