UPPER LIMBS LYMPHOSCINTIGRAPHY IN PATIENTS WITH LYMPHOEDEMA AFTER THERAPY FOR BREAST CARCINOMA

BACKGROUND: Upper limb lymphoedema appears in 7 - 40 % patients after therapy for breast carcinoma. Its early stage can be missed and the therapy focused at other symptoms. AIM: The aim of our study was to assess lymphatic drainage of the arm in patients with clinically manifested or suspected lymphoedema by lymphoscintigraphy. Methods: 81 patients after surgery for breast carcinoma and/or radiotherapy), underwent lymphoscintigraphy of the upper limbs. Technetium-99m-Nano-Albumon (20 MBq) was injected s.c. into the 1st and 4th interdigital spaces of both hands. An image of the injection sites was acquired immediately. After three hours, static images of both arms were obtained separately. The images were assessed visually (with respect to dermal backflow, enlarged lymphatic vessel and/or presence of regional lymph nodes), and semiquantitatively (total number of counts in axillary, forearm and upper arm regions were calculated and expressed as % of counts in the injection sites). The values in these regions were compared with corresponding values of healthy arm. Results: Lymphoscintigraphy confirmed lymphoedema in 62/81 patients (77%). 7 of them were patients with suspected latent lymphoedema. The most frequent findings in positive patients: diffuse dermal backflow of the arm (27) and local dermal backflow (30). In 1 patient, retention of the isotope at the injection site was observed (grade IV of lymphoedema). Enlarged lymphatic vessel was visualised in 4 patients. Regional lymph nodes were not visualised in 21/81 patients. In 76% of these patients, the finding was associated with diffuse dermal backflow of the arm and in 65% with the clinical grade III or IV of lymphoedema. Lymphoscintigraphy was negative in 19/81 patients (23%). There was no clinical suspicion of lymphoedema in 11 of these patients. Clinical impression of latent lymphedema was not supported by lymphoscintigraphy in other 8 patients. Conclusion: Non-invasive lymphoscintigraphy is a sensitive method for the diagnosis of the secondary lymphoedema of the upper limbs including its clinically latent stages. Semiquantitive evaluation is helpful in patients with latent lymphoedema or a morphologically controversial finding ( images after 5-6 hours).