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The New Possibility of Lymphoscintigraphy to Guide a Clinical Treatment for Lymphedema in Patient With Breast Cancer

Seo, Kwan Sik, MD, PhD*; Suh, Minseok, MD; Hong, Sunmok, MD; Cheon, Gi Jeong, MD, PhD; Lee, Shi-Uk, MD, PhD§; Jung, Gwang Pyo, MD*

doi: 10.1097/RLU.0000000000002443
Original Articles

Objectives Lymphedema is a chronic disease that occurs frequently after breast cancer treatment. For the treatment of lymphedema, surgical approach such as vascularized lymph node transfer and super-microscopic lymphovenous anastomosis surgery is well established. Complex decongestive therapy (CDT) and sympathetic ganglion block (SGB) are two non-surgical therapeutic options. This study aimed to evaluate the effectiveness of lymphoscintigraphy in guiding the selection of the optimal non-surgical treatment in lymphedema.

Methods A total of 81 lymphedema patients who underwent lymphoscintigraphy and were treated with CDT or SGB were retrospectively evaluated. The parameters for the lymphoscintigraphic findings included the extent of dermal backflow (small extent/large extent groups), the level of lymphatic flow (trunk flow pattern/upper arm-restricted pattern/forearm-restricted pattern groups), and the visualization of lymph nodes (visualized/non-visualized groups). The change in the circumferential difference between the two sides of the body at the upper arm and forearm was used as the clinical outcome variable. Paired comparison and group comparison analysis were conducted.

Results Of 81 patients, 41 received CDT and 40 received SGB. There were no significant differences in demographic data between the CDT and SGB groups. Both CDT and SGB had a significant therapeutic effect. Upper arm edema was more significantly reduced after SGB than after CDT in the small extent group (P = 0.004), the forearm-restricted pattern group (P = 0.002), and the non-visualized group (P = 0.018). In the other groups, SGB and CDT showed comparable therapeutic effects without statistical differences.

Conclusion SGB was found to have a better therapeutic effect in the lymphedema patients with specific lymphoscintigraphic findings compared with CDT. Lymphoscintigraphy may be helpful in selecting the appropriate approach to lymphedema treatment. Further well-designed prospective studies are warranted to validate the findings of this study.

From the Departments of *Rehabilitation Medicine and

Nuclear Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul;

Seoul National University College of Medicine, Seoul; and

§Department of Rehabilitation Medicine, Seoul National University College of Medicine, Boramae Medical Center, Seoul, Korea.

Received for publication April 16, 2018; revision accepted November 19, 2018.

M.S. contributed this paper evenly as co-first authors.

Conflicts of interest and sources of funding: This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (No. 2018R1A2B6001296). None declared to all authors.

Correspondence to: Gwang Pyo Jung, MD, Department of Rehabilitation Medicine, Seoul National University Hospital, 101 Daehangno, Jongro-gu, Seoul 110-744, South Korea. E-mail: dext2000@gmail.com.

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