Lymphatic remapping by long-term lymphoscintigraphy follow-up in secondary lymphedema after breast cancer surgery

• Published in: Scientific reports Vol. 14; no. 1; p. 728
• Main Authors: Hong, Garam, Lee, Koeun, Han, Sangwon, Jeon, Jae Yong
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 06.01.2024; Nature Publishing Group; Nature Portfolio
• Subjects: 631/67; 631/67/1347; Breast cancer; Breast Cancer Lymphedema - diagnostic imaging; Breast Cancer Lymphedema - etiology; Breast Neoplasms - diagnostic imaging; Breast Neoplasms - surgery; Chronic Disease; Cohort Studies; Female; Follow-Up Studies; Humanities and Social Sciences; Humans; Imaging; Lymphatic system; Lymphedema; Lymphedema - diagnostic imaging; Lymphedema - etiology; Lymphoscintigraphy; multidisciplinary; Patients; Science; Science (multidisciplinary); Surgery
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-023-50558-7

The purpose of the study is to investigate long-term changes on lymphoscintigraphy and their association with clinical factors in breast cancer-related lymphedema (BCRL) patients. This single-center cohort study included BCRL patients who underwent baseline and follow-up lymphoscintigraphy. The percentage of excessive circumference (PEC) of the affected upper limb compared with the unaffected side was used as an indicator of the clinical severity of BCRL. Each 99m Tc-phytate lymphoscintigraphy image was categorized according to the Taiwan lymphoscintigraphy staging system. Clinical parameters and the lymphoscintigraphy stage at baseline and follow-up were compared and analyzed. Eighty-seven patients were included. Baseline and follow-up lymphoscintigraphies were performed at median 7 (interquartile range [IQR]: 2‒14) and 78 (IQR: 49‒116) months after surgery, respectively. Both lymphoscintigraphy stage and PEC showed variable change with overall increases in their severity. Stepwise multivariable analysis revealed follow-up lymphoscintigraphy stage ( P  = 0.001) to be independent variables for PEC at follow-up, however, baseline lymphoscintigraphy stage was not. The clinical courses of BCRL and patients’ lymphoscintigraphy patterns showed diverse changes over long-term follow-up. In addition to initial lymphoscintigraphy for diagnosis, lymphatic remapping by follow-up lymphoscintigraphy can be useful to visualize functional changes in the lymphatic system that may guide the optimal management in BCRL.