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General Rehabilitation

Long-term changes in lymphoscintigraphy and its association with clinical parameters in secondary lymphedema after breast cancer surgery

(Research Hub Theater) Long-term Changes in Lymphoscintigraphy and Its Association with Clinical Parameters in Secondary Lymphedema After Breast Cancer Surgery

Thursday, November 16, 2023
5:00 PM – 7:00 PM CT

    Primary Author(s)

  • Hyun Ah Lee, MD

    Fellowship doctor
    n/a
    Songpa-gu, Seoul-t'ukpyolsi, Republic of Korea

    • Co-Author(s)

  • Yong Jae Na, MD

    Fellowship doctor
    Asan Medical Center
    Song Pa, Seoul-t'ukpyolsi, Republic of Korea

  • Inho Woo, MD

    Fellowship doctor
    Asan Medical Center
    Songpa-gu, Seoul-t'ukpyolsi, Republic of Korea

  • GH

    Garam Hong, MD

    resident
    n/a
    Songpagu, Seoul-t'ukpyolsi, Republic of Korea

  • SH

    Sangwon Han, MD, PhD

    Professor
    Asan Medical Center
    Seoul, Seoul-t'ukpyolsi, Republic of Korea

  • Jae Yong Jeon, MD

    professor
    Asan Medical Center
    Seoul, Seoul-t'ukpyolsi, Republic of Korea

Background and/or Objectives: To investigate long-term changes and associations in clinical features and lymphoscintigraphy in breast cancer related lymphedema (BCRL) patients.

Design: This is a single-center cohort study of BCRL patients who underwent baseline and follow-up lymphoscintigraphy.

Setting: The percentage of excessive circumference (PEC) of the affected upper limb compared to the unaffected side was used as a measure of clinical severity of BCRL.

Participants: Each 99mTc-phytate lymphoscintigraphy image was categorized into 0‒6 stages according to Taiwan lymphoscintigraphy staging system. Clinical parameters including PEC and the lymphoscintigraphy stage at baseline and follow-up were compared and analyzed.

Interventions: not applicable

Main Outcome Measures: A total of 87 patients were included. Baseline and follow-up lymphoscintigraphies were performed at median 7 (interquartile range [IQR] 2‒4) and 78 (IQR 49‒116) months after surgery, respectively. Both lymphoscintigraphy stage and PEC changed variably during the study period with overall increase in their severities (median PEC: 3.8% to 13.4%; median lymphoscintigraphy stage: 1 to 4).

Results: The PEC and lymphoscintigraphy stage showed positive correlation at baseline (rho = 0.27, P = 0.001) and follow-up (rho = 0.50, P < 0.001). The stepwise multivariable analysis revealed cellulitis (adjusted β: 4.34; 95% confidence interval [CI] 0.77‒7.91) and lymphoscintigraphy stage at follow-up (adjusted β: 1.47; 95% CI 0.67‒2.28) as independent variables for PEC at follow-up.

Conclusions: The clinical course of BCRL and lymphoscintigraphy pattern showed diverse changes during long-term follow-up. In addition to initial lymphoscintigraphy for the diagnosis, follow-up lymphoscintigraphy can be useful to visualize functional changes in lymphatic system that may help to guide the optimal management plan in BCRL.