Quantification of breast cancer-related lymphedema of the upper limbs

Objectives: As objective measures of lymphedema are warranted for the comparison of treatment strategies and monitoring of therapeutic interventions, we set out to characterize breast cancer-related lymphedema quantitatively.

Methods: Eleven women (34-68 years) with unilateral arm lymphedema following breast cancer treatment underwent bilateral lymphoscintigraphy with ^99mTc-labeled human serum albumin. Based on the rate of removal of tracer from the injection site and measured activity in the arm, a mean transit time (MTT) was calculated for both arms. This was compared to visual scoring of lymphedema based on the presence of dermal backflow and visualization of lymph nodes. Correlation with arm volume calculated from circumference measurements was also tested for.

Results: All patients demonstrated unilateral lymphedema clinically and scintigraphically. Median excess arm volume was 12.4% (range 5.8-27.0%). The mean MTT of lymphedema arms (MTT_lymph) was clearly and significantly different from that of unaffected arms (MTT_norm), being 60.1±27.7 min and 5.4±2.5 min, respectively, p<0.0001. Mean MTT_lymph was longer in four patients with prior erysipelas infection in the lymphedema arm than in the patients without; 87.9±12.7 min vs. 44.2±19.7 min, p=0.002. MTT_lymph was positively correlated to excess arm volume (r=0.64, p=0.04) and number of lymph nodes removed (r=0.65, p=0.03) as well as prior erysipelas (r=0.84, p<0.01), but not to the visual score, duration of lymphedema, hand dominance, age, or body mass index. Number of lymph nodes removed and excess arm volume were interrelated (r=0.72, p=0.01). Number of lymph nodes removed also correlated to occurrence of erysipelas (r=0.66, p=0.03) suggesting that more extensive surgery increased the risk of lymphedema as well as that of infection.

Conclusion: MTT separated lymphedema arms from normal ones and correlated well with relevant markers of disease severity. Since computations took input to the arm into account, this objective measure of lymphatic function was independent of differences in injection dose and technique and applicable also without a healthy control arm. Research Support: The last author is a PhD candidate and received PhD scholarships from The PhD Research Fund at Odense University Hospital and The PhD Research Fund at University of Southern Denmark, Odense, Denmark.