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

Figures & data

Figure 1 Lymphoscintigraphy including the area from the hand to the abdominal region.

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): 147–152.²⁹

Notes: Sequential ordinal classification of the site reached by lymphatic flow from the injection site (minimum classification) to the spleen (maximum classification).

Table 1 Descriptive statistics of the sample ALND and SLNB groups

Variable	ALND			SLNB			P-value (M–W)
	n	Mean (SD)	Min–max	n	Mean (SD)	Min–max
Age (years)	22	51.0 (0.0)	26.0–71.0	17	53.9 (9.0)	36.0–73.0	0.27
BMI (kg/m^2)	22	27.4 (5.2)	18.0–40.7	17	26.9 (4.0)	19.3–34.4	0.96
RLN (number)	22	19.0 (6.2)	11.0–34.0	17	1.6 (0.8)	1.0–3.0	<0.01
PLN (number)	22	4.3 (6.2)	0.0–22.0	17	0.0 (0.0)	–	–

Abbreviations: ALND, axillary lymph node dissection; BMI, body mass index; M–W, Mann–Whitney U test; PLN, positive lymph nodes; RLN, removed lymph nodes; SD, standard deviation; SLNB, sentinel lymph node biopsy.

Table 2 Types of surgery in ALND and SLNB groups

Type of surgery	ALND, n (%)	SLNB, n (%)
Patey’s mastectomy	6 (27.3)	0 (0.0)
Madden’s mastectomy	4 (18.2)	0 (0.0)
Simple mastectomy	2 (9.1)	2 (11.8)
Skin-sparing mastectomy	0 (0.0)	1 (5.9)
Quadrantectomy	10 (45.5)	14 (82.4)
Total	22 (100)	17 (100)

Abbreviations: ALND, axillary lymph node dissection; SLNB, sentinel lymph node biopsy.

Table 3 Sites reached by the lymphatic flow in the ALND and SLNB groups distributed over the dynamic, static, and WBS image stages and classified into forearm, arm/axilla, and thoracic extra-axillary lymph nodes

Progression	Group		P-valuea
	ALND, n (%)	SLNB, n (%)
Dynamic images
Forearm	6/18 (33.3)	5.16 (31.2)	0.99
Arm/axilla	12/18 (67.7)	11/16 (68.8)	0.99
Thoracic LN	0/18 (0.0)	0/16 (0.0)	–
Static images
Forearm	3/19 (15.8)	3/16 (18.7)	0.99
Arm/axilla	16/19 (84.2)	13/16 (81.3)	0.65
Thoracic LN	0/19 (0.0)	0/16 (0.0)	–
Whole-body scan
Forearm	0/19 (0.0)	0/16 (0.0)	–
Arm/axilla	11/19 (57.9)	2/16 (12.5)	0.01
Thoracic LN	8/19 (42.1)	0/16 (0.0)	,0.01

Note:

a Fisher’s exact test.

Abbreviations: ALND, axillary lymph node dissection; SLNB, sentinel lymph node biopsy; LN, lymph nodes; WBS, whole-body scan.

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 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 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.

Table 4 Location of lymph nodes in the ALND and SLNB groups observed in the dynamic, static, and WBS imaging

Progression	Group		P-valuea
	ALND, n (%)	SLNB, n (%)
Cubital lymph node
DI	5/19 (26.3)	0/16 (0.0)	0.004
SI	4/20 (20.0)	5/16 (31.2)	0.470
WBS	8/19 (42.1)	7/12 (58.3)	0.473
Deltopectoral lymph node
DI	2/19 (10.5)	0/16 (0.0)	0.489
SI	3/20 (15.0)	0/16 (0.0)	0.238
WBS	3/19 (15.8)	0/12 (0.0)	0.265
Axillary lymph node
DI	2/19 (10.5)	4/16 (25.0)	0.379
SI	3/20 (15.0)	5/16 (31.2)	0.422
WBS	7/19 (36.8)	12 (100.0)	<0.01

Note:

a Fisher’s exact test.

Abbreviations: ALND, axillary lymph node dissection; DI, dynamic imaging; SLNB, sentinel lymph node biopsy; SI, static imaging; WBS, whole-body scan.

SarriAJMoriguchiSMDiasRPhysiotherapeutic stimulation: Early prevention of lymphedema following axillary lymph node dissection for breast cancer treatmentExp Ther Med20101114715223136607

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