The lymphatic anatomy of the breast and its implications for sentinel lymph node biopsy: a human cadaver study.
BACKGROUND
Current understanding of the lymphatic system of the breast is derived mainly from the work of the anatomist Sappey in the 1850s, with many observations made during the development and introduction of breast lymphatic mapping and sentinel node biopsy contributing to our knowledge.


METHODS
Twenty four breasts in 14 fresh human cadavers (5 male, 9 female) were studied. Lymph vessels were identified with hydrogen peroxide and injected with a lead oxide mixture and radiographed. The specimens were cross sectioned and radiographed to provide three dimensional images. Lymph (collecting) vessels were traced from the periphery to the first-tier lymph node.


RESULTS
Lymph collecting vessels were found evenly spaced at the periphery of the anterior upper torso draining radially into the axillary lymph nodes. As they reached the breast some passed over and some through the breast parenchyma, as revealed in the cross-section studies. The pathways showed no significant difference between male and female specimens. We found also perforating lymph vessels that coursed beside the branches of the internal mammary vessels, draining into the ipsilateral internal mammary lymphatics. In some studies one sentinel node in the axilla drained almost the entire breast. In most more than one sentinel node was represented.


CONCLUSIONS
These anatomical findings are discordant with our current knowledge based on previous studies and demand closer examination by clinicians. These anatomical studies may help explain the percentage of false-negative sentinel node biopsy studies and suggest the peritumoral injection site for accurate sentinel lymph node detection.
Suami
Hiroo
H
Jack Brockhoff Reconstructive Plastic Surgery Research Unit, Department of Anatomy and Cell Biology, Royal Melbourne Hospital, University of Melbourne, E533, Medical Building, Grattan Street, Parkville, 3050, Victoria, Australia. hsuami@unimelb.edu.au
Pan
Wei-Ren
WR
Mann
G Bruce
GB
Taylor
G Ian
GI
D001940:Breast / Q000033:anatomy & histology*; D002102:Cadaver; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000033:anatomy & histology*; D042601:Lymphatic Vessels / Q000033:anatomy & histology*; D008297:Male; D021701:Sentinel Lymph Node Biopsy