Arm lymphoscintigraphy after axillary lymph node dissection or sentinel lymph node biopsy in breast cancer

Almir José Sarri, Rogério Dias, Carla Elaine Laurienzo, Mônica Carboni Pereira Gonçalves, Daniel Spadoto Dias, Sonia Marta Moriguchi, Almir José Sarri, Rogério Dias, Carla Elaine Laurienzo, Mônica Carboni Pereira Gonçalves, Daniel Spadoto Dias, Sonia Marta Moriguchi

Abstract

Purpose: Compare the lymphatic flow in the arm after breast cancer surgery and axillary lymph node dissection (ALND) versus sentinel lymph node biopsy (SLNB) using lymphos-cintigraphy (LS).

Patients and methods: A cross-sectional study with 39 women >18 years who underwent surgical treatment for unilateral breast cancer and manipulation of the axillary lymph node chain through either ALND or SLNB, with subsequent comparison of the lymphatic flow of the arm by LS. The variables analyzed were the area reached by the lymphatic flow in the upper limb and the sites and number of lymph nodes identified in the ALND or SLNB groups visualized in the three phases of LS acquisition (immediate dynamic and static images, delayed scan images). For all analyses, the level of significance was set at 5%.

Results: There was a significant difference between the ALND and SLNB groups, with predominant visualization of lymphatic flow and/or lymph nodes in the arm and axilla (P=0.01) and extra-axillary lymph nodes (P<0.01) in the ALND group. There was no significant difference in the total number of lymph nodes identified between the two groups. However, there was a significant difference in the distribution of lymph nodes in these groups. The cubital lymph node was more often visualized in the immediate dynamic images in the ALND group (P=0.004), while the axillary lymph nodes were more often identified in the delayed scan images of the SLNB group (P<0.01). The deltopectoral lymph node was only identified in the ALND group, but with no significant difference.

Conclusion: The lymphatic flow from the axilla was redirected to alternative extra-axillary routes in the ALND group.

Keywords: breast neoplasms; lymphadenectomy; lymphatic diseases; radionuclide imaging.

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Lymphoscintigraphy including the area from the hand to the abdominal region. Notes: Sequential ordinal classification of the site reached by lymphatic flow from the injection site (minimum classification) to the spleen (maximum classification). Source: Reprinted with permission from Sarri AJ, Moriguchi SM, Dias R, et al. Physiotherapeutic stimulation: Early prevention of lymphedema following axillary lymph node dissection for breast cancer treatment. Exp Ther Med. 2010;1(1): 147–152.
Figure 2
Figure 2
Difference in lymphatic progression between the (A) ALND and (B) SLNB groups. WBS of the ALND and SLNB groups. Notes: (A) Arrow points to the persistent visualization of lymphatic ducts in the upper limb with no evidence of lymph nodes (lymphatic stasis). (B) Arrow points to the usual visualization of axillary lymph nodes. Abbreviations: ALND, axillary lymph node dissection; SLNB, sentinel lymph node biopsy; WBS, whole-body scan.
Figure 3
Figure 3
WBS of the ALND group. Notes: Extra-axillary lymph nodes in addition to axillary lymph nodes. (A) Internal mammary lymph nodes on the left (short arrow). (B) Infraclavicular lymph node on the right (thick arrow), internal mammary chain lymph nodes on the left (long arrow), internal mammary chain lymph nodes on the right (short arrow). Abbreviations: ALND, axillary lymph node dissection; WBS, whole-body scan.
Figure 4
Figure 4
Lymphoscintigraphy. Different distributions of lymph nodes in the ALND and SLNB groups. Notes: (A) ALND group – Cubital lymph nodes (short arrow) slightly visible in the axillary region (long arrow). Deltopectoral lymph nodes between the two arrows. (B) SLNB group – Lymph nodes identified in the cubital region (short arrow) and well visualized in the axillary region (long arrow). Abbreviations: ALND, axillary lymph node dissection; SLNB, sentinel lymph node biopsy; WBS, whole-body scan.

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