Lymphoscintigraphic Investigations for Axillary Web Syndromes

Abstract

Background: Axillary web syndrome (AWS) is a frequent complication after surgery for breast cancer, but its lymphatic involvement is not definitively established. Here we report the results of lymphoscintigraphic investigations in patients with AWS. Methods and Results: We conducted a retrospective, single-center review of lymphoscintigraphic investigations performed in 46 patients with AWS that was either clinically obvious or suspected. Of this group, 23 patients had two investigations with a mean interval of 19 weeks between them (range, 6–98 weeks). Results of the lymphoscintigraphic investigations, which were performed according to a well-standardized protocol, were classified into four patterns: normal; functional lymphatic insufficiency only (no lymphatic vascular morphologic abnormality); lymphovascular blockade without collateralization; and vascular collateralization and/or dermal backflow. Of the 46 patients, on the first lymphoscintigraphic investigation, four (8.6%) had a normal pattern, seven (15.2%) had functional lymphatic insufficiency only, four (8.6%) had lymphovascular blockade without collateralization, and 31 (67.3%) had vascular collateralization and/or dermal backflow. Among patients who underwent two investigations, four of the five who had only functional lymphatic insufficiency at the first investigation had developed vascular collateralization and/or dermal backflow by the second. The three patients who had lymphovascular blockade without collateralization at the first examination had also progressed to collateralization and/or dermal backflow at the second. None of the 15 patients who initially had vascular collateralization and/or dermal backflow showed any reversal at the second examination. Conclusions: Our analysis confirms the lymphatic nature of AWS and shows the lymphoscintigraphic patterns and evolutions of the lymphatic lesions with potential therapeutic implications. The retrospective review of our database is approved by the institutional ethics committee under number 2048.

Lymphatic Alterations Under Tattoos: Preliminary Reports of One Observational Study

“…Some of these lympho-fluoroscopic figures under these tattoos are similar to what is observed at the level of the upper limb with Axillary Web Syndrome (AWS). 34 These AWS situations are frequent in patients operated for Breast Cancer but have also been reported in non-cancerous situations. 35–37 In the framework of lymphoscintigraphic investigations after subcutaneous injection of radiocolloids, it has been demonstrated that they are secondary to lymph stasis, lymphangitis and lymphangio-obliteration.…”

“…35–37 In the framework of lymphoscintigraphic investigations after subcutaneous injection of radiocolloids, it has been demonstrated that they are secondary to lymph stasis, lymphangitis and lymphangio-obliteration. 34 In BC patients with AWS, swelling at the onset of the syndrome is frequently seen. However, with the development of collaterals, clinically obvious edema remained in only one-third of the cases and was not observed in patients who presented no edema as part of their initial symptoms.…”

“…The lymphatic drainages will be controlled using the same NIRFI approach two months after the tattooing and it is expected that we should observe the same lymphatic evolutions as in our lymphoscintigraphic evaluations of AWS. 34 …”

A Case of Axillary Web Syndrome Caused by Venous Blood Sampling

“…In a study in which lymphoscintigraphy was performed in patients with AWS, it was reported that approximately 90% of the patients had changes such as decreased lymphatic function and obstruction of lymphatic vessels and 67% had collateral lymphatic vessels. These results suggest the involvement of lymphatic vessels in the pathogenesis of AWS [6]. In another report, a biopsy of cord-like structures in seven patients with AWS revealed that lymphatic vessels were involved in three cases, of which a thrombus in the lymphatic vessels was noted in one [7].…”

“…A consistent hypothesis is that the cord contains one or more tiny lymphatic vessels tethered to each other or the surrounding tissue by extravasated and cross-linked fluid proteins [8,9]. It is also considered a type of Mondor's disease in which subcutaneous cord-like induration appears due to inflammation or obstruction of veins running in the shallow subcutaneous layers of the chest, upper abdomen, and upper extremities [6].…”