Ann Rehabil Med.  2017 Dec;41(6):1065-1075. 10.5535/arm.2017.41.6.1065.

Quantitative Lymphoscintigraphy to Predict the Possibility of Lymphedema Development After Breast Cancer Surgery: Retrospective Clinical Study

Affiliations
  • 1Department of Rehabilitation Medicine, Gachon University Gil Medical Center, Incheon, Korea. bduck@gachon.ac.kr
  • 2Department of Breast Surgery, Gachon University Gil Medical Center, Incheon, Korea.

Abstract


OBJECTIVE
To predict the probability of lymphedema development in breast cancer patients in the early post-operation stage, we investigated the ability of quantitative lymphoscintigraphic assessment.
METHODS
This retrospective study included 201 patients without lymphedema after unilateral breast cancer surgery. Lymphoscintigraphy was performed between 4 and 8 weeks after surgery to evaluate the lymphatic system in the early postoperative stage. Quantitative lymphoscintigraphy was performed using four methods: ratio of radiopharmaceutical clearance rate of the affected to normal hand; ratio of radioactivity of the affected to normal hand; ratio of radiopharmaceutical uptake rate of the affected to normal axilla (RUA); and ratio of radioactivity of the affected to normal axilla (RRA). During a 1-year follow-up, patients with a circumferential interlimb difference of 2 cm at any measurement location and a 200-mL interlimb volume difference were diagnosed with lymphedema. We investigated the difference in quantitative lymphoscintigraphic assessment between the non-lymphedema and lymphedema groups.
RESULTS
Quantitative lymphoscintigraphic assessment revealed that the RUA and RRA were significantly lower in the lymphedema group than in the non-lymphedema group. After adjusting the model for all significant variables (body mass index, N-stage, T-stage, type of surgery, and type of lymph node surgery), RRA was associated with lymphedema (odds ratio=0.14; 95% confidence interval, 0.04-0.46; p=0.001).
CONCLUSION
In patients in the early postoperative stage after unilateral breast cancer surgery, quantitative lymphoscintigraphic assessment can be used to predict the probability of developing lymphedema.

Keyword

Breast cancer; Lymphedema; Lymphoscintigraphy; Quantitative assessment

MeSH Terms

Axilla
Breast Neoplasms*
Breast*
Clinical Study*
Follow-Up Studies
Hand
Humans
Lymph Nodes
Lymphatic System
Lymphedema*
Lymphoscintigraphy*
Radioactivity
Retrospective Studies*
Unilateral Breast Neoplasms

Figure

  • Fig. 1 Points for objective circumference measurements to diagnose lymphedema, as suggested by Starritt et al. [21]. MP, midpoint between the lateral epicondyle of the humerus and the acromion of the shoulder; C-15, 15 cm above the lateral epicondyle of the humerus; F-MP, midpoint between the ulnar styloid process and the lateral epicondyle of the humerus; C-10, 10 cm below the lateral epicondyle of the humerus; A, acromion; B, lateral epicondyle; C, ulnar styloid process.

  • Fig. 2 Typical images of qualitative lymphoscintigraphy of the upper arms of a patient after breast cancer surgery. The images were acquired approximately 5 minutes (A) and 20 minutes (B) after injection and used to calculate the clearance rate from the injection site.

  • Fig. 3 Typical images of qualitative lymphoscintigraphy of the upper arms of a patient after breast cancer surgery. The images were acquired approximately 30 minutes (A) and 60 minutes (B) after injection and used to calculate the uptake rate of the axillary nodes. RT, right; LT, left.

  • Fig. 4 Correlation between quantitative lymphoscintigraphy analysis and difference in circumference. The maximum circumference difference between the upper arms of patients with lymphedema show a significant inverse correlation with the RUA (A) and the RRA (B). RUA, ratio of radiopharmaceutical uptake rate of the affected to normal axilla; RRA, ratio of radioactivity of the affected to normal axilla.


Cited by  1 articles

Effects of Different Bandaging Methods for Treating Patients With Breast Cancer-Related Lymphedema
Se Hyun Oh, Sung Hwan Ryu, Ho Joong Jeong, Jung Hyun Lee, Young-Joo Sim
Ann Rehabil Med. 2019;43(6):677-685.    doi: 10.5535/arm.2019.43.6.677.


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