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Upper Extremity Lymphedema After Axillary Lymph Node Dissection: Prospective Lymphoscintigraphic Evaluation.
Lymphology
|June 16, 2018
Summary
Axillary lymph node dissection (ALND) can lead to lymphedema, but quantitative lymphoscintigraphy may not show impairment. New lymph node function after surgery may protect against lymphedema development.
Area of Science:
- Oncology
- Radiology
- Lymphedema Research
Background:
- Axillary lymph node dissection (ALND) is a common procedure for breast cancer treatment.
- Post-ALND upper extremity lymphedema is a significant concern for patients.
- Lymphatic drainage changes after ALND require further investigation.
Purpose of the Study:
- To evaluate changes in upper extremity lymphatic drainage after ALND using lymphoscintigraphy.
- To compare lymphatic drainage post-ALND with preoperative status.
- To assess the incidence of lymphedema and patient-reported symptoms after ALND.
Main Methods:
- Prospective study of 44 women undergoing ALND for breast cancer.
- Lymphoscintigraphy and arm measurements performed preoperatively and at 1 week, 1 year, and 2 years post-surgery.
- Substudy included randomization into four physiotherapy groups (rehabilitation, manual drainage, compression pump, education).
Main Results:
- Lymphedema diagnosed in 9% at 1 year and 25% at 2 years post-ALND; however, many cases were subclinical.
- Quantitative lymphoscintigraphy and photoplethysmography showed no significant impairment in lymphatic transport or venous function.
- Qualitative analysis revealed lymph node disappearance and dermal backflow in lymphedema cases, while new lymph node appearance suggested a protective effect.
Conclusions:
- While lymphedema can develop post-ALND, quantitative imaging may not detect early functional changes.
- Qualitative lymphoscintigraphy findings, including dermal backflow and new lymph node formation, are crucial for understanding lymphedema development and potential protective mechanisms.
- Early detection and management of lymphedema, even in subclinical cases, remain important.
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