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. 2023 Jun;26(3):286-291.
doi: 10.4048/jbc.2023.26.e16. Epub 2023 Mar 31.

Anatomy Versus Physiology: Is Breast Lymphatic Drainage to the Internal Thoracic (Internal Mammary) Lymphatic System Clinically Relevant?

Priscilla Machado  1 , Ji-Bin Liu  2 , Laurence Needleman  2 , Christine Lee  3 , Flemming Forsberg  2
Affiliations

Anatomy Versus Physiology: Is Breast Lymphatic Drainage to the Internal Thoracic (Internal Mammary) Lymphatic System Clinically Relevant?

Priscilla Machado et al. J Breast Cancer. 2023 Jun.

Abstract

Approximately 15%-25% of breast lymphatic drainage passes through the internal thoracic (internal mammary) lymphatic system, draining the inner quadrants of the breast. This study aimed to use lymphosonography to identify sentinel lymph nodes (SLNs) in the axillary and internal thoracic lymphatic systems in patients with breast cancer. Seventy-nine patients received subcutaneous ultrasound contrast agent injections around the tumor. Lymphosonography was used to identify SLNs. In 14 of the 79 patients (17.7%), the tumor was located in the inner quadrant of the breast. Lymphosonography identified 217 SLNs in 79 patients, averaging 2.7 SLNs per patient. The 217 identified SLNs in the 79 patients were located in the axillary lymphatic system; none were located in the internal thoracic (internal mammary) lymphatic system, although it was expected in two to four patients (i.e., 4-11 SLNs). These results implied that SLNs associated with breast cancer are predominantly located in the axillary lymphatic system.

Keywords: Breast Neoplasms; Contrast Media; Lymph Nodes; Lymphatic System; Ultrasonography.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1. Example of a study case. The patient is a 53-year-old female diagnosed with an invasive lobular carcinoma located in the right breast at the 12 o’clock position, measuring 1.2 cm. Dual-image contrast-enhanced ultrasound and B-mode of the sentinel lymph node (arrow).
See this image and copyright information in PMC

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