Differences in lymph drainage between swollen and non-swollen regions in arms with breast-cancer-related lymphoedema.
Identifieur interne : 009A53 ( Main/Exploration ); précédent : 009A52; suivant : 009A54Differences in lymph drainage between swollen and non-swollen regions in arms with breast-cancer-related lymphoedema.
Auteurs : A W Stanton [Royaume-Uni] ; W E Svensson ; R H Mellor ; A M Peters ; J R Levick ; Peter Mortimer (dermatologue) [Royaume-Uni]Source :
- Clinical science (London, England : 1979) [ 0143-5221 ] ; 2001.
Descripteurs français
- KwdFr :
- Analyse de régression, Analyse de variance, Bras, Caméras à rayons gamma, Exercice physique, Femelle, Humains, Immunoglobuline G, Lymphoedème (imagerie diagnostique), Lymphoedème (physiopathologie), Lymphoedème (étiologie), Main, Modèles linéaires, Méthode des moindres carrés, Scintigraphie, Statistique non paramétrique, Sujet âgé, Technétium, Tumeurs du sein (), Tumeurs du sein (imagerie diagnostique), Tumeurs du sein (physiopathologie), Études cas-témoins.
- MESH :
- imagerie diagnostique : Lymphoedème, Tumeurs du sein.
- physiopathologie : Lymphoedème, Tumeurs du sein.
- étiologie : Lymphoedème.
- Analyse de régression, Analyse de variance, Bras, Caméras à rayons gamma, Exercice physique, Femelle, Humains, Immunoglobuline G, Main, Modèles linéaires, Méthode des moindres carrés, Scintigraphie, Statistique non paramétrique, Sujet âgé, Technétium, Tumeurs du sein, Études cas-témoins.
English descriptors
- KwdEn :
- Aged, Analysis of Variance, Arm, Breast Neoplasms (complications), Breast Neoplasms (diagnostic imaging), Breast Neoplasms (physiopathology), Case-Control Studies, Exercise, Female, Gamma Cameras, Hand, Humans, Immunoglobulin G, Least-Squares Analysis, Linear Models, Lymphedema (diagnostic imaging), Lymphedema (etiology), Lymphedema (physiopathology), Radionuclide Imaging, Regression Analysis, Statistics, Nonparametric, Technetium.
- MESH :
- chemical : Immunoglobulin G, Technetium.
- complications : Breast Neoplasms.
- diagnostic imaging : Breast Neoplasms, Lymphedema.
- etiology : Lymphedema.
- physiopathology : Breast Neoplasms, Lymphedema.
- Aged, Analysis of Variance, Arm, Case-Control Studies, Exercise, Female, Gamma Cameras, Hand, Humans, Least-Squares Analysis, Linear Models, Radionuclide Imaging, Regression Analysis, Statistics, Nonparametric.
Abstract
Recent research indicates that the pathophysiology of breast-cancer-related lymphoedema (BCRL) is more complex than simple axillary lymphatic obstruction as a result of the cancer treatment. Uneven distribution of swelling (involvement of the mid-arm region is common, but the hand is often spared) is puzzling. Our aim was to test the hypothesis that local differences in lymphatic drainage contribute to the regionality of the oedema. Using lymphoscintigraphy, we measured the removal rate constant, k (representing local lymph flow per unit distribution volume, VD), for 99mTc-labelled human immunoglobulin G in the oedematous proximal forearm, and in the hand (finger web) in women in whom the hand was unaffected. Tracer was injected subcutaneously, and the depot plus the rest of the arm was monitored with a gamma-radiation camera for up to 6 h. VD was assessed from image width. Contralateral arms served as controls. k was 25% lower in oedematous forearm tissue than in the control arm (BCRL, -0.070+/-0.026% x min(-1); control, -0.093+/-0.028% x min(-1); mean+/-S.D.; P=0.012) and VD was greater. In the non-oedematous hand of the BCRL arm, k was 18% higher than in the control hand (BCRL, -0.110+/-0.027% x min(-1); control, -0.095+/-0.028% x min(-1); P=0.057) and 59% higher than forearm k on the BCRL side (P=0.0014). VD did not differ between the hands. Images of the BCRL arm following hand injection showed diffuse activity in the superficial tissues, sometimes extending almost to the shoulder. A possible interpretation is that the hand is spared in some patients because local lymph flow is increased and diverted along collateral dermal routes. The results support the hypothesis that regional differences in surviving lymphatic function contribute to the distribution of swelling.
