Evidence map›Paper›PMID 40665199›Full record

ArticleBreast cancer (Tokyo, Japan)2025

Major anatomic variations of the lateral upper arm lymphatic pathway in a healthy female population.

James E Fanning, Madeleine Givant, Angela Chen, Sarah Thomson, Elizabeth Tillotson, Aaron Fleishman, Kevin Donohoe, Dhruv Singhal

Abstract read
In one paragraph

Article in Breast cancer (Tokyo, Japan), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

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3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

James E FanningDivision of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis St, Suite 5A, Boston, MA, 02215, USA.
Madeleine GivantDivision of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis St, Suite 5A, Boston, MA, 02215, USA.
Angela ChenDivision of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis St, Suite 5A, Boston, MA, 02215, USA.
Sarah ThomsonDivision of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis St, Suite 5A, Boston, MA, 02215, USA.
Elizabeth TillotsonDivision of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis St, Suite 5A, Boston, MA, 02215, USA.
Aaron FleishmanDivision of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis St, Suite 5A, Boston, MA, 02215, USA.
Kevin DonohoeDepartment of Nuclear Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Dhruv SinghalDivision of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis St, Suite 5A, Boston, MA, 02215, USA. dsinghal@bidmc.harvard.edu.

Funding

Organ Specific ProjectU54HL165440 · NHLBI · BETH ISRAEL DEACONESS MEDICAL CENTER · PI HONG, YOUNG-KWON, SINGHAL, DHRUV · 2022 to 2025
$5.8M
Structural and Functional Remodeling of the Lymphatic System After Axillary Lymph Node DissectionR01HL157991 · NHLBI · BETH ISRAEL DEACONESS MEDICAL CENTER · PI Dhruv Singhal · 2021 to 2026
$3.1M
Common Fund U54HL165440JOBST 2024 JOBST Lymphatic Research GrantJOBST 2025 JOBST Lymphatic Research GrantNHLBI NIH HHS R01 HL157991NHLBI NIH HHS R01HL157991NHLBI NIH HHS U54 HL165440
6 · The paper itself

Abstract

backgroundThe lateral upper arm (LUA) pathway is a route of superficial lymphatic drainage that bypasses the axilla by draining to the deltopectoral, clavicular, and cervical lymph nodes. Despite the fact that anatomic variations of the LUA pathway have been implicated in breast cancer-related lymphedema (BCRL) risk after axillary lymph node dissection (ALND), the incidence of the LUA pathway variations in the healthy population has never been reported.

methodsHealthy female volunteers underwent bilateral lymphatic mapping of the upper extremities with indocyanine green (ICG) lymphography. ICG was injected in six standard sites in the hand/wrist and upper arm. Major anatomic variations of the LUA pathway were recorded including bundle phenotype (long, short, or absent), proximal visualization sites, and forearm pathway continuation to the long bundle phenotype.

results90 arms of 45 volunteers were included. The LUA pathway was present in 99% of arms and a long-versus-short bundle phenotype was observed in 71% versus 28% of arms. When the long bundle was present, it was formed by continuity with the forearm posterior radial channel alone (47%), posterior ulnar channel alone (34%), or both channels (19%). The LUA pathway was traced proximally to the deltopectoral groove in 89% of arms and to the axilla in 11% of arms.

conclusionsWe observed similar proportions of arms with long and short bundle phenotypes in comparison to our previous report of the LUA pathway in breast cancer patients with nodal disease. Defining the incidence of the LUA pathway with its variations in the general population is important as variations in this pathway may have implications for an individual's risk of developing BCRL.

Indexed as

Anatomic VariationArmLymphatic VesselsAdultAxillaBreast NeoplasmsFemaleHealthy VolunteersHumansIndocyanine GreenLymph Node ExcisionLymph NodesLymphographyMiddle AgedIndocyanine GreenAnatomyBreast cancerBreast cancer-related lymphedemaLymphatic surgeryUpper extremity

Identifiers

PMID40665199
PMCPMC12826541

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.