Regional Distribution of Epifascial Swelling and Epifascial Lymph Drainage Rate Constants in Breast Cancer-Related Lymphedema
Identifieur interne : 003479 ( Pmc/Corpus ); précédent : 003478; suivant : 003480Regional Distribution of Epifascial Swelling and Epifascial Lymph Drainage Rate Constants in Breast Cancer-Related Lymphedema
Auteurs : Stephanie Modi ; Anthony W. B. Stanton ; Russell H. Mellor ; A. Michael Peters ; J. Rodney Levick ; Peter S. MortimerSource :
- Lymphatic research and biology [ 1539-6851 ] ; 2005.
Abstract
Url:
DOI: 10.1089/lrb.2005.3.3
PubMed: 15770081
PubMed Central: 1351041
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PMC:1351041Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Regional Distribution of Epifascial Swelling and Epifascial Lymph Drainage Rate Constants in Breast Cancer-Related Lymphedema</title>
<author><name sortKey="Modi, Stephanie" sort="Modi, Stephanie" uniqKey="Modi S" first="Stephanie" last="Modi">Stephanie Modi</name>
<affiliation><nlm:aff id="A1">Department of Cardiac & Vascular Sciences (Dermatology Unit), St. George's Hospital Medical School, London</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Stanton, Anthony W B" sort="Stanton, Anthony W B" uniqKey="Stanton A" first="Anthony W. B." last="Stanton">Anthony W. B. Stanton</name>
<affiliation><nlm:aff id="A1">Department of Cardiac & Vascular Sciences (Dermatology Unit), St. George's Hospital Medical School, London</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Mellor, Russell H" sort="Mellor, Russell H" uniqKey="Mellor R" first="Russell H." last="Mellor">Russell H. Mellor</name>
<affiliation><nlm:aff id="A1">Department of Cardiac & Vascular Sciences (Dermatology Unit), St. George's Hospital Medical School, London</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Michael Peters, A" sort="Michael Peters, A" uniqKey="Michael Peters A" first="A." last="Michael Peters">A. Michael Peters</name>
<affiliation><nlm:aff id="A2">Department of Nuclear Medicine, Addenbrooke's Hospital, Cambridge</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Rodney Levick, J" sort="Rodney Levick, J" uniqKey="Rodney Levick J" first="J." last="Rodney Levick">J. Rodney Levick</name>
<affiliation><nlm:aff id="A3">Department of Basic Medical Sciences (Physiology), St George's Hospital Medical School, London, United Kingdom</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Mortimer, Peter S" sort="Mortimer, Peter S" uniqKey="Mortimer P" first="Peter S." last="Mortimer">Peter S. Mortimer</name>
<affiliation><nlm:aff id="A1">Department of Cardiac & Vascular Sciences (Dermatology Unit), St. George's Hospital Medical School, London</nlm:aff>
</affiliation>
</author>
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Regional Distribution of Epifascial Swelling and Epifascial Lymph Drainage Rate Constants in Breast Cancer-Related Lymphedema</title>
<author><name sortKey="Modi, Stephanie" sort="Modi, Stephanie" uniqKey="Modi S" first="Stephanie" last="Modi">Stephanie Modi</name>
<affiliation><nlm:aff id="A1">Department of Cardiac & Vascular Sciences (Dermatology Unit), St. George's Hospital Medical School, London</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Stanton, Anthony W B" sort="Stanton, Anthony W B" uniqKey="Stanton A" first="Anthony W. B." last="Stanton">Anthony W. B. Stanton</name>
<affiliation><nlm:aff id="A1">Department of Cardiac & Vascular Sciences (Dermatology Unit), St. George's Hospital Medical School, London</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Mellor, Russell H" sort="Mellor, Russell H" uniqKey="Mellor R" first="Russell H." last="Mellor">Russell H. Mellor</name>
<affiliation><nlm:aff id="A1">Department of Cardiac & Vascular Sciences (Dermatology Unit), St. George's Hospital Medical School, London</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Michael Peters, A" sort="Michael Peters, A" uniqKey="Michael Peters A" first="A." last="Michael Peters">A. Michael Peters</name>
<affiliation><nlm:aff id="A2">Department of Nuclear Medicine, Addenbrooke's Hospital, Cambridge</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Rodney Levick, J" sort="Rodney Levick, J" uniqKey="Rodney Levick J" first="J." last="Rodney Levick">J. Rodney Levick</name>
<affiliation><nlm:aff id="A3">Department of Basic Medical Sciences (Physiology), St George's Hospital Medical School, London, United Kingdom</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Mortimer, Peter S" sort="Mortimer, Peter S" uniqKey="Mortimer P" first="Peter S." last="Mortimer">Peter S. Mortimer</name>
