title: Evaluation of lymphatic compensation by lymphoscintigraphy in the postoperative period of breast cancer surgery with axillary dissection.
abstract: OBJECTIVE
  To evaluate postoperative lymphatic compensation in the upper limb after mastectomy with axillary dissection.
  
  
  METHODS
  Twenty-three patients who underwent lymphoscintigraphy before and 60 days after surgery were enrolled from September 2006 to June 2007, in Campinas, Brazil. Protocol examination consisted in static imaging of each upper limb in semi-flexion and thoracic imaging after 10 min and 1 and 2 hr after subcutaneous injection of 1 mCi (37 MBq) of 99mTc dextran into the dorsum of the hand. A comparative analysis was made of hepatic uptake of the radiopharmaceutical, velocity of axillary lymph node visualization (I, visible at 10 min; II, at 1 hr; III, at 2 hr; IV, not visible) and degree (intensity) of uptake (a, marked; b, moderate; c, mild; d, absent) before and 60 days after surgery.
  
  
  RESULTS
  In the preoperative period, 3 (13%) patients were considered to have an optimal pattern (Ia) and 2 (9%) showed total involvement (IVd). Compared to velocity in the postoperative period, 9 (39%) patients showed no difference, 5 (22%) improved, 9 (39%) became worse, and one was considerably worse. Regarding the degree, 10 (43%) patients showed no difference, 9 (39%) became worse, and 4 (17%) improved. Regarding classification, 2 (9%) patients had an optimal lymphatic pattern (Ia) and 3 (13%) had total involvement (IVd). No patient presented decreased hepatic uptake after surgical treatment.
  
  
  CONCLUSIONS
  The study found relevant changes in preoperative and postoperative lymphoscintigraphy, demonstrating the existence of functional differences in the lymphatic system of the upper limb. Alterations in lymphatic drainage pattern may already be perceived 60 days postoperatively, as can signs of lymphovenous anastomoses.
authors.affiliation: Department of Obstetrics and Gynecology, Universidade Estadual de Campinas UNICAMP Medical School, São Paulo, Brazil. rezendelaura@hotmail.com
authors.forename: Laura Ferreira
authors.initials: LF
authors.lastname: de Rezende
authors.forename: Felipe Villela
authors.initials: FV
authors.lastname: Pedras
authors.forename: Celso Dario
authors.initials: CD
authors.lastname: Ramos
authors.forename: Maria Salete Costa
authors.initials: MS
authors.lastname: Gurgel
mesh_terms: D000328:Adult; D000368:Aged; D001365:Axilla; D001938:Brazil; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects*; D008208:Lymphatic System / Q000503:physiopathology* / Q000601:surgery; D042601:Lymphatic Vessels / Q000503:physiopathology; D008209:Lymphedema / Q000209:etiology / Q000503:physiopathology; D061305:Lymphoscintigraphy; D008408:Mastectomy / Q000009:adverse effects / Q000379:methods*; D008875:Middle Aged; D011184:Postoperative Period; D020127:Recovery of Function; D012307:Risk Factors; D016896:Treatment Outcome; D034941:Upper Extremity / Q000000981:diagnostic imaging / Q000503:physiopathology