Bilateral Changes in Deep Tissue Environment After Manual Lymphatic Drainage in Patients with Breast Cancer Treatment-Related Lymphedema.
Breast cancer treatment-related lymphedema (BCRL) arises from a mechanical insufficiency following cancer therapies. Early BCRL detection and personalized intervention require an improved understanding of the physiological processes that initiate lymphatic impairment. Here, internal magnetic resonance imaging (MRI) measures of the tissue microenvironment were paired with clinical measures of tissue structure to test fundamental hypotheses regarding structural tissue and muscle changes after the commonly used therapeutic intervention of manual lymphatic drainage (MLD).



Measurements to identify lymphatic dysfunction in healthy volunteers (n = 29) and patients with BCRL (n = 16) consisted of (1) limb volume, tissue dielectric constant, and bioelectrical impedance (i.e., non-MRI measures); (2) qualitative 3 Tesla diffusion-weighted, T1-weighted and T2-weighted MRI; and (3) quantitative multi-echo T2MRI of the axilla. Measurements were repeated in patients immediately following MLD. Normative control and BCRL T2values were quantified and a signed Wilcoxon Rank-Sum test was applied (significance: two-sided p < 0.05). Non-MRI measures yielded significant capacity for discriminating between arms with versus without clinical signs of BCRL, yet yielded no change in response to MLD. Alternatively, a significant increase in deep tissue T2on the involved (pre T2= 0.0371 ± 0.003 seconds; post T2= 0.0389 ± 0.003; p = 0.029) and contralateral (pre T2= 0.0365 ± 0.002; post T2= 0.0395 ± 0.002; p < 0.01) arms was observed. Trends for larger T2increases on the involved side after MLD in patients with stage 2 BCRL relative to earlier stages 0 and 1 BCRL were observed, consistent with tissue composition changes in later stages of BCRL manifesting as breakdown of fibrotic tissue after MLD in the involved arm. Contrast consistent with relocation of fluid to the contralateral quadrant was observed in all stages.



Quantitative deep tissue T2MRI values yielded significant changes following MLD treatment, whereas non-MRI measurements did not vary. These findings highlight that internal imaging measures of tissue composition may be useful for evaluating how current and emerging therapies impact tissue function.
1 Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center , Nashville, Tennessee.|2 Vanderbilt Dayani Center for Health and Wellness , Nashville, Tennessee.
Paula M C
PM
Donahue
3 Department of Radiology, Vanderbilt University Medical Center , Nashville, Tennessee.
Rachelle
R
Crescenzi
3 Department of Radiology, Vanderbilt University Medical Center , Nashville, Tennessee.
Allison O
AO
Scott
3 Department of Radiology, Vanderbilt University Medical Center , Nashville, Tennessee.
Vaughn
V
Braxton
3 Department of Radiology, Vanderbilt University Medical Center , Nashville, Tennessee.
Aditi
A
Desai
3 Department of Radiology, Vanderbilt University Medical Center , Nashville, Tennessee.
Seth A
SA
Smith
4 Benchmark Physical Therapy , Chattanooga, Tennessee.
John
J
Jordi
5 Department of Surgical Oncology, Vanderbilt University Medical Center , Nashville, Tennessee.
Ingrid M
IM
Meszoely
5 Department of Surgical Oncology, Vanderbilt University Medical Center , Nashville, Tennessee.
Ana M
AM
Grau
5 Department of Surgical Oncology, Vanderbilt University Medical Center , Nashville, Tennessee.
Rondi M
RM
Kauffmann
5 Department of Surgical Oncology, Vanderbilt University Medical Center , Nashville, Tennessee.
Raeshell S
RS
Sweeting
6 Vanderbilt School of Nursing , Nashville, Tennessee.
Kandace
K
Spotanski
6 Vanderbilt School of Nursing , Nashville, Tennessee.
Sheila H
SH
Ridner
3 Department of Radiology, Vanderbilt University Medical Center , Nashville, Tennessee.|7 Department of Psychiatry, Vanderbilt University Medical Center , Nashville, Tennessee.|8 Department of Neurology, Vanderbilt University Medical Center , Nashville, Tennessee.|9 Department of Physics and Astronomy, Vanderbilt University , Nashville, Tennessee.
Manus J
MJ
Donahue
D000328:Adult; D001365:Axilla; D000072656:Breast Cancer Lymphedema / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy*; D001943:Breast Neoplasms / Q000150:complications / Q000628:therapy; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects; D042601:Lymphatic Vessels / Q000503:physiopathology*; D008279:Magnetic Resonance Imaging; D008405:Massage / Q000379:methods*; D008875:Middle Aged; D016896:Treatment Outcome
MLD; MRI; cancer; lymphatic; lymphedema; manual lymphatic drainage; therapy