{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T03:57:25Z","timestamp":1790740645677,"version":"4.1.0"},"reference-count":17,"publisher":"Georg Thieme Verlag KG","issue":"06","funder":[{"name":"RSNA R&E Resident Research","award":["RR1820"],"award-info":[{"award-number":["RR1820"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Reconstr Microsurg"],"published-print":{"date-parts":[[2021,7]]},"abstract":"<jats:title>Abstract:<\/jats:title><jats:p>\n          Background\u2003A distinct pattern of edema distribution is seen in breast cancer-related lymphedema. The area of edema sparing has not been characterized in relation to anatomy. Specifically, alternate lymphatic pathways are known to travel adjacent to the cephalic vein. Our study aims to define the location of edema sparing in the arm relative to the cephalic vein.<\/jats:p><jats:p>\n          Methods\u2003A retrospective review of patients who underwent magnetic resonance imaging (MRI) between March 2017 and September 2018 was performed. Variables including patient demographics, arm volumes, and MRI data were extracted. MRIs were reviewed to define the amount of sparing, or angle of sparing, and the deviation between the center of sparing and the cephalic vein, or angle of deviation.<\/jats:p><jats:p>\n          Results\u2003A total of 34 consecutive patients were included in the analysis. Five patients demonstrated circumferential edema (no sparing) and 29 patients demonstrated areas of edema sparing. Advanced age (69.7 vs. 57.6 years) and greater excess arm volume (40.4 vs. 20.8%) correlated with having circumferential edema without sparing (p\u2009=\u20090.003). In 29 patients with areas of edema sparing, the upper arm demonstrated the greatest angle of sparing (183.2 degrees) and the narrowest in the forearm (99.9 degrees; p\u2009=\u20090.0032). The mean angle of deviation to the cephalic vein measured 3.2, \u20130.1, and \u20135.2 degrees at the upper arm, elbow, and forearm, respectively.<\/jats:p><jats:p>\n          Conclusion\u2003Our study found that the area of edema sparing, when present, is centered around the cephalic vein. This may be explained by the presence of the Mascagni-Sappey (M-S) pathway as it is located alongside the cephalic vein. Our findings represent a key springboard for additional research to better elucidate any trends between the presence of the M-S pathway, areas of sparing, and severity of lymphedema.<\/jats:p>","DOI":"10.1055\/s-0040-1722648","type":"journal-article","created":{"date-parts":[[2021,1,31]],"date-time":"2021-01-31T18:32:50Z","timestamp":1612117970000},"page":"519-523","source":"Crossref","is-referenced-by-count":8,"title":["Breast Cancer-Related Lymphedema: Magnetic Resonance Imaging Evidence of Sparing Centered Along the Cephalic Vein"],"prefix":"10.1055","volume":"37","author":[{"given":"Geunwon","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna Rose","family":"Johnson","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryoko","family":"Hamaguchi","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Adondakis","sequence":"additional","affiliation":[{"name":"Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leo L.","family":"Tsai","sequence":"additional","affiliation":[{"name":"Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dhruv","family":"Singhal","sequence":"additional","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2021,1,31]]},"reference":[{"issue":"08","key":"ref1","doi-asserted-by":"crossref","first-page":"4686","DOI":"10.1007\/s00330-020-06790-0","article-title":"MRI staging of upper extremity secondary lymphedema: correlation with clinical measurements","volume":"30","author":"G Kim","year":"2020","journal-title":"Eur Radiol"},{"key":"ref2","volume-title":"Vasorum lymphaticorum corporis humani","author":"P Mascagni","year":"1787"},{"key":"ref3","volume-title":"Anatomie, physiologie, pathologie de vaisseaux lymphatiques","author":"P C Sappey","year":"1874"},{"issue":"01","key":"ref4","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1055\/s-0039-1694757","article-title":"The all but forgotten mascagni-sappey pathway: learning from immediate lymphatic reconstruction","volume":"36","author":"A R Johnson","year":"2020","journal-title":"J Reconstr Microsurg"},{"key":"ref5","first-page":"191","article-title":"The role of the lateral upper arm bundle and the lymphatic watersheds in the formation of collateral pathways in lymphedema","volume":"31","author":"S Kubik","year":"1980","journal-title":"Acta Biol Acad Sci Hung"},{"key":"ref6","first-page":"11","article-title":"Lymphatic drainage of the upper limb","volume":"4","author":"A Leduc","year":"1993","journal-title":"Substitution lymphatic pathways. 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