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Lymphoscintigraphy including the area from the hand to the abdominal region. Source: Reprinted with permission from Sarri AJ, Moriguchi SM, Dias R, et al. Physiotherapeutic stimulation: Early prevention of lymphedema following axillary lymph node dissection for breast cancer treatment. Exp Ther Med. 2010;1(1): 147–152.²⁹
Source publication
Purpose
Compare the lymphatic flow in the arm after breast cancer surgery and axillary lymph node dissection (ALND) versus sentinel lymph node biopsy (SLNB) using lymphos-cintigraphy (LS).
Patients and methods
A cross-sectional study with 39 women >18 years who underwent surgical treatment for unilateral breast cancer and manipulation of the axill...
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Citations
Backgrounds:
Axillary lymph node dissection (ALND) can cause breast cancer-related lymphedema (BCRL). However, ALND does not always produce lymphedema to the breast cancer survivors. Therefore, we aimed to investigate the correlation between the finding of lymphoscintigraphy and lymphedema in patients undergoing breast cancer surgery with ALND.
Methods and Results:
Patients with BCRL (n = 73, mean age: 53.92 ± 11.13 years) after full ALND (levels I, II, and III) were retrospectively included in this study. All patients underwent lymphoscintigraphy and according to the findings of the imaging, patients were divided into three groups: negative group, periclavicular lymph nodes (P-LN) activation, and axillary lymph nodes (A-LN) activation. According to the extent of radiation therapy, groups were classified as the following: no radiation group (None), breast radiation group (BI), and breast irradiation in addition to P-LN (BI+PC). The percentage difference in the upper extremities was used as the marker of severity of lymphedema. The subjects in the negative group, P-LN, and A-LN were 34 (46.6%), 33 (45.2%), and 6 (8.2%) patients, respectively. The findings of lymphangiography showed statistically significant relationship with the severity of lymphedema. The extent of radiation therapy did not have statistically significant relationship. Despite ALND, 53.4% patients had active L/N capable of removing the upper limb lymphatic fluids and 45.2% patients showed activation of collateral formation of lymphatic circulation after ALND.
Conclusion:
The collateral lymphatic formation was provoked after breast cancer operation with ALND, which decreased the severity of lymphedema in breast cancer survivors.
Lymphedema is a chronic progressive and potentially debiliating disease that is frequently observed after cancer treatment. Radical lymphadenectomy and radiotherapy which are strongly associated with development of a lymphedema remain essential components of the therapeutic concept of cancer. Resection of fibrotic tissue should only be evaluated at the end stage of the disease, while liposuction is less invasive and seems to be highly effective in reducing extremity circumferences. Lymphovenous anastomoses and microvascular lymphnode transfers provide valuable therapeutic options for a properly selected patient population and can improve skin quality and limit progression of the disease. In order to further confirm the promising results, scientifically prospective studies with higher numbers of patients as well as long-term follow-up studies are necessary.
Objectives:
The purpose of this study was to assess the clinical value of ultrasound (US) features of breast lesions for predicting the risk of axillary lymph node metastasis in patients with breast cancer.
Methods:
In this retrospective study, 425 patients with breast cancer were recruited, and their preoperative US features and postoperative pathologic results were collected. The association of these US features of breast cancer with axillary lymph node metastasis was determined by univariate and multivariate analyses.
Results:
Among the 425 patients, 200 (47.1%) had axillary lymph node metastasis, and 225 (52.9%) did not. The parameters of tumor shape, color Doppler flow imaging grades, histologic grade, and E-cadherin level were significantly and independently associated with axillary lymph node metastasis (P < .05 for all).
Conclusions:
Axillary lymph node metastasis was prone to happen in patients with US features of an irregular tumor shape and higher color Doppler flow imaging grades. Ultrasound imaging provides a promising tool for predicting axillary lymph node metastasis in patients with breast cancer.
