Arch Hand Microsurg.  2023 Mar;28(1):57-62. 10.12790/ahm.22.0070.

Comparison of groin lymph node anatomy in patients with upper-extremity lymphedema and healthy subjects using contrast-enhanced computed tomography

Affiliations
  • 1Department of Plastic Surgery, Korea University Ansan Hospital, Ansan, Korea

Abstract

Purpose
Lymphedema is a chronic disease that affects patients’ quality of life. Vascularized groin lymph node transfer is a reliable treatment that requires detailed anatomic knowledge of the superficial inguinal lymph nodes (SILNs). This study compared the anatomy of SILNs between patients with upper-extremity lymphedema and individuals without lymphedema using pelvic computed tomography (CT).
Methods
The CT scans of 17 patients (the patient group) with upper-extremity lymphedema and 34 individuals without lymphedema (the normal group) were studied. The reference point was marked 3 cm perpendicularly below one-third of the line from the pubic tubercle to the anterior superior iliac spine. The number, distance, and concentration of SILNs were measured relative to the reference point.
Results
The SILNs in the normal group had a mean count of 6.47±1.19, a mean distance from the reference point of 21.10±9.66 mm, and a mean concentration of 84%. The patient group had a mean lymph node count of 7.68±1.63, a mean distance of 22.48±9.51 mm, and a mean concentration of 77%. The normal and patient groups had significantly different mean lymph node counts (p=0.01). The mean distance from the reference point (p=0.07) and the mean lymph node concentration (p=0.20) did not differ significantly between groups.
Conclusion
Pelvic CT is a reliable method to evaluate the anatomy of SILNs in detail. A statistically significant difference was found in the number of lymph nodes between the lymphedema patient group and the normal group, but not in their distribution.

Keyword

Lymph node transfer; Pelvis computed tomography; Lymphedema; Superficial inguinal lymph node; Anatomical study

Figure

  • Fig. 1. Coronal view of contrast-enhanced pelvic computed tomography. A line was drawn between the anterior superior iliac spine (ASIS) and pubic tubercle (PT), which coincided with the inguinal ligament (white line). Superficial inguinal lymph nodes were marked with red circles and those inferior to the inguinal ligament were counted.

  • Fig. 2. A reference point was marked on a point 3 cm inferior and perpendicular to the middle one-third of the line drawn from the pubic tubercle (PT) to the anterior superior iliac spine (ASIS).

  • Fig. 3. The distance from a lymph node (LN) to the reference point was calculated using the Pythagorean theorem. (A) The coordinates of each LN were obtained by defining the inguinal ligament line as the X-axis and a line perpendicular to this as the Y-axis. (B) The image is rotated for a better understanding of the X-axis and Y-axis. (C) The Pythagorean theorem is used. (D) The distance from the reference point to the lymph nodes was calculated using this formula. ASIS, anterior superior iliac spine; PT, pubic tubercle.

  • Fig. 4. Based on the distance calculated previously, the percentage of lymph nodes within a 3-cm boundary from the reference point was calculated. ASIS, anterior superior iliac spine; PT, pubic tubercle.


Reference

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