Abstract
1106
Background: Taiwan Staging Lymphoscintigraphy (TSL) has been classified in three patterns of unilateral extremity lymphedema, that is correlated with Cheng Lymphedema Grading (CLG). The three patterns of lymphatic drainage of TSL are normal lymphatic drainage (L0), partial obstruction (P1,P2,P3), or total obstruction (T4, T5 and T6). However, another pattern was found in the current practice. We describe a new lymphoscintigraphy pattern for upper extremity lymphedema staging criteria on post-surgery and axillary lymph node dissection (ALND) breast cancer patient.
Methods: Patients with breast cancer underwent surgery and ALND prior to lymphoscintigraphy procedure were included in the study. Subjects were categorized into lymphedema and non-lymphedema based on clinical signs and symptoms like sore, tender, rigidity of unilateral superior extremity, and limb circumferential measurement. Lymphoscintigraphy was further classified into normal lymphatic, pre-obstruction (delayed drainage), partial obstruction and total obstruction.
Results: From 120 subjects, 62.5% belong to lymphedema group, while the rest of it with non-lymphedema. In the lymphedema group, 32% subject show total obstruction, 62.7% with partial obstruction, and 4% pre-obstruction. Interestingly, 1.3% subject show normal lymphatic channel despite of the clinical status. In this subject, arthritis is a comorbidity and clinically can mimic lymphedema. Discrepancy also found in 17.8% non-lymphedema subject showing partial obstruction, 37.8% pre-obstruction, and 44.4% show normal lymphatic.
Conclusions: Lymphoscintigraphy pattern have incremental value to define the stage of lymphedema compared to clinical staging alone. Particularly, in clinically non-lymphedema cases, lymphoscintigraphy can detect pre-obstruction and partial obstruction stages. Further research should be conducted to establish this new pattern for staging criteria in the clinical setting. Keyword: lymphedema, lymphoscintigraphy, lymphatic system, lymphatic obstruction, breast cancer, axillary lymph node dissection