PubMed: 11473486
Affiliations:
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lymphoedema.</title><author><name sortKey="Stanton, A W" sort="Stanton, A W" uniqKey="Stanton A" first="A W" last="Stanton">A W Stanton</name><affiliation wicri:level="1"><nlm:affiliation>Division of Physiological Medicine (Dermatology), Department of Medicine, St George's Hospital Medical School, Cranmer Terrace, London SW170RE, UK. astanton@sghms.ac.uk</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Division of Physiological Medicine (Dermatology), Department of Medicine, St George's Hospital Medical School, Cranmer Terrace, London SW170RE</wicri:regionArea><wicri:noRegion>London SW170RE</wicri:noRegion></affiliation></author><author><name sortKey="Svensson, W E" sort="Svensson, W E" uniqKey="Svensson W" first="W E" last="Svensson">W E Svensson</name></author><author><name sortKey="Mellor, R H" sort="Mellor, R H" uniqKey="Mellor R" first="R H" last="Mellor">R H Mellor</name></author><author><name sortKey="Peters, A M" sort="Peters, A M" uniqKey="Peters A" first="A M" last="Peters">A M Peters</name></author><author><name sortKey="Levick, J R" sort="Levick, J R" uniqKey="Levick J" first="J R" last="Levick">J R Levick</name></author><author><name sortKey="Mortimer, P S" sort="Mortimer, P S" uniqKey="Mortimer P" first="P S" last="Mortimer">Peter Mortimer (dermatologue)</name><affiliation><country>Royaume-Uni</country><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName><orgName type="university">Université de Londres</orgName></affiliation></author></analytic><series><title level="j">Clinical science (London, England : 1979)</title><idno type="ISSN">0143-5221</idno><imprint><date when="2001" type="published">2001</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Aged</term><term>Analysis of Variance</term><term>Arm</term><term>Breast Neoplasms 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(étiologie)</term><term>Main</term><term>Modèles linéaires</term><term>Méthode des moindres carrés</term><term>Scintigraphie</term><term>Statistique non paramétrique</term><term>Sujet âgé</term><term>Technétium</term><term>Tumeurs du sein ()</term><term>Tumeurs du sein (imagerie diagnostique)</term><term>Tumeurs du sein (physiopathologie)</term><term>Études cas-témoins</term></keywords><keywords scheme="MESH" type="chemical" xml:lang="en"><term>Immunoglobulin G</term><term>Technetium</term></keywords><keywords scheme="MESH" qualifier="complications" xml:lang="en"><term>Breast Neoplasms</term></keywords><keywords scheme="MESH" qualifier="diagnostic imaging" xml:lang="en"><term>Breast Neoplasms</term><term>Lymphedema</term></keywords><keywords scheme="MESH" qualifier="etiology" xml:lang="en"><term>Lymphedema</term></keywords><keywords scheme="MESH" qualifier="imagerie diagnostique" xml:lang="fr"><term>Lymphoedème</term><term>Tumeurs du sein</term></keywords><keywords scheme="MESH" qualifier="physiopathologie" xml:lang="fr"><term>Lymphoedème</term><term>Tumeurs du sein</term></keywords><keywords scheme="MESH" qualifier="physiopathology" xml:lang="en"><term>Breast Neoplasms</term><term>Lymphedema</term></keywords><keywords scheme="MESH" qualifier="étiologie" xml:lang="fr"><term>Lymphoedème</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Aged</term><term>Analysis of Variance</term><term>Arm</term><term>Case-Control Studies</term><term>Exercise</term><term>Female</term><term>Gamma Cameras</term><term>Hand</term><term>Humans</term><term>Least-Squares Analysis</term><term>Linear Models</term><term>Radionuclide