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In-Vivo Functional Imaging of Forearm Lymph Nodes
Madeleine Givant
*1, James E. Fanning
1, Angela Chen
1, Sarah Thomson
1, Kathleen Shillue
2, Aaron Fleishman
1, Caitlin Connolly
3, Kevin Donohoe
4, Dhruv Singhal
11Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA; 2Department of Rehabilitation Services, Beth Israel Deaconess Medical Center, Boston, MA; 3Department of Radiology, Mount Auburn Hospital, Boston, MA; 4Department of Nuclear Medicine, Beth Israel Deaconess Medical Center, Boston, MA
Background: Variations of upper extremity lymphatic anatomy and function may affect an individual's risk of developing breast cancer-related lymphedema (BCRL). Forearm lymph nodes have been variably described in cadaveric dissections. To our knowledge, there are no studies investigating the presence or absence of forearm lymph nodes in-vivo. The ability to identify forearm lymph nodes with in-vivo imaging may impact our understanding of an individual's risk of developing lymphedema.
Methods: We recruited healthy female volunteers and female breast cancer survivors without a clinical history of BRCL at least two years after ALND to undergo lymphoscintigraphy with standard hand/wrist injections and mapped lymphatic drainage to forearm lymph nodes of the upper extremity. The presence of forearm lymph nodes was recorded and compared between cohorts with Fisher's exact test.
Results: A total of 55 healthy female volunteers and 28 breast cancer survivors completed the study from May 2022 to April 2025. Both arms of the healthy cohort (n=110) and the at-risk arm of the breast cancer survivor cohort (n=28) met inclusion criteria. We observed forearm lymph nodes in 0.9% (1/110) of healthy volunteer arms and 17.9% (5/28) of the at-risk arms of female breast cancer survivors who did not develop BCRL after ALND (p = 0.001).
Conclusion: This study represents the first report of in-vivo functional drainage to forearm lymph nodes. The higher incidence of forearm lymph nodes in the at-risk arms of breast cancer survivors may reflect a form of superficial-to-deep collateralization. The absence or presence of forearm lymph nodes may play a role in understanding an individual's risk of developing breast cancer-related lymphedema.
Models adjusted for BMI, tissue expander size, and axillary irradiation. OR > 1 indicates higher odds with early exchange.
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Models adjusted for BMI, tissue expander size, and axillary irradiation. OR > 1 indicates higher odds with early exchange.
