Brain Function
Authors: M. Holzbauer
Journal: BMJ (1965)

<b>417</b> <h3><b>Objectives:</b></h3> Breast-cancer-related lymphoedema (BCRL) is a common complication in postoperative patients with breast cancer. Reported arm lymphedema rates after an axillary lymph nodes dissection(ALND) range from 6% to 62%. Although sentinel lymph node biopsy (SLNB) has been established as a less invasive approach for axillary staging , but there are still 2% -7% of patients after SLNB will occur in upper extremity lymphedema.More and more researchers are trying to protect lymph nodes to keep away from lymphedema, however, there is little research about the location of the upper extremity lymph nodes.The aim of this study is to analyze the characteristics of normal upper extremity lymphatic drainage, to analyze the relationship between the change of long-term postoperative upper limb lymphatic drainage and breast cancer related lymphedema,and at the same time analysis the diagnostic value of lymphoscintigraphy in axillary lymph node metastasis of breast cancer. <b>Materials and Methods:</b> From October 2015 to February 2016 we continuously collected 67 patients with breast carcinoma postoperative follow-up, and 74 patients who were going to undertake sentinel lymph node biopsy or axillary lymph nodes dissection. All preoperative patients completed lymphoscintigraphy between 2 to 4 h prior to the surgical procedure.For lymphoscintigraphy ,74Mbq of <sup>99m</sup>Tc - DX in a volume of 0.1-0.2 ml was injected intradermally in the second interdigital space of both hands , Anterior and posterior planar images of upper extremities were scanned in supine position at 5, 15, 60 and 120 minutes with Phillips Precedence 6 SPECT/CT, SPECT/CT was also performed to clarify the relationships between functional and morphological information. Image observation including the anatomical extent of lymphatic disorders , the presence or absence of lymph nodes , the visualization of lymph vessels and the presence of dermal backflow . <h3><b>Results:</b></h3> The final pathology of 74 cases of preoperative imaging confirmed axillary lymph node metastasis in 53 ones and axillary lymph node metastasis in 21 ones.Upper limb axillary reverse mapping(ARM) of 53 cases without axillary lymph node metastasis shows that, all of the normal upper limb lymphatic drainage has the imaging of axillary ARM lymphatics and lymph nodes. Axillary region ARM lymph node imaging rate is 100%, and the clavicle area ARM lymph node imaging rate is 50%.The patients who suffered BCRL have a lower rate of armpit ARM lymph node imaging ( 14.0% VS 66.7%, P values &lt; 0.05). The clavicle area ARM lymph node imaging rate of patients who suffer more serious BCRL is significantly lower than the lighter (27.6% VS 80.7%, P values &lt; 0.05). In the group of preoperative patients ,21 had pathologically metastatic axillary nodes, while SPECT/CT imaging found metastasis lymph node in 19 ones, the sensitivity ,specificity and accuracy of SPECT/CT imaging in diagnosis of metastasis lymph nodes in this group was 90.4%, 98.1% and 95.9% . <b>Conclusion:</b> The ARM lymph nodes exist in clavicle area may help to reduce the degree of BCRL,the occurrence of upper limb lymphedema may associated with the compensation degree of lymph nodes in the clavicle area .SPECT/CT lymphoscintigraphy has high sensitivity and specificity for the detection and localization of metastatic lymph nodes in breast cancer.