Imaging</term><term>Regression Analysis</term><term>Statistics, Nonparametric</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Analyse de régression</term><term>Analyse de variance</term><term>Bras</term><term>Caméras à rayons gamma</term><term>Exercice physique</term><term>Femelle</term><term>Humains</term><term>Immunoglobuline G</term><term>Main</term><term>Modèles linéaires</term><term>Méthode des moindres carrés</term><term>Scintigraphie</term><term>Statistique non paramétrique</term><term>Sujet âgé</term><term>Technétium</term><term>Tumeurs du sein</term><term>Études cas-témoins</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Recent research indicates that the pathophysiology of breast-cancer-related lymphoedema (BCRL) is more complex than simple axillary lymphatic obstruction as a result of the cancer treatment. Uneven distribution of swelling (involvement of the mid-arm region is common, but the hand is often spared) is puzzling. Our aim was to test the hypothesis that local differences in lymphatic drainage contribute to the regionality of the oedema. Using lymphoscintigraphy, we measured the removal rate constant, k (representing local lymph flow per unit distribution volume, VD), for 99mTc-labelled human immunoglobulin G in the oedematous proximal forearm, and in the hand (finger web) in women in whom the hand was unaffected. Tracer was injected subcutaneously, and the depot plus the rest of the arm was monitored with a gamma-radiation camera for up to 6 h. VD was assessed from image width. Contralateral arms served as controls. k was 25% lower in oedematous forearm tissue than in the control arm (BCRL, -0.070+/-0.026% x min(-1); control, -0.093+/-0.028% x min(-1); mean+/-S.D.; P=0.012) and VD was greater. In the non-oedematous hand of the BCRL arm, k was 18% higher than in the control hand (BCRL, -0.110+/-0.027% x min(-1); control, -0.095+/-0.028% x min(-1); P=0.057) and 59% higher than forearm k on the BCRL side (P=0.0014). VD did not differ between the hands. Images of the BCRL arm following hand injection showed diffuse activity in the superficial tissues, sometimes extending almost to the shoulder. A possible interpretation is that the hand is spared in some patients because local lymph flow is increased and diverted along collateral dermal routes. The results support the hypothesis that regional differences in surviving lymphatic function contribute to the distribution of swelling.</div></front></TEI><affiliations><list><country><li>Royaume-Uni</li></country><region><li>Angleterre</li><li>Grand Londres</li></region><settlement><li>Londres</li></settlement><orgName><li>Université de Londres</li></orgName></list><tree><noCountry><name sortKey="Levick, J R" sort="Levick, J R" uniqKey="Levick J" first="J R" last="Levick">J R Levick</name><name sortKey="Mellor, R H" sort="Mellor, R H" uniqKey="Mellor R" first="R H" last="Mellor">R H Mellor</name><name sortKey="Peters, A M" sort="Peters, A M" uniqKey="Peters A" first="A M" last="Peters">A M Peters</name><name sortKey="Svensson, W E" sort="Svensson, W E" uniqKey="Svensson W" first="W E" last="Svensson">W E Svensson</name></noCountry><country name="Royaume-Uni"><noRegion><name sortKey="Stanton, A W" sort="Stanton, A W" uniqKey="Stanton A" first="A W" last="Stanton">A W Stanton</name></noRegion><name sortKey="Mortimer, P S" sort="Mortimer, P S" uniqKey="Mortimer P" first="P S" last="Mortimer">Peter Mortimer (dermatologue)</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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