title: Validity of Quantitative Lymphoscintigraphy as a Lymphedema Assessment Tool for Patients With Breast Cancer.
abstract: OBJECTIVE
  To evaluate the validity of quantitative lymphoscintigraphy as a useful lymphedema assessment tool for patients with breast cancer surgery including axillary lymph node dissection (ALND).
  
  
  METHODS
  We recruited 72 patients with lymphedema after breast cancer surgery that included ALND. Circumferences in their upper limbs were measured in five areas: 15 cm proximal to the lateral epicondyle (LE), the elbow, 10 cm distal to the LE, the wrist, and the metacarpophalangeal joint. Then, maximal circumference difference (MCD) was calculated by subtracting the unaffected side from the affected side. Quantitative asymmetry indices (QAI) were defined as the radiopharmaceutical uptake ratios of the affected side to the unaffected side. Patients were divided into 3 groups by qualitative lymphoscintigraphic patterns: normal, decreased function, and obstruction.
  
  
  RESULTS
  The MCD was highest in the qualitative obstruction (2.76±2.48) pattern with significant differences from the normal (0.69±0.78) and decreased function (1.65±1.17) patterns. The QAIs of the axillary LNs showed significant differences among the normal (0.82±0.29), decreased function (0.42±0.41), and obstruction (0.18±0.16) patterns. As the QAI of the axillary LN increased, the MCD decreased. The QAIs of the upper limbs were significantly higher in the obstruction (3.12±3.07) pattern compared with the normal (1.15±0.10) and decreased function (0.79±0.30) patterns.
  
  
  CONCLUSIONS
  Quantitative lymphoscintigraphic analysis is well correlated with both commonly used qualitative lymphoscintigraphic analysis and circumference differences in the upper limbs of patients with breast cancer surgery with ALND. Quantitative lymphoscintigraphy may be a good alternative assessment tool for diagnosing lymphedema after breast cancer surgery with ALND.
authors.affiliation: Department of Rehabilitation Medicine, Kyungpook National University College of Medicine, Daegu, Korea.
authors.forename: Ji-Na
authors.initials: JN
authors.lastname: Yoo
authors.affiliation: Department of Rehabilitation Medicine, Kyungpook National University College of Medicine, Daegu, Korea.
authors.forename: Youn-Soo
authors.initials: YS
authors.lastname: Cheong
authors.affiliation: Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu, Korea.
authors.forename: Yu-Sun
authors.initials: YS
authors.lastname: Min
authors.affiliation: Department of Nuclear Medicine, Kyungpook National University Medical Center, Daegu, Korea.
authors.forename: Sang-Woo
authors.initials: SW
authors.lastname: Lee
authors.affiliation: Department of Surgery, Breast Cancer Center, Kyungpook National University Medical Center, Daegu, Korea.
authors.forename: Ho Yong
authors.initials: HY
authors.lastname: Park
authors.affiliation: Department of Rehabilitation Medicine, Kyungpook National University College of Medicine, Daegu, Korea.; Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu, Korea.
authors.forename: Tae-Du
authors.initials: TD
authors.lastname: Jung
keywords: Breast cancer; Lymph node dissection; Lymphedema; Lymphoscintigraphy; Upper extremity