Breast Cancer Related Lymphedema (BCRL) affects 1.2 million patients in the United States
and has no cure. The symptoms of lymphedema include fatigue, tightness, pain, and
life-threatening infections. However, two-thirds of women undergoing breast cancer
treatment with the highest risk factors for developing lymphedema do not develop the
disease. While there is no explanation for this finding, one hypothesis is that normal
anatomic variations of the lymphatic system pre-dispose certain women to developing
lymphedema after breast cancer treatment. Specifically, the main back-up lymphatic
pathway of the arm, the Mascagni-Sappey (M-S) pathway, is variably present in cadaver
studies and avoids areas that are usually damaged with breast cancer treatment. Moreover,
when present in these cadaver studies, the M-S pathway has variable anatomic connections
which can impact its ability to drain the arm effectively. The investigators hypothesize
that, utilizing modern imaging techniques, the investigators can define the anatomy of
the M-S pathway and its variations in normal women and in breast cancer survivors who
have undergone high risk breast cancer treatment and did not develop lymphedema.
Utilizing this information, the investigators will be able to predict which variations
predispose women to develop lymphedema. Finally, the investigators will develop a novel
method of non-invasive intraoperative optical imaging to assess the function of this
pathway during breast cancer operations to predict the patient's risk of developing
lymphedema. The ability to evaluate real-time lymphatic function would allow cancer teams
to implement preventive interventions in high risk patients. As the most common cause of
lymphedema in the United States is secondary to cancer procedures, this model of
lymphedema prevention could be widely applied to the treatment of other high risk cancer
populations including gynecologic cancers, urologic cancers, skin cancers, and sarcomas.
The investigators will use ICG lymphography and lymphoscintigraphy with SPECT/CT
(single-photon emission computed tomography) imaging to evaluate the anatomy of the M-S
pathway in two separate populations:
Group 1: The research study staff will recruit healthy female volunteers without a
history of lymphedema or ALND (axillary lymph node dissection) surgery to map the normal
anatomy of the M-S pathway. The investigators hope to quantify the percentage of women
who do not have this pathway present, do not have peripheral connections between the M-S
pathway and the forearm, and/or whose terminal M-S pathway draining nodal basins are in
the axilla.
Group 2: Research study staff will measure changes that occur in the M-S pathway anatomy
in women at least 2 years status-post ALND surgery without developing lymphedema in the
time following their surgery (Aim 2) using the same methodology. By understanding the M-S
pathway anatomy in relation to the main lymphatic drainage pathway of the forearm in the
setting of an ALND without lymphedema the investigators can gain critical insight about
which patients are at the highest risk of developing BCRL and why this is more likely to
occur in some patients than others.