Upper extremity lymphatic function at rest and during exercise in breast cancer survivors with and without lymphedema compared with healthy controls

• Published in: Journal of applied physiology (1985) Vol. 103; no. 3; pp. 917 - 925
• Main Authors: Lane, Kirstin N, Dolan, Lianne B, Worsley, Dan, McKenzie, Don C
• Format: Journal Article
• Language: English
• Published: Bethesda, MD Am Physiological Soc 01-09-2007; American Physiological Society
• Subjects: Aged; Biological and medical sciences; Breast cancer; Breast Neoplasms - radiotherapy; Breast Neoplasms - surgery; Case-Control Studies; Comparative analysis; Cross-Sectional Studies; Exercise; Exercise - physiology; Female; Fundamental and applied biological sciences. Psychology; Humans; Lymphatic system; Lymphatic Vessels - diagnostic imaging; Lymphatic Vessels - physiopathology; Lymphedema - diagnostic imaging; Lymphedema - etiology; Lymphedema - physiopathology; Middle Aged; Postoperative Complications - physiopathology; Prospective Studies; Radionuclide Imaging; Upper Extremity - diagnostic imaging; Upper Extremity - physiopathology; Physical exercise; lymphoscintigraphy; Mammary gland diseases; Vertebrata; Rest; Mammalia; Lymphedema; Cardiovascular disease; Breast cancer; Malignant tumor; Lymphatic vessel disease
• ISSN: 8750-7587; 1522-1601
• DOI: 10.1152/japplphysiol.00077.2007

Departments of 1 Medicine, 2 Human Kinetics, and 3 Radiology, University of British Columbia, Vancouver, British Columbia, Canada
Submitted 16 January 2007
; accepted in final form 15 June 2007
Lymphoscintigraphy was used to measure lymphatic function at rest and during exercise in breast cancer survivors with lymphedema (BCRL, n = 10), breast cancer survivors (BC, n = 10), and controls (Cont, n = 10). After injection of 99m Tc-antimony colloid to the hands, subjects rested or performed 12 repeated sets of arm cranking for 2.5 min at 0.6 W/kg followed by 2.5 min of rest. One-minute spot views were taken with a gamma-radiation camera immediately postinjection and every 10 min over 60 min to calculate clearance rate. As well, an upper body scan was taken at 65 min postinjection to measure radiopharmaceutical uptake in the axilla (Ax) and forearm (Fore). All groups displayed similar increases in clearance rate with exercise ( P = 0.000). Ax significantly increased with exercise in Cont only [Cont: (mean ± SD) 4.9 ± 2.6 vs. 7.9 ± 4.2%, P = 0.000; BCRL: 1.4 ± 1.2 vs. 1.7 ± 2.1%, P = 0.531; BC: 3.9 ± 3.4 vs. 5.2 ± 3.2%, P = 0.130], whereas Fore, indicating dermal backflow, significantly increased in BCRL only (BCRL: 2.4 ± 0.87 vs. 4.4 ± 2.0%, P = 0.004; BC: 1.1 ± 0.25 vs. 1.1 ± 0.31%, P = 0.784; Cont: 0.93 ± 0.26 vs. 1.0 ± 0.20%, P = 0.296). The results indicate that, in women with BCRL, exercise causes radiopharmaceuticals to clear from the hand at the same rate as BC and Cont, but, instead of reaching the axilla, a greater amount of activity gets trapped in the dermis of the forearm. BC, meanwhile, have similar lymphatic function as Cont; however, there is a highly variable response that may suggest that some BC subjects may be at risk for developing lymphedema.
lymphoscintigraphy
Address for reprint requests and other correspondence: K. N. Lane, Division of Sports Medicine, Univ. of British Columbia, 3055 Wesbrook Mall, Vancouver, BC, Canada, V6T 1Z3 (e-mail: klane{at}interchange.ubc.ca )