Findings of lymphoscintigraphy and the severity of lymphedema according to the extent of axillary lymph node dissection

Abstract

Summary: Background: Lymphedema of the upper extremity is a common disease in breast cancer patients following breast cancer operation accompanied by lymphadenectomy. However, clinically, there is a discrepancy between the extent of axillary lymph node dissection (ALND) and the severity of lymphedema. Therefore, we investigated the relationship between the severity of lymphedema following breast cancer operation, including ALND, and axillary lymph node findings on lymphoscintigraphy. Methods: Eighty-two patients with lymphedema following breast cancer operation with ALND (82 women; mean age 55.57 ± 9.39, range 36–65) were retrospectively recruited. Lymphoscintigraphy was conducted after an average of 5.44 ± 2.01 months following operation. Percentage differences in the circumference of the upper extremities between affected and unaffected sides were used as a severity index. Results: Percentage differences in the circumference of the upper extremities in a positive and negative group in lymphoscintigraphy were 3.42 ± 2.47% and 12.87 ± 10.23% in the mid-arm respectively (p < 0.05), and 3.36 ± 3.80% and 12.83 ± 10.00% in the mid-forearm respectively (p < 0.05). However, the extent of lymph node dissection and the difference in the circumference of mid-arm and mid-forearm volume did not have a statistically significant relationship. Conclusion: Lymph node activity in the proximal upper extremity is not related to the extent of ALND. The existence of a bypass connection and remainder function of a lymph node is crucial for the severity of lymphedema. Keywords: Lymphedema, ALND, Lymphoscintigraphy