The Map of Superficial Lymphatic System of the Breast and Relation to the Sentinel Lymph Node

Overview

Aim:
The aim of study was to topographically map the superficial lymphatic drainage of the breast and its relation to sentinel node.

Design:
Anatomical study.

Setting:
Department of Oncogynecology, Clinic of Obstetric and Gynecology of 1st Medical Faculty of Charles University and General Hospital, Prague.

Methods:
The study was performed on 19 female cadavers. After slow intradermal administration of

Patent Blau into the periareolar region, into the centers and into the borders of the individual quadrants of the breast, the lymphatics were visualized and a careful resection of these lymphatics and lymph nodes was performed. The lymphatics were drawn onto a schematic map of the breast on a transparent sheet and afterwards a summation of all schematic maps was performed. A map of the lymphatic vessels of the breast was based on this summation.

Results:
After subcutaneous administration of patent blue were clearly visualized the subareolar plexus and draining sentinel node in the axilla, as well as one or two supplying lymphatics. Despite great variability in the lymphatic drainage of the breast, it was demonstrated that the natural dominant drainage for the outflow of lymph from the superficial areas of the breast are the axillary nodes.

Conclusion:
From the course of the lymphatic vessels it is evident that the breast cannot be divided into functionally separate segments. According to the lymphatic map of the breast, one can assume that in carcinoma of the breast it is the lymphatic drainage and not the localization of the tumor that plays a primary role in the development of metastases. One cannot ignore the existence of alternative drainage pathways of the breast, but their role in the beginning of dissemination of tumor cells in comparison with the axilla is negligible. Subdermal administration of Patent Blau is a reliable and effective method of visualizing lymphatic vessels and the draining lymph nodes of the breast. Due to the meandering course of lymphatics in the breast, we cannot understimate the role of radiation therapy after breast conserving surgery.

Key words:
lymphatics mapping, sentinel node, breast cancer