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Omgo E. Nieweg - One of the best experts on this subject based on the ideXlab platform.
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Lymphatic Drainage of melanomas located on the manubrium sterni to cervical lymph nodes: a case series assessed by SPECT/CT.
Clinical Nuclear Medicine, 2013Co-Authors: Hidde J. Veenstra, M. Klop, Peter J. F. M. Lohuis, Omgo E. Nieweg, Renato A. Valdés OlmosAbstract:The Lymphatic Drainage of cutaneous melanomas located on the upper trunk is often complex and sometimes follows an unexpected pattern. Occasionally, even direct Drainage to cervical lymph nodes is seen. In this case series, 3 patients with Lymphatic Drainage to the neck derived from melanomas located over the manubrium sterni are described. There appears to be a restricted area that involves the manubrium sterni from which Lymphatic Drainage to different cervical node basins appears more frequent. SPECT/CT was helpful in visualizing these patterns and for the localization of the sentinel nodes.
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Lymphatic Drainage Patterns from the Treated Breast
Annals of Surgical Oncology, 2010Co-Authors: Iris M. C. Van Der Ploeg, Hester S. A. Oldenburg, Emiel J. Th. Rutgers, Marie-jeanne T. F. D. Baas-vrancken Peeters, Bin B. R. Kroon, Renato A. Valdés Olmos, Omgo E. NiewegAbstract:Introduction Lymphatic Drainage patterns from the breast have been described in the past. Drainage may change after treatment of a breast or axilla, and this may have implications for Lymphatic mapping. The aim of this study was to determine the Lymphatic Drainage patterns in breast cancer patients with a previously treated ipsilateral breast. Methods Between January 1999 and November 2008, 115 sentinel node procedures were performed in breast cancer patients who had undergone treatment of the ipsilateral breast in the past. Lymphatic Drainage patterns were analyzed based on preoperative lymphoscintigraphy and sentinel lymph node biopsy. Patients were divided into subgroups according to their previous treatment. Results Sentinel nodes were found in 84% of the patients: in 81 patients (70%) in the axilla, 43 patients (37%) had Drainage to more than one site, and in 18 patients (16%) no Drainage was detected. The percentage of Drainage outside the axilla was higher than in a series of untreated breast cancer patients from our institution (51% versus 33%, P = 0.01). The 16% nonidentification rate was also higher than the 3.1% in patients without previous treatment ( P = 0.003). Four patients (3.5%) had Lymphatic Drainage to the contralateral axilla. Twelve patients (10%) had involved sentinel nodes; these were harvested from the contralateral axilla in two of them. No lymph node recurrences were observed during a median follow-up time of 39 months. Conclusion Lymphatic mapping yields a lymph node in 84% of breast cancer patients who have undergone previous treatment of the breast. Nonidentification and extra-axillary nodes are more frequently encountered than in patients without treatment of the breast in the past. The finding of involved nodes suggests that sentinel node biopsy improves staging. Long-term follow-up will determine the sensitivity of the procedure in this specific situation.
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Lymphatic Drainage Patterns from the Treated Breast
Annals of Surgical Oncology, 2009Co-Authors: Iris M. C. Van Der Ploeg, Renato A. Valdés Olmos, Hester S. A. Oldenburg, Emiel J. Th. Rutgers, Marie-jeanne T. F. D. Baas-vrancken Peeters, Bin B. R. Kroon, Omgo E. NiewegAbstract:Introduction Lymphatic Drainage patterns from the breast have been described in the past. Drainage may change after treatment of a breast or axilla, and this may have implications for Lymphatic mapping. The aim of this study was to determine the Lymphatic Drainage patterns in breast cancer patients with a previously treated ipsilateral breast.
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Lymphatic Drainage patterns in breast cancer patients who previously underwent mantle field radiation.
Annals of Surgical Oncology, 2009Co-Authors: Iris M. C. Van Der Ploeg, Omgo E. Nieweg, Renato A. Valdés Olmos, Hester S. A. Oldenburg, Bin B. R. Kroon, Nicola S. Russell, Emiel J. Th. RutgersAbstract:Background Lymphatic Drainage may change after radiation of a breast or its regional lymph node basins, and this may have implications for Lymphatic mapping afterward. The aim of this study was to determine the Lymphatic Drainage patterns in breast cancer patients who had undergone mantle field radiation for Hodgkin’s lymphoma in the past.
