Quantitative lymphoscintigraphy with Tc-99m--technephyte in breast cancer patients with upper limb lymphedema after mastectomy and axillary lymph nodes dissection

«Radiation and Risk», 2023, vol. 32, No. 1, pp.93-107

DOI: 10.21870/0131-3878-2023-32-1-93-107

Authors

Sigov M.A. – Researcher. Contacts: 4 Korolyov str., Obninsk, Kaluga region, Russia, 249035. Tel.: +7(484) 399-30-11; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it. .
Davydov G.A. – Head of Dep., MD
Pasov V.V. – Lead. Researcher, MD
Spichenkova O.N. – Lead. Engineer
Davydova E.V. – Researcher
Zhigulsky A.V. – Clin. Resident
Ivanov S.A. – Director, Corr. Member of RAS, MD, Prof. A. Tsyb MRRC.
A. Tsyb MRRC, Obninsk

Abstract

The paper presents results of research on the potential of quantitative radionuclide lymphoscintigraphy (LS) with radioactive tracer (99mTc-technephyte) for evaluation of the upper limb lymphedema, developed in different time periods after mastectomy and axillary lymph nodes dissection in 56 breast cancer patients (females). Before LS-imaging the tracer was subcutaneously injected in the affected and normal extremities. The 99mTc-technephyte clearance rate from the injection site on the affected hand was higher than the tracer clearance rate from the site of injection on the normal hand, the difference in the rates was statistically insignificant. This difference did not depend on the lymphoma stage (the difference between clearance rates was 4-9%, difference in the amount of tracers cleared was 6-8%). It means that informative value of 99mTc-technephyte clearance is very low and cannot be used for differential diagnostics of lymphedema stage. To obtain more important information the quantitative asymmetry index (QAI) was used. It was shown that in all parts of the upper limb lymphedema (forearm, shoulder, and arm in general) there was a significant difference between QAI indices for lymphedema stages I, II and III. However, the significant variability of the QAI indices makes difficult proper interpretation of LS provided images. The obtained data show that the clinical and functional staging of the lymphedema is not identical, and also confirm the possibility of the presence of areas in the edematous extremity at different stages of lymph drainage disorder. The data also support the hypothesis that lymph drainage in the edematous extremity parts may be im-paired in areas with different lymph drainage stages. Quantifying LS with QAI can be useful when choosing a treatment method, evaluating its effectiveness, and dynamic monitoring.

Key words
upper limb lymphedema, breast cancer, postmastectomy syndrome, radionuclide diagnostics, lymphoscintigraphy, nanocolloidal radiopharmaceuticals, 99mTc-technephyte, 99mTc-phytate, quantitative analysis of lymphodynamics, asymmetry index.

References

1. Sostoyanie onkologicheskoi pomoshchi naseleniyu Rossii v 2019 godu [The state of cancer care for the population of Russia in 2019]. Eds: A.D. Kaprin, V.V. Starinskiy, A.O. Shakhzadova. Moscow, P.A. Herzen MNIOI, 2020. 238 p.

2. De Rezende L.F., Pedras F.V., Ramos C.D., Gurgel M.S.C. Evaluation of lymphatic compensation by lymphoscintigraphy in the postoperative period of breast cancer surgery with axillary dissection. Tumori, 2011, vol. 97, no. 15, pp. 309-315.

3. Myasnikova M.O., Sedov V.M., Katsev V.M., Dmitrieva L.A., Ermoshchenkova M.V. Use of lymphoscin-tigraphy in diagnosis and prognosis of post-mastectomy edema of extremities. Voprosy Oncologii – Problems of Oncology, 2003, vol. 49, no. 1, pp. 85-87. (In Russian).

4. Szuba A., Pyszel A., Jedzejuk D., Janczak D., Andrzejak B. Presence of functional lymph nodes and lymph drainage within arms and without breast cancer-related lymphedema. Lymphology, 2007, vol. 40, no. 2, pp. 81-86.

5. Ermoshchenkova M.V., Filonenko E.V., Zikiryakhodzhaev A.D. Federal clinical recommendations for the diagnosis and treatment of postmastectomy syndrome. Vestnik vosstanovitel’noi meditsiny – Bulletin of Restorative Medicine, 2014, no. 5, pp. 69-74. (In Russian).

6. Szuba A., Shin W.S., Strauss H.W., Rockson S. The third circulation: radionuclide lymphoscintigraphy in the evaluation of lymphedema. J. Nucl. Med., 2003, vol. 44, no. 1, pp. 43-57.

