Short-term effects of axillary lymph node clearance surgery on lymphatic physiology of the arm in breast cancer.
It is not known why some women develop breast cancer-related lymphedema (BCRL) of the arm, whereas others having similar treatment do not. We speculated that increased uptake of protein into local blood may protect against BCRL. Sixteen women were given bilateral subcutaneous hand webspace injections of polyclonal immunoglobulin (HIgG), (99m)Tc-HIgG on one side and (111)In-HIgG on the other, before and 3 mo after axillary clearance surgery. The rates of clearance of activity from the depot (k) and accumulation in central blood (b(contra)) were measured using a scintillation probe and bilateral antecubital vein blood sampling, respectively. Activity accumulating in blood ipsilateral to the injected side, in excess of central blood activity (b(ipsi)) was also calculated as a measure of local vascular uptake. The k correlated with b(contra), but neither changed in response to surgery. However, b(ipsi) for injections of (99m)Tc-HIgG into the affected arm increased in all seven patients in whom data were available (0.018 +/- 0.006 to 0.038 +/- 0.007%/min; P < 0.05); indeed, in five of these seven, b(ipsi) paradoxically exceeded b(contra), and none developed BCRL at 3-yr follow-up. We conclude that uptake of protein into local blood and/or proteolysis increases after axillary surgery and may protect against BCRL.
Pain
Simon J
SJ
Cambridge Breast Unit, Addenbrooke's Hospital, UK.
Barber
Robert W
RW
Solanki
Chandra K
CK
Ballinger
James R
JR
Britton
Tom Bennett
TB
Mortimer
Peter S
PS
Purushotham
Anand D
AD
Peters
A Michael
AM
D000328:Adult; D000368:Aged; D001132:Arm / Q000503:physiopathology / Q000601:surgery; D001365:Axilla / Q000503:physiopathology / Q000601:surgery; D001693:Biological Transport, Active; D001943:Breast Neoplasms / Q000150:complications / Q000503:physiopathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood*; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000503:physiopathology* / Q000601:surgery*; D008207:Lymphatic Metastasis; D008209:Lymphedema / Q000209:etiology / Q000503:physiopathology*; D008875:Middle Aged; D013997:Time Factors
D007074:Immunoglobulin G