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anatomical mapping of Lymphatic Drainage in penile carcinoma with spect ct implications for the extent of inguinal lymph node dissection
European Urology, 2008Co-Authors: Joost A P Leijte, Omgo E. Nieweg, Renato Valdes A Olmos, Simon HorenblasAbstract:Abstract Background Knowledge regarding the Lymphatic Drainage pattern of penile cancer is the basis for the extent of inguinal lymph node dissection for this disease. Objective To prospectively analyze the Lymphatic Drainage pattern of penile carcinoma using SPECT-CT and evaluate the implications for the extent of inguinal lymph node dissection. Design, Setting, and Participants The Lymphatic Drainage patterns of 50 patients scheduled for dynamic sentinel node biopsy were analyzed using a hybrid SPECT-CT scanner. Measurements A total of 86 clinically node-negative (cN0) inguinal and pelvic regions was evaluated. The sentinel and higher-tier nodes on SPECT-CT were divided into different zones in the groin and pelvic region. The groin was divided according to Daseler's five zones, four zones obtained by drawing a vertical and horizontal line over the saphenofemoral junction and one zone directly overlying this junction. The nodes in the pelvic region were classified into three zones: the external iliac/obturator zone, the common iliac zone, and the paraaortal zone. Results and Limitations Lymphatic Drainage was visualised in 82 of the 86 cN0 groins (95.3%). A total of 115 sentinel nodes and 182 higher-tier nodes was found. All sentinel nodes were located in superior and central inguinal zones. The higher-tier nodes were located in the groin and pelvic region. No Lymphatic Drainage was seen to the inferior two regions of the groin. A potential limitation of the study is that the unilateral Lymphatic Drainage seen in some patients could be normal, but it could also be caused by blockage of Lymphatic Drainage due to a grossly involved metastatic lymph node. Another possible limitation is that this study relies on the quality and accuracy of lymphoscintigraphy and the subsequent sentinel node procedure. Conclusions All sentinel and higher-tier nodes were located in the superior and central inguinal zones and the pelvic region. No Lymphatic Drainage to the inferior inguinal zones was seen. This suggests that the extent of inguinal node dissection in cN0 patients could be reduced to removal of the superior and central inguinal zones. This may decrease the extensive morbidity associated with this procedure.
Renato A. Valdés Olmos - One of the best experts on this subject based on the ideXlab platform.
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Unexpected Lymphatic Drainage of the Treated Breast
Clinical nuclear medicine, 2019Co-Authors: Richard Raghoo, Lenka M. Pereira Arias-bouda, Renato A. Valdés OlmosAbstract:This case highlights the use of lymphoscintigraphy with SPECT/CT in patients with previous chest and/or axillary surgery. A 67-year-old woman with a history of left breast carcinoma treated with lumpectomy and radiotherapy, and a second lumpectomy of the ipsilateral breast for a second breast carcinoma, underwent a lymphoscintigraphy for a new left breast lesion. Planar images visualized an alternative Lymphatic Drainage to the contralateral axilla and to the left paravertebral area. SPECT/CT confirmed sentinel nodes in both stations.
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Lymphatic Drainage of melanomas located on the manubrium sterni to cervical lymph nodes: a case series assessed by SPECT/CT.
Clinical Nuclear Medicine, 2013Co-Authors: Hidde J. Veenstra, M. Klop, Peter J. F. M. Lohuis, Omgo E. Nieweg, Renato A. Valdés OlmosAbstract:The Lymphatic Drainage of cutaneous melanomas located on the upper trunk is often complex and sometimes follows an unexpected pattern. Occasionally, even direct Drainage to cervical lymph nodes is seen. In this case series, 3 patients with Lymphatic Drainage to the neck derived from melanomas located over the manubrium sterni are described. There appears to be a restricted area that involves the manubrium sterni from which Lymphatic Drainage to different cervical node basins appears more frequent. SPECT/CT was helpful in visualizing these patterns and for the localization of the sentinel nodes.
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Lymphatic Drainage Patterns from the Treated Breast
Annals of Surgical Oncology, 2009Co-Authors: Iris M. C. Van Der Ploeg, Renato A. Valdés Olmos, Hester S. A. Oldenburg, Emiel J. Th. Rutgers, Marie-jeanne T. F. D. Baas-vrancken Peeters, Bin B. R. Kroon, Omgo E. NiewegAbstract:Introduction Lymphatic Drainage patterns from the breast have been described in the past. Drainage may change after treatment of a breast or axilla, and this may have implications for Lymphatic mapping. The aim of this study was to determine the Lymphatic Drainage patterns in breast cancer patients with a previously treated ipsilateral breast.
