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

项目摘要/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。淋巴水肿的症状包括疲倦、乏力、疼痛和 危及生命的感染。然而，三分之二患有乳腺癌的女性 使用发生淋巴水肿的最高风险因素治疗不会发展为 疾病。虽然这一发现无法解释，但有一种假设是正常的 淋巴系统的解剖变异使某些女性易于发育 乳腺癌治疗后的淋巴水肿。具体地说，主要的备用淋巴管 手臂的通路，即Mascagni-Sappy(MS)通路，在身体中以不同的方式存在 研究并避免通常在乳腺癌治疗中受损的区域。 此外，当出现在这些身体研究中时，MS途径具有变量 可能影响其有效引流手臂的能力的解剖连接。我们 假设，利用现代成像技术，我们可以定义 MS通路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，没有出现淋巴水肿。 利用这些信息，我们将能够预测哪些变异倾向于女性 发展成淋巴浮肿。最后，我们将开发一种新的非侵入性内照射方法。 手术光学成像评估乳腺癌过程中这一通路的功能 手术以预测患者发生淋巴水肿的风险。有能力 实时评估淋巴功能将使癌症团队能够实施预防 对高危患者的干预。作为淋巴水肿的最常见原因， 美国是次要的癌症手术，这种预防淋巴水肿的模式 可广泛应用于其他高危癌症人群的治疗，包括 妇科癌症、泌尿系癌症、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.