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The Epitrochlear Lymph Node: A Biomarker For Deep Lymphatic Function
James E. Fanning, B.S., Angela Chen, B.S., Aaron Fleishman, M.P.H., Kathleen Shillue, D.P.T., Kevin Donohoe, M.D., Dhruv Singhal, M.D..
Beth Israel Deaconess Medical Center, Boston, MA, USA.
PURPOSE: Deep lymphatic function has been demonstrated as protective against breast cancer-related lymphedema (BCRL). The epitrochlear lymph node is a superficial to deep drainage pathway in the antecubital fossa described in cadaveric dissections, but remains unexamined with in-vivo imaging. We utilized SPECT/CT lymphoscintigraphy to compare epitrochlear lymph node drainage with deep interval (humeral) lymph node drainage.
METHODS: Thirty six consecutive healthy female volunteers were enrolled. Volunteers received bilateral hand/wrist injections of 0.1 mL 99-Tc sulfur radiocolloid and were imaged with SPECT/CT at 2 hours. Two nuclear medicine physicians independently reviewed SPECT/CT scans and labeled lymph nodes with tracer uptake. A Chi Square test of analysis was run between arms with epitrochlear and humeral lymph node drainage.
RESULTS: 72 arms of 36 volunteers were included. Epitrochlear and humeral lymph node drainage were observed in 57% (41/72) and 51% (37/72) of arms, respectively. Epitrochlear and humeral lymph node drainage were significantly associated (X
2= 14.262 (1), p < 0.001). Superficial to deep lymphatic drainage from epitrochlear lymph nodes to humeral lymph nodes was present in 40% (29/72) of healthy female volunteer arms.
CONCLUSION: Our findings demonstrate significant association between epitrochlear and humeral lymph nodes, supporting that the epitrochlear lymph node is a superficial to deep drainage pathway. Moreover, we provide functional evidence that this superficial to deep pathway is present at baseline in 40% of healthy arms. The epitrochlear lymph node may be an important biomarker for the presence of a superficial to deep lymphatic pathway that is protective against BCRL.
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