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Lymphatic Drainage patterns in breast cancer patients who previously underwent mantle field radiation.
Annals of Surgical Oncology, 2009Co-Authors: Iris M. C. Van Der Ploeg, Omgo E. Nieweg, Renato A. Valdés Olmos, Hester S. A. Oldenburg, Bin B. R. Kroon, Nicola S. Russell, Emiel J. Th. RutgersAbstract:Background Lymphatic Drainage may change after radiation of a breast or its regional lymph node basins, and this may have implications for Lymphatic mapping afterward. The aim of this study was to determine the Lymphatic Drainage patterns in breast cancer patients who had undergone mantle field radiation for Hodgkin’s lymphoma in the past.
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Lymphatic Drainage patterns from the breast.
Annals of Surgery, 2004Co-Authors: S. H. Estourgie, Omgo E. Nieweg, Renato A. Valdés Olmos, Emiel J. Th. Rutgers, Bin B. R. KroonAbstract:The existence of Lymphatic Drainage of the breast to axillary and extra-axillary sites has been known for centuries.1 Although also these latter nodes are known to sometimes contain metastatic disease, their removal has never been pursued enthusiastically. Interest in Drainage patterns of breast cancer, however, is growing since the introduction of the sentinel node procedure. Lymphatic mapping allows visualization and identification of sentinel nodes and the possibility to document the Drainage patterns. The aim of this study was to describe the Drainage patterns in all breast cancer patients who underwent a sentinel node procedure at our institute. Our intratumoral tracer injection technique enables accurate visualization of Drainage from the actual primary tumors.
Roger F. Uren - One of the best experts on this subject based on the ideXlab platform.
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The unpredictability of Lymphatic Drainage from the ear in melanoma patients, and its implications for management.
Annals of surgical oncology, 2012Co-Authors: Howard Peach, Roger F. Uren, Augustinus P. T. Van Der Ploeg, Lauren E. Haydu, Jonathan R. Stretch, Kerwin Shannon, John F. ThompsonAbstract:Background The ear is known to have variable Lymphatic Drainage. The purpose of this study was to define better the Lymphatic Drainage patterns of the ear by correlating the location of primary tumors, classified according to the embryologically derived anatomical subunits of the ear, with their mapped sentinel nodes (SNs) identified by lymphoscintigraphy (LS).
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Predicting Lymphatic Drainage patterns and primary tumour location in patients with breast cancer
Breast cancer research and treatment, 2011Co-Authors: Evan I. Blumgart, Roger F. Uren, Poul M. F. Nielsen, Martyn P. Nash, Hayley M. ReynoldsAbstract:Detailed knowledge of the Lymphatic Drainage of the breast is limited. Lymphoscintigraphy is a technique used during breast cancer treatment to accurately map patterns of Lymphatic Drainage from the primary tumour to the draining lymph nodes. This study aimed to create a statistical model to analyse the spread of breast cancer and primary tumour location using a large lymphoscintigraphy database, and visualise the results with a novel computational model. This study was based on lymphoscintigraphy data from 2,304 breast cancer patients treated at the Royal Prince Alfred Hospital Medical Centre in Sydney, Australia. Bayesian inferential techniques were implemented to estimate the probabilities of Lymphatic Drainage from each region of the breast to each draining node field, to multiple node fields, and to determine probabilities of tumour prevalence in each breast region. A finite element model of the torso and discrete model of the draining node fields were created to visualise these data and a software tool was developed to display the results (www.abi.auckland.ac.nz/breast-cancer). Results confirmed that Lymphatic Drainage is most likely to occur to the axillary node field, and that there is significant likelihood of Drainage to the internal mammary node field. The likelihood of Lymphatic Drainage from the whole breast to the axillary, internal mammary, infraclavicular, supraclavicular and interpectoral node fields were 98.2, 35.3, 1.7, 3.1, and 0.7%, respectively; whilst the probability of Lymphatic Drainage to multiple node fields was estimated to be 36.4%. Additionally, primary tumours are most likely to develop in the upper regions of the breast. The models developed provide quantitative estimates of Lymphatic Drainage of the breast, giving important insights into understanding breast cancer metastasis and have the potential to benefit both clinicians and patients during breast cancer diagnosis and treatment.
