title: An investigation of lymphovenous communications in the upper limbs of breast cancer patients.
abstract: BACKGROUND
  Approximately 25% of breast cancer patients who undergo treatment to the axilla develop breast cancer-related lymphoedema (BCRL). The aim of this study was to test the hypothesis that lymphovenous communications (LVCs) open and act as a protective mechanism against the development of BCRL.
  
  
  METHODS
  Five patients (Group 1) received intradermal injections of (99m)Technetium-labelled autologous erythrocytes into the 2nd ipsilateral hand webspace before and 6-12 weeks following axillary node clearance surgery (ANC). Ten patients at least three years after ANC were also recruited (Group 2); seven had developed BCRL and three had not. Blood was sampled from ipsilateral and contralateral antecubital veins 5, 15, 30, 60, 120 and 180 min post-injection to assess pre-nodal shunting from lymph to blood (LVCs), since nodes block erythrocyte transit. The proportion of activity remaining in the depot was used to calculate the degree of shunting in those with evidence of LVCs.
  
  
  RESULTS
  Significant erythrocyte-bound activity, increasing over time, was detected contralaterally in 3 of the 5 patients from Group 1 (none of whom developed BCRL) and 3 of 7 patients with BCRL from Group 2, which indicated the presence of LVCs. The degree of shunting was more marked in those patients who did not develop BCRL compared with those who did.
  
  
  CONCLUSIONS
  The time-course of erythrocyte-bound contralateral activity indicates transit through lymphovenous communications rather than needle-induced trauma. Lymphovenous communications large enough to transmit erythrocytes are probably constitutional rather than induced. A larger study is warranted to assess any resulting protection against BCRL.
authors.affiliation: Division of Cancer Studies, King's College London, UK; Guy's & St Thomas' NHS Foundation Trust, UK.
authors.forename: S K
authors.initials: SK
authors.lastname: Bains
authors.affiliation: Guy's & St Thomas' NHS Foundation Trust, UK.
authors.forename: J
authors.initials: J
authors.lastname: Ballinger
authors.affiliation: Guy's & St Thomas' NHS Foundation Trust, UK.
authors.forename: S
authors.initials: S
authors.lastname: Allen
authors.affiliation: Clinical Sciences, St George's, University of London, UK.
authors.forename: A W B
authors.initials: AW
authors.lastname: Stanton
authors.affiliation: Clinical Sciences, St George's, University of London, UK.
authors.forename: J R
authors.initials: JR
authors.lastname: Levick
authors.affiliation: Clinical Sciences, St George's, University of London, UK.
authors.forename: P S
authors.initials: PS
authors.lastname: Mortimer
authors.affiliation: Division of Cancer Studies, King's College London, UK; Guy's & St Thomas' NHS Foundation Trust, UK. Electronic address: ea-purushotham@kcl.ac.uk.
authors.forename: A D
authors.initials: AD
authors.lastname: Purushotham
authors.affiliation: Department of Nuclear Medicine, Brighton and Sussex University Hospitals NHS Trust, UK.
authors.forename: A M
authors.initials: AM
authors.lastname: Peters
mesh_terms: D000328:Adult; D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D016022:Case-Control Studies; D004912:Erythrocytes; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects*; D008198:Lymph Nodes / Q000473:pathology*; D008208:Lymphatic System / Q000503:physiopathology; D042601:Lymphatic Vessels / Q000503:physiopathology*; D008209:Lymphedema / Q000209:etiology / Q000503:physiopathology*; D008875:Middle Aged; D015609:Organotechnetium Compounds; D011849:Radioactive Tracers; D034941:Upper Extremity
chemical_list: D015609:Organotechnetium Compounds; D011849:Radioactive Tracers
keywords: Breast cancer; Lymphoedema; Lymphovenous communications