<affiliation><nlm:aff id="A1">Department of Cardiac & Vascular Sciences (Dermatology Unit), St. George's Hospital Medical School, London</nlm:aff>
</affiliation>
</author>
</analytic>
<series><title level="j">Lymphatic research and biology</title>
<idno type="ISSN">1539-6851</idno>
<idno type="eISSN">1557-8585</idno>
<imprint><date when="2005">2005</date>
</imprint>
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<front><div type="abstract" xml:lang="en"><p id="P1"><italic>Background</italic>
: The view that breast cancer-related lymphedema (BCRL) is a simple, direct mechanical result of axillary lymphatic obstruction (‘stopcock’ mechanism) appears incomplete, because parts of the swollen limb (e.g., hand) can remain nonswollen. The lymph drainage rate constant (<italic>k</italic>
) falls in the swollen forearm but not in the spared hand, indicating regional differences in lymphatic function. Here the generality of the hypothesis that regional epifascial lymphatic failure underlies regional swelling was tested. To do so, the regional distribution of epifascial swelling along the forearm was compared with that of epifascial (subcutis) <italic>k</italic>
.</p>
<p id="P2"><italic>Methods and Results</italic>
: Epifascial <italic>k</italic>
(local lymph flow per unit distribution volume) was measured by quantitative lymphoscintigraphy of subcutaneous radiolabeled human immunoglobulin IgG in regions of maximal and minimal % swelling in the ipsilateral swollen forearm, and at matching sites in the contralateral nonswollen arm, in 11 women with BCRL. Swelling was maximal distally in 5 patients and proximally in 6. Proximal <italic>k</italic>
, −0.085 ± 0.025% min<sup>−1</sup>
(mean ± SD), was 27% bigger than distal <italic>k</italic>
, −0.067 ± 0.021% min<sup>−1</sup>
, irrespective of swelling (<italic>p</italic>
= 0.02, two-way repeated measures ANOVA). <italic>k</italic>
fell by 11% from −0.080 ± 0.028% min<sup>−1</sup>
in the nonswollen arm to −0.072 ± 0.021% min<sup>−1</sup>
in the swollen arm (<italic>p</italic>
= 0.17, <italic>t</italic>
test). Local epifascial <italic>k</italic>
was not significantly lower, however, at sites of maximal swelling than minimal swelling, and <italic>k</italic>
correlated positively with arm circumference.</p>
<p id="P3"><italic>Conclusions</italic>
: A systematic difference in lymph drainage along the axis of the forearm was demonstrated for the first time. Local differences in epifascial <italic>k</italic>
did not, however, explain the regionality of swelling, in keeping with previous evidence that epifascial <italic>k</italic>
does not correlate with differences in swelling between arms, whereas subfascial <italic>k</italic>
does. The results lead to the rejection of the hypothesis that epifascial (<italic>cf.</italic>
subfascial) lymph drainage rate constants govern epifascial swelling in human forearm.</p>
</div>
</front>
</TEI>
<pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<pmc-dir>properties manuscript</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-journal-id">101163587</journal-id>
<journal-id journal-id-type="pubmed-jr-id">32169</journal-id>
<journal-id journal-id-type="nlm-ta">Lymphat Res Biol</journal-id>
<journal-id journal-id-type="iso-abbrev">Lymphat Res Biol</journal-id>
<journal-title-group><journal-title>Lymphatic research and biology</journal-title>
</journal-title-group>
<issn pub-type="ppub">1539-6851</issn>
<issn pub-type="epub">1557-8585</issn>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">15770081</article-id>
<article-id pub-id-type="pmc">1351041</article-id>
<article-id pub-id-type="doi">10.1089/lrb.2005.3.3</article-id>
<article-id pub-id-type="manuscript">UKMS6387</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Article</subject>
</subj-group>
</article-categories>
<title-group><article-title>Regional Distribution of Epifascial Swelling and Epifascial Lymph Drainage Rate Constants in Breast Cancer-Related Lymphedema</article-title>
</title-group>
<contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>MODI</surname>
<given-names>STEPHANIE</given-names>
</name>
<degrees>M.Sc.</degrees>
<xref ref-type="aff" rid="A1">1</xref>
</contrib>
<contrib contrib-type="author"><name><surname>STANTON</surname>
<given-names>ANTHONY W. B.</given-names>
</name>
<degrees>M.B. B.Ch., Ph.D.</degrees>
<xref ref-type="aff" rid="A1">1</xref>
</contrib>
<contrib contrib-type="author"><name><surname>MELLOR</surname>