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Lymphatic Drainage and tumour prevalence in the breast: a statistical analysis of symmetry, gender and node field independence.
Journal of anatomy, 2011Co-Authors: Evan I. Blumgart, Roger F. Uren, Poul M. F. Nielsen, Martyn P. Nash, Hayley M. ReynoldsAbstract:Current understanding of the Lymphatics draining the breast is controversial, despite its known importance in the spread of breast cancer. Similarly, knowledge regarding the spatial distribution of primary tumours in the breast is limited. This study sought to test commonly held assumptions in this field, including: (i) that breast Lymphatic Drainage and tumour prevalence are symmetric between the left and right sides of the body, (ii) that males and females have the same Drainage patterns and tumour prevalences, and (iii) that Lymphatic Drainage in the breast occurs independently to different node fields. This study has used lymphoscintigraphy data from 2304 breast cancer patients treated at the RPAH Medical Centre, Sydney, Australia. Symmetry of Lymphatic Drainage and tumour distribution as well as gender differences were tested using Fisher's exact test. Drainage independence was assessed using Fisher's exact test, and a multivariate probit model was used to test for Drainage correlations. Results showed that the breasts are likely to have symmetric Lymphatic Drainage and tumour prevalence, and that there is no significant difference between males and females. Furthermore, results showed that direct Lymphatic Drainage of the breasts is likely to be independent between node fields. Collectively, these results serve to further our understanding of Lymphatic anatomy and the distribution of tumours in the breast.
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THREE-DIMENSIONAL VISUALIZATION OF SKIN Lymphatic Drainage PATTERNS OF THE HEAD AND NECK
Head and Neck-journal for The Sciences and Specialties of The Head and Neck, 2009Co-Authors: Hayley M. Reynolds, Roger F. Uren, John F. Thompson, Nicolas P. Smith, P. Rod DunbarAbstract:Background. Lymphatic Drainage from skin on the head and neck is complex. We sought to provide improved visualization and analysis of the patterns of head and neck skin Lymphatic Drainage using aggregated lymphoscintigraphy data. Methods. Lymphoscintigraphy data from 929 patients with cutaneous melanoma on the head and neck collected at the Sydney Melanoma Unit have been mapped onto a 3-dimen- sional computer model of the skin and lymph nodes. Results. Novel heat maps and interactive software have been created, which show subtle differences in Lymphatic Drainage patterns when compared with those that are previ- ously reported. Posterior head and neck node fields largely drained posterior regions of the head and neck, whereas an- terolateral skin regions were generally drained by the other
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Three-dimensional visualisation of Lymphatic Drainage patterns in patients with cutaneous melanoma
Lancet Oncology, 2007Co-Authors: Hayley M. Reynolds, Roger F. Uren, John F. Thompson, P. Rod Dunbar, Shane A. Blackett, Nicolas P. SmithAbstract:Summary Background Lymphoscintigraphy accurately maps Lymphatic Drainage from sites of cutaneous melanoma to the draining sentinel lymph nodes. The Sydney Melanoma Unit has accumulated lymphoscintigraphy data from over 5000 patients with cutaneous melanoma over more than 15 years, collectively revealing patterns of skin Lymphatic Drainage. We aimed to map these data onto a three-dimensional computer model to provide improved visualisation and analysis of Lymphatic Drainage from sites of cutaneous melanoma. Methods Lymphoscintigraphy data from 5239 patients with cutaneous melanoma were collected between July 27, 1987 and Dec 16, 2005. 4302 of these patients had primary melanoma sites below the neck, and were included in this analysis. From these patients, two-dimensional lymphoscintigraphy data were mapped onto an anatomically based three-dimensional computer model of the skin and lymph nodes. Spatial analysis was done to visualise the relation between primary melanoma sites and the locations of sentinel lymph nodes. Findings We created three-dimensional, colour-coded heat maps that showed the Drainage patterns from melanoma sites below the neck to individual lymph-node fields and to many lymph-node fields. These maps highlight the inter-patient variability in skin Lymphatic Drainage, and show the skin regions in which highly variable Drainage can occur. To enable interactive and dynamic analysis of these data, we also developed software to predict Lymphatic Drainage patterns from melanoma skin sites to sentinel lymph-node fields. Interpretation The heat maps confirmed that the commonly used Sappey's lines are not effective in predicting Lymphatic Drainage. The heat maps and the interactive software could be a new resource for clinicians to use in preoperative discussions with patients with melanoma and other skin cancers that can metastasise to the lymph nodes, and could be used in the identification of sentinel lymph-node fields during follow-up of such patients.
