Recently we read the article by Robbins and coworkers'1 entitled "Standardizing Neck Dissection Terminology." According to the classic anatomic description, the linear and continued progression of metastasis along the lymphatic chains of the neck toward the jugulosubclavian angle is a rare event, even in those patients who may reach a terminal state without any treatment.
In the context of adipose tissue, small lymphoid aggregates are seen. Venous vessels linked by vascular capillary structures (interpretable as lymphovenous shunts) are isolated in the jugulodigastric region.
To investigate this apparent anatomic-functional discrepancy we are now observing the ways of drainage with lymphoscintigraphy, without any diagnostic aim. We always observed a fast drainage and a distribution of the tracer similar to the N + anatomic distribution in the clinical cases; similar results were obtained with a marker of neoplastic involvement (gallium 67 citrate). The study was performed on both sides of the neck, ie,
Vierucci S, Cantalupi D, Dessanti P. Possible Implications of Neck Lymphovenous Shunts. Arch Otolaryngol Head Neck Surg. 1995;121(3):352–353. doi:10.1001/archotol.1995.01890030078014