<given-names>RUSSELL H.</given-names>
</name>
<degrees>Ph.D.</degrees>
<xref ref-type="aff" rid="A1">1</xref>
</contrib>
<contrib contrib-type="author"><name><surname>MICHAEL PETERS</surname>
<given-names>A.</given-names>
</name>
<degrees>M.Sc., M.D., F.R.C.R., F.R.C.Path., F.R.C.P.</degrees>
<xref ref-type="aff" rid="A2">2</xref>
</contrib>
<contrib contrib-type="author"><name><surname>RODNEY LEVICK</surname>
<given-names>J.</given-names>
</name>
<degrees>B.M. B.Ch., D.Phil., D.Sc., M.R.C.P.</degrees>
<xref ref-type="aff" rid="A3">3</xref>
</contrib>
<contrib contrib-type="author"><name><surname>MORTIMER</surname>
<given-names>PETER S.</given-names>
</name>
<degrees>M.D., F.R.C.P.</degrees>
<xref ref-type="aff" rid="A1">1</xref>
</contrib>
<aff id="A1"><label>1</label>
Department of Cardiac & Vascular Sciences (Dermatology Unit), St. George's Hospital Medical School, London</aff>
<aff id="A2"><label>2</label>
Department of Nuclear Medicine, Addenbrooke's Hospital, Cambridge</aff>
<aff id="A3"><label>3</label>
Department of Basic Medical Sciences (Physiology), St George's Hospital Medical School, London, United Kingdom</aff>
</contrib-group>
<author-notes><corresp id="CR1">Address reprint requests to: <italic>Stephanie Modi Department of Cardiac and Vascular Sciences (Dermatology Unit) St George's Hospital Medical School Cranmer Terrace London SW17 0RE, U.K. E-mail:</italic>
<email>smodi@sghms.ac.uk</email>
</corresp>
</author-notes>
<pub-date pub-type="nihms-submitted"><day>6</day>
<month>12</month>
<year>2005</year>
</pub-date>
<pub-date pub-type="ppub"><year>2005</year>
</pub-date>
<pub-date pub-type="pmc-release"><day>25</day>
<month>1</month>
<year>2006</year>
</pub-date>
<volume>3</volume>
<issue>1</issue>
<fpage>3</fpage>
<lpage>15</lpage>
<abstract><p id="P1"><italic>Background</italic>
: The view that breast cancer-related lymphedema (BCRL) is a simple, direct mechanical result of axillary lymphatic obstruction (‘stopcock’ mechanism) appears incomplete, because parts of the swollen limb (e.g., hand) can remain nonswollen. The lymph drainage rate constant (<italic>k</italic>
) falls in the swollen forearm but not in the spared hand, indicating regional differences in lymphatic function. Here the generality of the hypothesis that regional epifascial lymphatic failure underlies regional swelling was tested. To do so, the regional distribution of epifascial swelling along the forearm was compared with that of epifascial (subcutis) <italic>k</italic>
.</p>
<p id="P2"><italic>Methods and Results</italic>
: Epifascial <italic>k</italic>
(local lymph flow per unit distribution volume) was measured by quantitative lymphoscintigraphy of subcutaneous radiolabeled human immunoglobulin IgG in regions of maximal and minimal % swelling in the ipsilateral swollen forearm, and at matching sites in the contralateral nonswollen arm, in 11 women with BCRL. Swelling was maximal distally in 5 patients and proximally in 6. Proximal <italic>k</italic>
, −0.085 ± 0.025% min<sup>−1</sup>
(mean ± SD), was 27% bigger than distal <italic>k</italic>
, −0.067 ± 0.021% min<sup>−1</sup>
, irrespective of swelling (<italic>p</italic>
= 0.02, two-way repeated measures ANOVA). <italic>k</italic>
fell by 11% from −0.080 ± 0.028% min<sup>−1</sup>
in the nonswollen arm to −0.072 ± 0.021% min<sup>−1</sup>
in the swollen arm (<italic>p</italic>
= 0.17, <italic>t</italic>
test). Local epifascial <italic>k</italic>
was not significantly lower, however, at sites of maximal swelling than minimal swelling, and <italic>k</italic>
correlated positively with arm circumference.</p>
<p id="P3"><italic>Conclusions</italic>
: A systematic difference in lymph drainage along the axis of the forearm was demonstrated for the first time. Local differences in epifascial <italic>k</italic>
did not, however, explain the regionality of swelling, in keeping with previous evidence that epifascial <italic>k</italic>
does not correlate with differences in swelling between arms, whereas subfascial <italic>k</italic>
does. The results lead to the rejection of the hypothesis that epifascial (<italic>cf.</italic>
subfascial) lymph drainage rate constants govern epifascial swelling in human forearm.</p>
</abstract>
<funding-group><award-group><funding-source country="United Kingdom">Wellcome Trust : </funding-source>
<award-id>063025 || WT</award-id>
</award-group>
</funding-group>
</article-meta>
</front>
</pmc>
</record>
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