Andrzej Wojnar - One of the best experts on this subject based on the ideXlab platform.
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Infralevator Lymphatic Drainage of Low-Rectal Cancers: Preliminary Results
Annals of Surgical Oncology, 2009Co-Authors: Marek Bębenek, Andrzej WojnarAbstract:Background Some low-rectal cancers may spread into or recur in the inguinal lymph nodes despite optimal resection of the primary tumor. Hence, we hypothesized that Lymphatic Drainage of low-rectal malignancies may be inhomogeneous and that an extramesorectal route may be involved in at least some cases. The idea of our preliminary study was to analyze the potential Lymphatic Drainages in low-rectal cancer patients. Methods The first stage of the experiment included two consecutive low-rectal adenocarcinoma patients (free from inguinal lymph node metastases), in whom the Lymphatics of the primary tumor were traced with Patentbalu dye. During the second stage the records of 206 consecutive low-rectal cancer patients were analyzed for presence of inguinal lymph node metastases. Results An evaluation of specimens from two rectal cancer patients revealed extramesorectal Lymphatic Drainage of the primary tumor besides the mesorectal route. An analysis of 206 patients revealed six cases of inguinal node metastases. Median age of patients was 55 years. They were all diagnosed with rectal adenocarcinoma, T3 or T4 tumors with G2 or G3 grade. Conclusion The demonstration of an alternative route of Lymphatic Drainage suggests that more radical surgical procedures are necessary for successful treatment of low-rectal cancers.
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Infralevator Lymphatic Drainage of Low-Rectal Cancers: Preliminary Results
Annals of surgical oncology, 2009Co-Authors: Marek Bebenek, Andrzej WojnarAbstract:Background Some low-rectal cancers may spread into or recur in the inguinal lymph nodes despite optimal resection of the primary tumor. Hence, we hypothesized that Lymphatic Drainage of low-rectal malignancies may be inhomogeneous and that an extramesorectal route may be involved in at least some cases. The idea of our preliminary study was to analyze the potential Lymphatic Drainages in low-rectal cancer patients.
Hayley M. Reynolds - One of the best experts on this subject based on the ideXlab platform.
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Predicting Lymphatic Drainage patterns and primary tumour location in patients with breast cancer
Breast cancer research and treatment, 2011Co-Authors: Evan I. Blumgart, Roger F. Uren, Poul M. F. Nielsen, Martyn P. Nash, Hayley M. ReynoldsAbstract:Detailed knowledge of the Lymphatic Drainage of the breast is limited. Lymphoscintigraphy is a technique used during breast cancer treatment to accurately map patterns of Lymphatic Drainage from the primary tumour to the draining lymph nodes. This study aimed to create a statistical model to analyse the spread of breast cancer and primary tumour location using a large lymphoscintigraphy database, and visualise the results with a novel computational model. This study was based on lymphoscintigraphy data from 2,304 breast cancer patients treated at the Royal Prince Alfred Hospital Medical Centre in Sydney, Australia. Bayesian inferential techniques were implemented to estimate the probabilities of Lymphatic Drainage from each region of the breast to each draining node field, to multiple node fields, and to determine probabilities of tumour prevalence in each breast region. A finite element model of the torso and discrete model of the draining node fields were created to visualise these data and a software tool was developed to display the results (www.abi.auckland.ac.nz/breast-cancer). Results confirmed that Lymphatic Drainage is most likely to occur to the axillary node field, and that there is significant likelihood of Drainage to the internal mammary node field. The likelihood of Lymphatic Drainage from the whole breast to the axillary, internal mammary, infraclavicular, supraclavicular and interpectoral node fields were 98.2, 35.3, 1.7, 3.1, and 0.7%, respectively; whilst the probability of Lymphatic Drainage to multiple node fields was estimated to be 36.4%. Additionally, primary tumours are most likely to develop in the upper regions of the breast. The models developed provide quantitative estimates of Lymphatic Drainage of the breast, giving important insights into understanding breast cancer metastasis and have the potential to benefit both clinicians and patients during breast cancer diagnosis and treatment.
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Lymphatic Drainage and tumour prevalence in the breast: a statistical analysis of symmetry, gender and node field independence.
