Alstrup Mathias, Johannessen Andreas L, Mohanakumar Sheyanth, Offersen Birgitte V, Hjortdal Vibeke E
Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark.
Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Plast Reconstr Surg Glob Open. 2021 Aug 25;9(8):e3779. doi: 10.1097/GOX.0000000000003779. eCollection 2021 Aug.
Lymphedema is a highly feared complication of breast cancer treatment, but the underlying complex mechanisms are still unknown. Thus, we investigated the lymphatic morphology and contractility in the lymphatic vessels of arms of high-risk breast cancer patients treated for node-positive early breast cancer.
In this prospective cohort study 32 women treated for unilateral node-positive breast cancer were enrolled and studied 36 ± 23 days after loco-regional radiotherapy. Near-infrared fluorescence imaging was used to assess morphology and function of the superficial lymphatic vessels. Strain-gauge plethysmography was performed to evaluate the capillary filtration of fluid.Both arms were investigated, with the non-treated arm acting as control. The patients were questioned about the presence of lymphedema yearly and finally 574 ± 118 days after ended radiotherapy.
Morphologically, 25% of the treated arms expressed lymphatic vessel abnormalities compared to the control arms ( = 0.0048). No difference in functional parameters (maximal pumping pressure, = 0.20; contraction frequency, = 0.63; contraction velocity, = 0.55) was found between the treated and control arms. Patients who later developed lymphedema had a difference in velocity compared to those who did not develop lymphedema ( = 0.02). The capillary filtration rate was similar between the two arms ( = 0.18).
Peripheral lymphatic vessels were morphologically changed in the ipsilateral arm in 25% of the patients and patients who later developed lymphedema showed an early increase in velocity. Other functional parameters and capillary filtration were unchanged in this early phase. These discrete changes might be early indicators of later development of lymphedema.
淋巴水肿是乳腺癌治疗中一种令人高度恐惧的并发症，但其潜在的复杂机制仍不清楚。因此，我们研究了接受淋巴结阳性早期乳腺癌治疗的高危乳腺癌患者手臂淋巴管的淋巴形态和收缩性。
在这项前瞻性队列研究中，纳入了32例接受单侧淋巴结阳性乳腺癌治疗的女性，并在局部区域放疗后36±23天进行研究。使用近红外荧光成像评估浅表淋巴管的形态和功能。进行应变片体积描记法以评估液体的毛细血管滤过。对双臂进行研究，未治疗的手臂作为对照。每年询问患者是否存在淋巴水肿，最终在放疗结束后574±118天进行询问。
在形态学上，与对照手臂相比，25%的治疗手臂表现出淋巴管异常（P = 0.0048）。治疗手臂与对照手臂之间在功能参数（最大泵压，P = 0.20；收缩频率，P = 0.63；收缩速度，P = 0.55）上未发现差异。后来发生淋巴水肿的患者与未发生淋巴水肿的患者在速度上存在差异（P = 0.02）。双臂之间的毛细血管滤过率相似（P = 0.18）。
25%的患者同侧手臂的外周淋巴管在形态上发生了改变，后来发生淋巴水肿的患者早期速度增加。在这个早期阶段，其他功能参数和毛细血管滤过没有变化。这些离散的变化可能是淋巴水肿后期发展的早期指标。
