title: A constitutional predisposition to breast cancer-related lymphoedema and effect of axillary lymph node surgery on forearm muscle lymph flow.
abstract: OBJECTIVE
  The aims of this prospective study were (a) to examine the relationship between pre-operative muscle lymph flow and the predisposition to BCRL in women treated by axillary nodal surgery for breast cancer; and (b) to test the 'stopcock' hypothesis that axillary lymph node surgery impairs forearm lymph flow in the short term.
  
  
  METHODS
  (99m)Tc-nanocoll was injected intramuscularly into both forearms of women undergoing surgery for breast cancer. Lymphatic clearance rate constant, k, representing lymph flow per unit interstitial fluid volume, was measured as the fractional disappearance rate of radioactivity from the depot site by gamma camera imaging. Axillary lymph node activity was calculated as percentage injected activity. BCRL was assessed by clinical examination and upper limb perometry.
  
  
  RESULTS
  Of 38 pre-operative women, 33 attended at 8 ± 6 weeks post-operatively and 31 at 58 ± 9 weeks post-operatively. Seven patients (18%) developed BCRL. Prior to surgery the BCRL-destined patients had a higher mean k (0.0962 ± 0.034%/min) than non-BCRL patients (0.0830 ± 0.019%/min) (p = 0.10, unpaired t test). Post-operative k values were not significantly different from pre-operative, in either the ipsilateral (operated) or contralateral limb. Also, post-operative k values did not differ significantly between both upper limbs. Furthermore, there was no significant difference between pre- and post-operative axillary activity.
  
  
  CONCLUSIONS
  Patients who develop BCRL have high lymph flow pre-surgery, which may predispose them to lymphatic overload and failure. Axillary lymph node surgery has no early, measurable effect on forearm muscle lymph flow despite surgical disruption of routes of lymph drainage.
authors.affiliation: Division of Cancer Studies, King's College London, United Kingdom; Guy's & St Thomas' NHS Foundation Trust, United Kingdom.
authors.forename: S K
authors.initials: SK
authors.lastname: Bains
authors.affiliation: Clinical Sciences, St George's, University of London, United Kingdom.
authors.forename: A W B
authors.initials: AW
authors.lastname: Stanton
authors.affiliation: Clinical Sciences, St George's, University of London, United Kingdom.
authors.forename: V
authors.initials: V
authors.lastname: Cintolesi
authors.affiliation: Guy's & St Thomas' NHS Foundation Trust, United Kingdom.
authors.forename: J
authors.initials: J
authors.lastname: Ballinger
authors.affiliation: Guy's & St Thomas' NHS Foundation Trust, United Kingdom.
authors.forename: S
authors.initials: S
authors.lastname: Allen
authors.affiliation: Department of Breast Surgery, Brighton and Sussex University Hospitals NHS Trust, United Kingdom.
authors.forename: C
authors.initials: C
authors.lastname: Zammit
authors.affiliation: Clinical Sciences, St George's, University of London, United Kingdom.
authors.forename: J R
authors.initials: JR
authors.lastname: Levick
authors.affiliation: Clinical Sciences, St George's, University of London, United Kingdom.
authors.forename: P S
authors.initials: PS
authors.lastname: Mortimer
authors.affiliation: Department of Nuclear Medicine, Brighton and Sussex University Hospitals NHS Trust, United Kingdom.
authors.forename: A M
authors.initials: AM
authors.lastname: Peters
authors.affiliation: Division of Cancer Studies, King's College London, United Kingdom; Guy's & St Thomas' NHS Foundation Trust, United Kingdom. Electronic address: claire.arnold@kcl.ac.uk.
authors.forename: A D
authors.initials: AD
authors.lastname: Purushotham
mesh_terms: D000328:Adult; D000368:Aged; D001365:Axilla; D001824:Body Constitution; D001943:Breast Neoplasms / Q000150:complications / Q000601:surgery*; D004198:Disease Susceptibility; D005260:Female; D005542:Forearm; D006801:Humans; D008196:Lymph / Q000502:physiology*; D008198:Lymph Nodes / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D008209:Lymphedema / Q000453:epidemiology / Q000209:etiology*; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000502:physiology*; D011446:Prospective Studies
keywords: Breast cancer; Lymph flow; Lymphoedema; Lymphoscintigraphy; Upper limb