Mapping & quantifying lymphatic drainage of the arm's alternate pathway

项目总结/摘要 乳腺癌相关淋巴水肿影响美国120万患者 而且无法治愈水肿的症状包括疲劳、紧绷、疼痛和 危及生命的感染然而，三分之二的乳腺癌患者 具有发生水肿的最高风险因素的治疗不会发生 疾病虽然没有解释这一发现，一个假设是，正常的， 淋巴系统的解剖变异使某些妇女易患 乳腺癌治疗后的水肿。具体来说，主要备用淋巴 手臂的通路，Mascagni-Sappey（MS）通路，在尸体中不存在 研究和避免通常与乳腺癌治疗受损的领域。 此外，当存在于这些尸体研究中时，MS途径具有可变的 解剖连接，这可能会影响其有效引流手臂的能力。我们 假设，利用现代成像技术，我们可以定义的解剖结构， MS途径及其在正常女性和乳腺癌幸存者中的变化， 接受过高危乳腺癌治疗，没有出现水肿。 利用这些信息，我们将能够预测哪些变化使女性更容易受到影响。 发展为水肿。最后，我们将开发一种新的方法，非侵入性内， 手术光学成像以评估乳腺癌期间该通路的功能 手术来预测病人发生水肿的风险。的能力 评估实时淋巴功能将允许癌症团队实施预防性治疗， 对高危患者进行干预。作为最常见的原因， 美国是继发性癌症的程序，这种模式预防水肿 可广泛应用于其他高危癌症人群的治疗， 妇科癌症、泌尿系统癌症、皮肤癌和肉瘤。

Project Summary/Abstract Breast Cancer Related Lymphedema 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 (MS) 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 MS pathway has variable anatomic connections which can impact its ability to drain the arm effectively. We hypothesize that, utilizing modern imaging techniques, we can define the anatomy of the MS 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, we will be able to predict which variations predispose women to develop lymphedema. Finally, we will develop a novel method of non-invasive intra- operative 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.