Br J Surg. 2005 Mar
Pain SJ, Vowler S, Purushotham AD.
Cambridge Breast Unit, Addenbrooke's Hospital, Hills Road, Cambridge CB2 2QQ, UK.
email: A. D. Purushotham (amy.byrtus@addenbrookes.nhs.uk)
*Correspondence to A. D. Purushotham, Cambridge Breast Unit, Box 97, Addenbrooke's Hospital, Hills Road, Cambridge CB2 2QQ, UKPresented in part to a meeting of the Association of Surgeons of Great Britain and Ireland, Manchester, UK, May 2003, and to the Nottingham International Breast Meeting, Nottingham, UK, September 2003
Conference: Association of Surgeons of Great Britain and Ireland, Manchester, UK, May 2003
Conference: Nottingham International Breast Meeting, Nottingham, UK, September 2003
Funded by: Addenbrooke's Charities
BACKGROUND: The aetiology of breast cancer-related lymphoedema (BCRL) is poorly understood and multifactorial. Previous work has suggested that acquired abnormalities of the axillary vein may contribute to arm swelling. This prospective study evaluated venous changes in patients with a new diagnosis of breast cancer who had surgery that included axillary lymph node clearance.
METHODS: Patients underwent arm volume measurement and Doppler ultrasonographic assessment of the axillary vein before, and at 3 and 12 months after surgery.
RESULTS: A complete data set was available for 70 patients. BCRL was observed in 16 per cent at 3 months and 11 per cent at 12 months. Significant alterations to venous flow patterns were observed in those with BCRL. Vein wall movement was significantly reduced after surgery for the group as a whole, but did not correlate with arm swelling. Venous stenosis with impaired flow was also observed in the absence of BCRL.
CONCLUSION: Axillary clearance can cause altered flow within the axillary vein, which is associated with an increased risk of developing lymphoedema. Copyright (c) 2005 British Journal of Surgery Society Ltd.
Wiley InterScienceShort-term effects of axillary lymph node clearance surgery on lymphatic physiology of the arm in breast cancer.
J Appl Physiol. 2005 Dec
Pain SJ, Barber RW, Solanki CK, Ballinger JR, Britton TB, Mortimer PS, Purushotham AD, Peters AM.
Cambridge Breast Unit, Addenbrooke's Hospital, UK.
It is not known why some women develop breast cancer-related lymphedema (BCRL) of the arm, whereas others having similar treatment do not. We speculated that increased uptake of protein into local blood may protect against BCRL. Sixteen women were given bilateral subcutaneous hand webspace injections of polyclonal immunoglobulin (HIgG), (99m)Tc-HIgG on one side and (111)In-HIgG on the other, before and 3 mo after axillary clearance surgery.
The rates of clearance of activity from the depot (k) and accumulation in central blood (b(contra)) were measured using a scintillation probe and bilateral antecubital vein blood sampling, respectively.
Activity accumulating in blood ipsilateral to the injected side, in excess of central blood activity (b(ipsi)) was also calculated as a measure of local vascular uptake. The k correlated with b(contra), but neither changed in response to surgery. However, b(ipsi) for injections of (99m)Tc-HIgG into the affected arm increased in all seven patients in whom data were available (0.018 +/- 0.006 to 0.038 +/- 0.007%/min; P <>
We conclude that uptake of protein into local blood and/or proteolysis increases after axillary surgery and may protect against BCRL.
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