Investigation of the relationship between the cranial collector and the incidence of lymphedema in patients with breast cancer after adjuvant treatments

Background: The cranial collector (CC) is known as a direct drainage lymphatic duct from the extremities to the axilla and running near the axillary vein. It might be helpful in avoiding incidence of lymphedema (LE) in patients with axillary lymph node dissection (ALND). However, it is not clear how the CC may influence for the incidence of LE after ALND and adjuvant treatments. Methods: A study was performed from December 2009 to April 2018 in 217 patients with breast cancer who underwent ALND with axillary reverse mapping (ARM). The ARM was performed by fluorescence imaging following the injection of indocyanine green into the ipsilateral arm. In 208 of the 217 patients, we investigated the relationship between the CC status identified by ARM and the incidence of LE in patients administered adjuvant treatments. Results: We identified the CC in the axilla of 81 of the 208 patients. The CC-negative patients had a significantly greater incidence of LE than that in CC-positive patients (P=0.0007, hazard ratio: 2.54). Among 127 CC-negative patients, younger age and adjuvant chemotherapy (mostly anthracycline and/or taxanes) were significant risk factors for LE. In contrast, radiation, especially that with supraclavicular radiation (SCRT) was a significant risk factor for LE in CC-positive patients. Conclusions: The CC status of patients undergoing ALND might affect the incidence of LE after the adjuvant chemotherapy or radiation.