Long-term changes on lymphoscintigraphy and their association with clinical parameters in secondary lymphedema after breast cancer surgery

Abstract

Abstract Purpose: To investigate long-term changes on lymphoscintigraphy and their association with clinical parameters in patients with breast cancer-related lymphedema (BCRL). Methods: This single-center cohort study included patients with BCRL who underwent baseline and follow-up lymphoscintigraphy. The percentage of excessive circumference (PEC) of the affected upper limb compared with the unaffected side was used as an indicator of the clinical severity of BCRL. Each 99mTc-phytate lymphoscintigraphy image was categorized into 0‒6 stages according to the Taiwan lymphoscintigraphy staging system. Clinical parameters including PEC and the lymphoscintigraphy stage at baseline and follow-up were compared and analyzed. Results: Eighty-seven patients were included. Baseline and follow-up lymphoscintigraphies were performed at a median 7 (interquartile range [IQR]: 2‒14) and 78 (IQR: 49‒116) months after surgery, respectively. Both lymphoscintigraphy stage and PEC showed variable change during the study period, with overall increases in their severity (median PEC: 3.8–13.4%; median lymphoscintigraphy stage: 1 to 4). PEC and lymphoscintigraphy stage showed positive correlations at baseline (rho = 0.27, P=0.001) and follow-up (rho = 0.50, P<0.001). Stepwise multivariable analysis revealed cellulitis (adjusted β: 4.34; 95% confidence interval [CI]: 0.77‒7.91) and lymphoscintigraphy stage at follow-up (adjusted β: 1.47; 95% CI: 0.67‒2.28) to be independent variables for PEC at follow-up. Conclusion: The clinical courses of BCRL and patients’ lymphoscintigraphy patterns showed diverse changes over long-term follow-up. In addition to initial lymphoscintigraphy for diagnosis, follow-up lymphoscintigraphy can be useful to visualize functional changes in the lymphatic system that may help to guide the optimal management plan in BCRL.