# Mapping & quantifying lymphatic drainage of the arm's alternate pathway

> **NIH NIH R01** · BETH ISRAEL DEACONESS MEDICAL CENTER · 2021 · $452,750

## Abstract

Project Summary/Abstract
Breast Cancer Related Lymphedema affects 1.2 million patients in the United States
and has no cure. The symptoms of lymphedema include fatigue, tightness, pain, and
life-threatening infections. However, two-thirds of women undergoing breast cancer
treatment with the highest risk factors for developing lymphedema do not develop the
disease. While there is no explanation for this finding, one hypothesis is that normal
anatomic variations of the lymphatic system pre-dispose certain women to developing
lymphedema after breast cancer treatment. Specifically, the main back-up lymphatic
pathway of the arm, the Mascagni-Sappey (MS) pathway, is variably present in cadaver
studies and avoids areas that are usually damaged with breast cancer treatment.
Moreover, when present in these cadaver studies, the MS pathway has variable
anatomic connections which can impact its ability to drain the arm effectively. We
hypothesize that, utilizing modern imaging techniques, we can define the anatomy of
the MS pathway and its variations in normal women and in breast cancer survivors who
have undergone high risk breast cancer treatment and did not develop lymphedema.
Utilizing this information, we will be able to predict which variations predispose women
to develop lymphedema. Finally, we will develop a novel method of non-invasive intra-
operative optical imaging to assess the function of this pathway during breast cancer
operations to predict the patient's risk of developing lymphedema. The ability to
evaluate real-time lymphatic function would allow cancer teams to implement preventive
interventions in high risk patients. As the most common cause of lymphedema in the
United States is secondary to cancer procedures, this model of lymphedema prevention
could be widely applied to the treatment of other high risk cancer populations including
gynecologic cancers, urologic cancers, skin cancers, and sarcomas.

## Key facts

- **NIH application ID:** 10100475
- **Project number:** 1R01HL157991-01
- **Recipient organization:** BETH ISRAEL DEACONESS MEDICAL CENTER
- **Principal Investigator:** Dhruv Singhal
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $452,750
- **Award type:** 1
- **Project period:** 2021-01-26 → 2025-12-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10100475

## Citation

> US National Institutes of Health, RePORTER application 10100475, Mapping & quantifying lymphatic drainage of the arm's alternate pathway (1R01HL157991-01). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10100475. Licensed CC0.

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