| 제목 |
The Quantitative Parameters of Lymphoscintigraphy for the Evaluation of Mild Lymphedema |
| 소속 |
Pusan National University Hospital, Department of Rehabilitation Medicine1 |
| 저자 |
Ji Won Hong1*, Da Hwi Jung1, Myung Jun Shin1, Jin A Yoon1† |
Background
We aimed to evaluate the potential role of quantitative method of lymphoscintigraphy for the assessment of severity of lymphedema post-operative patients with breast cancer who did not show definite dermal backflow (DB) activity on the lymphoscintigraphy.
Method
We evaluated 49 mild lymphedema patients with International Society of Lymphology Classification of limb volume difference minimal (5% to 10%) and mild (10% to 20 %). The patients received a mastectomy and axillary dissection or sentinel lymph node dissection for invasive ductal carcinoma of the breast. A round ROI of axillary lymph node activity & Squared ROIs of arms drawn for the acquisition of the tracer uptake and for the calculation of quantitative asymmetry indices (QAI) for evaluate the asymmetric uptake was shown in Figure 1. The QAI of both arms were calculated at axilla, upper arm, fore arm and total arm. The QAI was defined as the radiopharmaceutical uptake ratio of affected side to the unaffected side. Arm circumference was measured at four locations per arm to identify the maximal circumference difference (MCD) between affected and unaffected sides. The ratio of measured circumference was also used for the analysis.
Results
The representative examples of lymphangiography without dermal backflow includes delayed flow and decreased activity of axillary lymph node (Figure 2A) or collateral lymph node activity, such as subclavian lymph node (Figure 2B). Among total patients, 21 patients showed minimal degree and 28 patients showed mild degree of lymphedema. There was weak correlation between QAIs and circumference difference in total and segmental analysis (Table 1). QAIs of forearm (QAI-F) and whole arm (QAI-T) showed significant difference between two groups (Figure 3).
Discussion
In our study, quantitative lymphangiography showed low correlation with MCD in mild lymphedema. Although the quantitative analyses are a useful lymphedema assessment tool, it showed less feasibility to distinguish the degree of circumference difference between affected and unaffected limb in these patients. Otherwise, to divide the patients by volume difference, whole arm and forearm QAI were significant values for the evaluation of the severity of lymphedema and may have potential to work as an objective tool for the assessment of mild lymphedema without dermal backflow. |
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Figure 1. An example of the region of interest (ROI) for quantification
Figure 2. Representative example of lymphedema without dermal backflow
Figure 3. Comparison of QAIs of forearm (QAI-F), upper arm (QAI-U) and whole arm (QAI-T)
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