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Short-term effects of axillary lymph node clearance surgery on lymphatic physiology of the arm in breast cancer

¹Cambridge Breast Unit, and ²Department of Nuclear Medicine, Addenbrooke's Hospital, Cambridge; ³Department of Physiological Medicine, St. George's Hospital Medical School, London, United Kingdom

Submitted 1 April 2005 ; accepted in final form 14 August 2005

It is not known why some women develop breast cancer-related lymphedema (BCRL) of the arm, whereas others having similar treatment do not. We speculated that increased uptake of protein into local blood may protect against BCRL. Sixteen women were given bilateral subcutaneous hand webspace injections of polyclonal immunoglobulin (HIgG), ^99mTc-HIgG on one side and ¹¹¹In-HIgG on the other, before and 3 mo after axillary clearance surgery. The rates of clearance of activity from the depot (k) and accumulation in central blood (b_contra) were measured using a scintillation probe and bilateral antecubital vein blood sampling, respectively. Activity accumulating in blood ipsilateral to the injected side, in excess of central blood activity (b_ipsi) was also calculated as a measure of local vascular uptake. The k correlated with b_contra, but neither changed in response to surgery. However, b_ipsi for injections of ^99mTc-HIgG into the affected arm increased in all seven patients in whom data were available (0.018 ± 0.006 to 0.038 ± 0.007%/min; P < 0.05); indeed, in five of these seven, b_ipsi paradoxically exceeded b_contra, and none developed BCRL at 3-yr follow-up. We conclude that uptake of protein into local blood and/or proteolysis increases after axillary surgery and may protect against BCRL.

^99mTc-immunoglobulin; proteolysis

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