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Abstract
Purpose: We aimed to evaluate the potential role of quantitative methods associated with lymphoscintigraphy for the assessment of severity of lymphedema post-operatively in patients with breast cancer who did not show definite dermal backflow activity on the lymphoscintigraphy.

Methods: We evaluated 47 lymphoscintigraphies without dermal backflow in patients with lymphedema who received a mastectomy and axillary dissection or sentinel lymph node dissection for invasive ductal carcinoma of the breast. The quantitative asymmetry indices (QAIs) of both arms were calculated for each axilla, upper arm, forearm, and the whole arm. The QAI was defined as the radiopharmaceutical uptake ratio of the affected side to the unaffected side. Arm circumference was measured at four locations per arm to identify the maximal circumference difference (MCD) between affected and unaffected sides.

Results: The total and forearm QAIs of each side arm were significantly higher in the group with above moderate stage lymphedema compared with the mild stage group. Previous radiotherapy also had a significant effect on radiotracer retention expressed as QAI. The MCD was significantly correlated with QAI values of the forearm and the whole arm. The QAI of axillary areas was not significantly correlated with circumferential measurements of the arm.

Conclusions: The QAIs have significant value for the diagnosis and severity of lymphedema and may therefore potentially be used as an objective tool for the assessment of lymphedema.

Affiliations

Keunyoung Kim  1 , In-Joo Kim  1 , Kyoungjune Pak  1 , Seong-Jang Kim  2 , Su Jung Choi  1 , Heeseung Park  3 , Taewoo Kang  3 , In Joo Kong  4 , Yong Beom Shin  4 , Hyojeong Kim  5 , Jin A Yoon  6
1 Department of Nuclear Medicine, Pusan National University Hospital and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.
2 Department of Nuclear Medicine and Research Institute for Convergence of Biomedical Science and Technology, Yangsan Pusan National University Hospital, Yangsan, Republic of Korea.
3 Department of Surgery, Busan Cancer Center, Pusan National University Hospital and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.
4 Department of Rehabilitation Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Gudeok-Ro Seo-Gu, Busan, 602-739, South Korea.
5 Department of Hemato-oncology, Pusan National University Hospital and Pusan National University School of Medicine, Busan, Republic of Korea.
6 Department of Rehabilitation Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Gudeok-Ro Seo-Gu, Busan, 602-739, South Korea. yjk5289@naver.com.