Constitutively Enhanced Lymphatic Pumping in the Upper Limbs of Women Who Later Develop Breast Cancer-Related Lymphedema.
It has previously been shown that the lymph drainage rate in both upper limbs is greater in women destined to develop breast cancer-related lymphedema (BCRL) than in those who do not develop BCRL, indicating a constitutive predisposition. We explored constitutive differences further by measuring the maximum lymphatic pump pressure (Ppump) and the rate of (99m)Tc-Nanocoll transport generated by the contractile upper limb lymphatics before and after breast cancer surgery in a group of women who were followed for 2 years to determine their eventual BCRL or non-BCRL status.



Ppump and tracer transport rate were measured by lymphatic congestion lymphoscintigraphy in the ipsilateral upper limb in 26 women pre- and post-breast cancer surgery. BCRL occurred in 10/26 (38.5%) cases. Ppump in the women who later developed BCRL (40.0 ± 8.2 mmHg) was 1.7-fold higher than in those who did not develop BCRL (23.1 ± 10.8 mmHg, p = 0.001). Moreover, the rate of lymph tracer transport into the forearm was 2.2-fold greater in the women who later developed BCRL (p = 0.052). Surgery did not significantly reduce Ppump measured 21 weeks postsurgery, but impaired forearm tracer transport in pre-BCRL women by 58% (p = 0.047), although not in those who did not develop BCRL.



Women destined to develop BCRL have higher pumping pressures and lymph transport, indicating harder-working lymphatics before cancer treatment. Axillary lymphatic damage from surgery appears to compromise lymph drainage in those women constitutively predisposed to higher lymphatic pressures and lymph transport.
1 Cardiovascular and Cell Sciences Research Institute, St George's, University of London , London, United Kingdom .
Viviana
V
Cintolesi
1 Cardiovascular and Cell Sciences Research Institute, St George's, University of London , London, United Kingdom .
Anthony W B
AW
Stanton
2 Department of Research Oncology, King's College London, Guy's Hospital , London, United Kingdom .
Salena K
SK
Bains
1 Cardiovascular and Cell Sciences Research Institute, St George's, University of London , London, United Kingdom .
Emma
E
Cousins
3 Department of Nuclear Medicine, Brighton and Sussex University Hospitals NHS Trust , Brighton, United Kingdom .
A Michael
AM
Peters
2 Department of Research Oncology, King's College London, Guy's Hospital , London, United Kingdom .
Arnie D
AD
Purushotham
1 Cardiovascular and Cell Sciences Research Institute, St George's, University of London , London, United Kingdom .
J Rodney
JR
Levick
1 Cardiovascular and Cell Sciences Research Institute, St George's, University of London , London, United Kingdom .|4 Department of Dermatology, St George's University Hospitals NHS Foundation Trust , London, United Kindom.|5 Skin Unit, The Royal Marsden NHS Foundation Trust , Sutton, Surrey, United Kingdom .
Peter S
PS
Mortimer
D000328:Adult; D000368:Aged; D001365:Axilla; D015992:Body Mass Index; D000072656:Breast Cancer Lymphedema / Q000175:diagnosis / Q000503:physiopathology*; D001943:Breast Neoplasms / Q000150:complications / Q000601:surgery; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008208:Lymphatic System / Q000473:pathology / Q000503:physiopathology*; D061305:Lymphoscintigraphy; D008875:Middle Aged; D009929:Organ Size; D034941:Upper Extremity / Q000473:pathology / Q000503:physiopathology*