7. Maccauro M., Villa G., Manzara A., Follacchio G.A., Manca G., Tartaglione G., Chondrogiannis S., Mango L., Rubello D. Lymphoscintigraphy for the evaluation of limb lymphatic flow disorders: report of technical procedural standards from an Italian Nuclear Medicine expert panel. Rev. Esp. Med. Nucl. Imagen. Mol., 2019, vol. 38, no. 5, pp. 335-340.

8. Villa G., Campisi C.C., Ryan M., Boccardo F., Di Summa P., Frascio M., Sambuseti G., Campisi C. Procedural recommendations for lymphoscintigraphy in the diagnosis of peripheral lymphedema: the Genoa protocol. Nucl. Med. Mol. Imaging, 2019, vol. 53, no. 1, pp. 47-56.

9. Yoo J.-N., Cheong Y.-S., Min Y.-S., Lee S.-W., Park H.Y., Jung T.-D. Validity of quantitative lymphoscintig-raphy as a lymphedema assessment tool for patients with breast cancer. Ann. Rehabil. Med., 2015, vol. 39, no. 6, pp. 931-940.

10. Sigov M.A., Davydov G.A., Pasov V.V., Davydova E.V., Ivanov S.A., Kaprin A.D. The method of quantita-tive assessment of the state of lymphodynamics in patients with secondary lymphatic edema of the upper extremities (arising after mastectomy) according to the data of lymphoscintigraphy with 99mTc-technephyte. Radiatsiya i risk – Radiation and Risk, 2019, vol. 28, no. 2, pp. 102-111. (In Russian).

11. Iimura T., Fukushima Y., Kumita S., Ogawa R., Hyakusoku H. Estimating lymphodynamic conditions and lymphovenous anastomosis efficacy using 99mTc-phytate lymphoscintigraphy with SPECT-CT in patients with lower-limb lymphedema. Plast. Reconstr. Surg. Glob. Open, 2015, vol. 3, no. 5, pp. 1-9.

12. Kim P., Lee J.K., Lim O.K., Park H.K., Park K.D. Quantitative lymphoscintigraphy to predict the possibility of lymphedema development after breast cancer surgery: retrospective clinical study. Ann. Rehabil. Med., 2017, vol. 41, no. 6, pp. 1065-1075.

13. Fujiwara M., Sawada M., Kasuya A., Matsushita Y., Yamada M., Fukumizu H., Magata Y., Sakahara H. Measurement of cutaneous lymphatic flow rates in patients with skin cancer: area extraction method. J. Dermatol., 2014, vol. 41, no. 6, pp. 498-504.

14. Stanton A.V., Modi S., Mellor R.H., Peters A.M., Swensson W.E., Levick J.R., Mortimer P.S. A quantitative lymphoscintigraphic evaluation of lymphatic function in the swollen hands of women with lymphedema follow-ing breast cancer treatment. Clin. Sci. (Lond.), 2006, vol. 110, no. 5, pp. 553-561.

15. Weissleder H., Weissleder R. Lymphedema: evaluation of qualitative and quantitative lymphoscintigraphy in 238 patients. Radiology, 1988, vol. 167, no. 3, pp. 729-735.

16. Kim H., Yoon J.A. The feasibility of quantitative parameters of lymphscitigraphy without significant dermal backflow for the evaluation of lymphedema in post-operative patients with breast cancer. Eur. J. Nucl. Mol. Imaging, 2020, vol. 47, no. 5, pp. 1094-1102.

17. Keamida G., Wroe E., Winterman N., Aplin M., Peters A.M. Lymphatic drainage efficiency: a new parameter of lymphatic function. Acta Radiol., 2018, vol. 59, no. 9, pp. 1097-1101.

18. The diagnosis and treatment of peripheral lymphedema: 2016 Consensus Document of the International Society of Lymphology. Lymphology, 2016, vol. 49, no. 4, pp. 170-184.

19. Kurochkina O.S., Baitinger V., Dudnikov A.V. Anatomy of lymphatic bed of upper limb: lymph drainage from upper limb in norm and after axillary lymph node dissection. Voprosy rekonstructivnoi i plasticheskoi khirurgii – Problems of Reconstructive and Plastic Surgery, 2018, no. 2, pp. 39-48. (In Russian).

20. Suami H. Lymphosome concept: anatomical study of the lymphatic system. J. Surg. Oncol., 2017, vol. 115, no. 1, pp. 13-17.

Full-text article (in Russian)