{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T12:17:02Z","timestamp":1789993022144,"version":"4.0.1"},"reference-count":16,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:00:00Z","timestamp":1789948800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:00:00Z","timestamp":1789948800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["R01HL157991"],"award-info":[{"award-number":["R01HL157991"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007627","name":"Common Fund for Commodities","doi-asserted-by":"publisher","award":["U54HL165440"],"award-info":[{"award-number":["U54HL165440"]}],"id":[{"id":"10.13039\/100007627","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Surgical Oncology"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Objectives<\/jats:title>\n                    <jats:p>Superficial\u2010to\u2010deep lymphatic drainage has been proposed as a mechanism to reduce an individual's risk of developing breast cancer\u2010related lymphedema (BCRL). The epitrochlear\u2010humeral pathway provides superficial\u2010to\u2010deep lymphatic drainage and may be preferentially recruited when the superficial lymphatic system becomes inadequate. We evaluated the presence or absence of epitrochlear\u2010humeral lymph node drainage in breast cancer survivors post\u2010axillary lymph node dissection (ALND) who did not develop BCRL.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Female breast cancer survivors without BCRL after ALND underwent lymphatic mapping with ICG lymphography and SPECT\/CT lymphoscintigraphy. The presence of epitrochlear and\/or humeral drainage was recorded and compared between volunteers based on linear versus nonlinear patterns on ICG lymphography.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twenty\u2010five volunteers, a median of 13.0\u2009years after ALND, met the inclusion criteria. Drainage to both the epitrochlear and humeral nodes was observed in 56% (14\/25). Linear ICG patterns were present in 32% (8\/25), while 68% (17\/25) demonstrated nonlinear patterns. Epitrochlear and humeral drainage was observed in 38% (3\/8) of volunteers with linear patterns compared with 65% (11\/17) of those with nonlinear patterns.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Superficial\u2010to\u2010deep lymphatic drainage is common in breast cancer survivors without BCRL after ALND and may represent an important compensatory mechanism of the deep lymphatic system.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jso.70407","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T11:55:15Z","timestamp":1789991715000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Epitrochlear and Humeral Lymphatic Pathway: Deep Lymphatic System Compensation After Axillary Lymph Node Dissection"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-6881-6109","authenticated-orcid":false,"given":"Madeleine","family":"Givant","sequence":"first","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center Harvard Medical School Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James E.","family":"Fanning","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center Harvard Medical School Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-8795-1002","authenticated-orcid":false,"given":"Angela","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center Harvard Medical School Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Thomson","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center Harvard Medical School Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen","family":"Shillue","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center Harvard Medical School Boston Massachusetts USA"},{"name":"Department of Rehabilitation Services, Beth Israel Deaconess Medical Center Harvard Medical School Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7338-8235","authenticated-orcid":false,"given":"Aaron","family":"Fleishman","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center Harvard Medical School Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caitlin M.","family":"Connolly","sequence":"additional","affiliation":[{"name":"Department of Radiology, Mount Auburn Hospital Harvard Medical School Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1429-2115","authenticated-orcid":false,"given":"Kevin","family":"Donohoe","sequence":"additional","affiliation":[{"name":"Division of Nuclear Medicine, Department of Radiology, Beth Israel Deaconess Medical Center Harvard Medical School Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6300-1647","authenticated-orcid":false,"given":"Dhruv","family":"Singhal","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center Harvard Medical School Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,21]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/SAP.0000000000001864"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2013.02.018"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(13)70076-7"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000010245"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10549-022-06777-z"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10549-025-07748-w"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000006893"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.prs.0000277995.25009.3e"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/jso.70002"},{"key":"e_1_2_8_11_1","volume-title":"Anatomy of the Human Lymphatic System","author":"Rouvi\u00e8re H.","year":"1938"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.aanat.2019.01.005"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/jso.27811"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/jso.27827"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000006550"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.24983\/scitemed.imj.2021.00140"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/jso.26343"}],"container-title":["Journal of Surgical Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jso.70407","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jso.70407","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jso.70407","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T11:55:16Z","timestamp":1789991716000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jso.70407"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,21]]},"references-count":16,"alternative-id":["10.1002\/jso.70407"],"URL":"https:\/\/doi.org\/10.1002\/jso.70407","archive":["Portico"],"relation":{},"ISSN":["0022-4790","1096-9098"],"issn-type":[{"value":"0022-4790","type":"print"},{"value":"1096-9098","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,21]]},"assertion":[{"value":"2026-06-23","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-15","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-21","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"jso.70407"}}