Jitworawisut and Tsukuura — Letter on Intraluminal Pressure Hypothesis
Response letter to Chowdhury et al - Truncal Melanoma Contralateral SLN Drainage Prevalence.
Correction — see Fact-Check Log
Original note said the authors “suggest using US to measure the lymph node size.” They actually recommend lymphatic ultrasound to assess vessel patency/obstruction, not node size.
Verified content
- The authors report their own clinical observation: when the ipsilateral lymphatic pathway is obstructed proximally (e.g. by lymph node dissection), ipsilateral lymphatic vessels dilate due to increased intraluminal pressure, diverting flow to the contralateral side
- They recommend lymphatic ultrasound (high-frequency/ultra-high-frequency) to evaluate vessel patency and obstruction pre-operatively — collecting lymph vessels are visible on US where they are not visible on ICG
- Purpose: to help identify atypical SLN locations, including contralateral nodes, before surgery
My take
This is the mechanistic hypothesis our Discussion needs — obstruction → pressure → rerouting. It’s also a concrete, citable suggestion (preoperative lymphatic US) we could mention as a strengths/limitations point our case didn’t use.