Michael E J Stouthandel1, Charlotte Debbaut2, Jurgen Deviche3, Bart Truyens4, Liv Veldeman5, Tom Van Hoof6. 1. Department of Human Structure and Repair, Ghent University, C. Heymanslaan 10, Radiotherapy Park, Entrance 98, B-9000, Ghent, Belgium. Electronic address: michael.stouthandel@ugent.be. 2. IBiTech-bioMMeda, Ghent University, C. Heymanslaan 10, Block B, Entrance 36, B-9000, Ghent, Belgium; Cancer Research Institute Ghent (CRIG), Ghent University, C. Heymanslaan 10, Block B, Entrance 36, B-9000, Ghent, Belgium. 3. IBiTech-bioMMeda, Ghent University, C. Heymanslaan 10, Block B, Entrance 36, B-9000, Ghent, Belgium. 4. Department of Radiation Oncology, Ghent University Hospital, C. Heymanslaan 10, Radiotherapy Park, Entrance 98, B-9000, Ghent, Belgium. 5. Department of Human Structure and Repair, Ghent University, C. Heymanslaan 10, Radiotherapy Park, Entrance 98, B-9000, Ghent, Belgium; Department of Radiation Oncology, Ghent University Hospital, C. Heymanslaan 10, Radiotherapy Park, Entrance 98, B-9000, Ghent, Belgium. 6. Department of Human Structure and Repair, Ghent University, C. Heymanslaan 10, Radiotherapy Park, Entrance 98, B-9000, Ghent, Belgium.
Abstract
BACKGROUND: Visualizing the lymphatic system and recording the spatial relations between the subclavian lymphatic trunk (SLT) and the surrounding anatomical structures will improve radiotherapy treatment planning for breast cancer patients with lymphatic involvement. An experimental approach to retrogradely fill the SLT with contrast agent was explored. METHODS: Six Thiel embalmed specimens were bilaterally dissected in the cervical and clavicular region to optimize the new experimental approach. A conservative dissection with minimum distortion of spatial relations between different anatomical structures was developed. A pressure reservoir was created inside the venous angle to allow retrograde filling of the SLT under the influence of time and pressure. RESULTS: The new methodology proved feasible, showing successful pressure build-up inside the venous reservoir, resulting in filling of the proximal end of the subclavian lymphatic trunk. The pressures needed to significantly fill the subclavian lymphatic trunk proved to be higher than the pressures that the venous walls could withstand. CONCLUSIONS: Thiel embalmed specimens proved useful for optimizing the experimental approach, but the embalming products could have negatively affected the vessel strength. The authors suggest that their method will be applied on fresh frozen specimens in future studies, to obtain SLT filling up to the axillary lymphatic plexus. Our findings also pointed out that there is still a lot to be learned about the anatomical variability of the SLT and its termination sites. The detailed description of our experimental approach offers valuable information for future lymphatic mapping studies.
BACKGROUND: Visualizing the lymphatic system and recording the spatial relations between the subclavian lymphatic trunk (SLT) and the surrounding anatomical structures will improve radiotherapy treatment planning for breast cancerpatients with lymphatic involvement. An experimental approach to retrogradely fill the SLT with contrast agent was explored. METHODS: Six Thiel embalmed specimens were bilaterally dissected in the cervical and clavicular region to optimize the new experimental approach. A conservative dissection with minimum distortion of spatial relations between different anatomical structures was developed. A pressure reservoir was created inside the venous angle to allow retrograde filling of the SLT under the influence of time and pressure. RESULTS: The new methodology proved feasible, showing successful pressure build-up inside the venous reservoir, resulting in filling of the proximal end of the subclavian lymphatic trunk. The pressures needed to significantly fill the subclavian lymphatic trunk proved to be higher than the pressures that the venous walls could withstand. CONCLUSIONS: Thiel embalmed specimens proved useful for optimizing the experimental approach, but the embalming products could have negatively affected the vessel strength. The authors suggest that their method will be applied on fresh frozen specimens in future studies, to obtain SLT filling up to the axillary lymphatic plexus. Our findings also pointed out that there is still a lot to be learned about the anatomical variability of the SLT and its termination sites. The detailed description of our experimental approach offers valuable information for future lymphatic mapping studies.
Authors: Michael E J Stouthandel; Françoise Kayser; Vincent Vakaet; Ralph Khoury; Pieter Deseyne; Chris Monten; Max Schoepen; Vincent Remouchamps; Alex De Caluwé; Guillaume Janoray; Wilfried De Neve; Stephane Mazy; Liv Veldeman; Tom Van Hoof Journal: Sci Rep Date: 2021-11-18 Impact factor: 4.379