Journal of anatomy, 2011Co-Authors: Evan I. Blumgart, Roger F. Uren, Poul M. F. Nielsen, Martyn P. Nash, Hayley M. ReynoldsAbstract:Current understanding of the Lymphatics draining the breast is controversial, despite its known importance in the spread of breast cancer. Similarly, knowledge regarding the spatial distribution of primary tumours in the breast is limited. This study sought to test commonly held assumptions in this field, including: (i) that breast Lymphatic Drainage and tumour prevalence are symmetric between the left and right sides of the body, (ii) that males and females have the same Drainage patterns and tumour prevalences, and (iii) that Lymphatic Drainage in the breast occurs independently to different node fields. This study has used lymphoscintigraphy data from 2304 breast cancer patients treated at the RPAH Medical Centre, Sydney, Australia. Symmetry of Lymphatic Drainage and tumour distribution as well as gender differences were tested using Fisher's exact test. Drainage independence was assessed using Fisher's exact test, and a multivariate probit model was used to test for Drainage correlations. Results showed that the breasts are likely to have symmetric Lymphatic Drainage and tumour prevalence, and that there is no significant difference between males and females. Furthermore, results showed that direct Lymphatic Drainage of the breasts is likely to be independent between node fields. Collectively, these results serve to further our understanding of Lymphatic anatomy and the distribution of tumours in the breast.
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THREE-DIMENSIONAL VISUALIZATION OF SKIN Lymphatic Drainage PATTERNS OF THE HEAD AND NECK
Head and Neck-journal for The Sciences and Specialties of The Head and Neck, 2009Co-Authors: Hayley M. Reynolds, Roger F. Uren, John F. Thompson, Nicolas P. Smith, P. Rod DunbarAbstract:Background. Lymphatic Drainage from skin on the head and neck is complex. We sought to provide improved visualization and analysis of the patterns of head and neck skin Lymphatic Drainage using aggregated lymphoscintigraphy data. Methods. Lymphoscintigraphy data from 929 patients with cutaneous melanoma on the head and neck collected at the Sydney Melanoma Unit have been mapped onto a 3-dimen- sional computer model of the skin and lymph nodes. Results. Novel heat maps and interactive software have been created, which show subtle differences in Lymphatic Drainage patterns when compared with those that are previ- ously reported. Posterior head and neck node fields largely drained posterior regions of the head and neck, whereas an- terolateral skin regions were generally drained by the other
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Three-dimensional visualisation of Lymphatic Drainage patterns in patients with cutaneous melanoma
Lancet Oncology, 2007Co-Authors: Hayley M. Reynolds, Roger F. Uren, John F. Thompson, P. Rod Dunbar, Shane A. Blackett, Nicolas P. SmithAbstract:Summary Background Lymphoscintigraphy accurately maps Lymphatic Drainage from sites of cutaneous melanoma to the draining sentinel lymph nodes. The Sydney Melanoma Unit has accumulated lymphoscintigraphy data from over 5000 patients with cutaneous melanoma over more than 15 years, collectively revealing patterns of skin Lymphatic Drainage. We aimed to map these data onto a three-dimensional computer model to provide improved visualisation and analysis of Lymphatic Drainage from sites of cutaneous melanoma. Methods Lymphoscintigraphy data from 5239 patients with cutaneous melanoma were collected between July 27, 1987 and Dec 16, 2005. 4302 of these patients had primary melanoma sites below the neck, and were included in this analysis. From these patients, two-dimensional lymphoscintigraphy data were mapped onto an anatomically based three-dimensional computer model of the skin and lymph nodes. Spatial analysis was done to visualise the relation between primary melanoma sites and the locations of sentinel lymph nodes. Findings We created three-dimensional, colour-coded heat maps that showed the Drainage patterns from melanoma sites below the neck to individual lymph-node fields and to many lymph-node fields. These maps highlight the inter-patient variability in skin Lymphatic Drainage, and show the skin regions in which highly variable Drainage can occur. To enable interactive and dynamic analysis of these data, we also developed software to predict Lymphatic Drainage patterns from melanoma skin sites to sentinel lymph-node fields. Interpretation The heat maps confirmed that the commonly used Sappey's lines are not effective in predicting Lymphatic Drainage. The heat maps and the interactive software could be a new resource for clinicians to use in preoperative discussions with patients with melanoma and other skin cancers that can metastasise to the lymph nodes, and could be used in the identification of sentinel lymph-node fields during follow-up of such patients.
