Preventative Measures for Lymphedema: Separating Fact from Fiction

Cemal, Yeliz; Pusic, Andrea L.; Mehrara, Babak J.

doi:10.1016/j.jamcollsurg.2011.07.001

Cited by 125 publications

(98 citation statements)

References 41 publications

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“…2,3 As many as 30% to 50% of breast cancer patients undergoing lymph node or sentinel lymph node dissection develop lymphedema. 4,5 Despite its critical role, the lymphatic system and many of its mechanisms are poorly understood, partly due to the poor contrast of the lymphatic vessels (LVs) and structures. Few imaging techniques are available to visualize the lymphatic system noninvasively in vivo, which has significantly hampered our ability to study and understand the lymphatic system.…”

Section: Introductionmentioning

confidence: 99%

Photoacoustic imaging of lymphatic pumping

2017

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Abstract. The lymphatic system is responsible for fluid homeostasis and immune cell trafficking and has been implicated in several diseases, including obesity, diabetes, and cancer metastasis. Despite its importance, the lack of suitable in vivo imaging techniques has hampered our understanding of the lymphatic system. This is, in part, due to the limited contrast of lymphatic fluids and structures. Photoacoustic imaging, in combination with optically absorbing dyes or nanoparticles, has great potential for noninvasively visualizing the lymphatic vessels deep in tissues. Multispectral photoacoustic imaging is capable of separating the components; however, the slow wavelength switching speed of most laser systems is inadequate for imaging lymphatic pumping without motion artifacts being introduced into the processed images. We investigate two approaches for visualizing lymphatic processes in vivo. First, single-wavelength differential photoacoustic imaging is used to visualize lymphatic pumping in the hindlimb of a mouse in real time. Second, a fast-switching multiwavelength photoacoustic imaging system was used to assess the propulsion profile of dyes through the lymphatics in real time. These approaches may have profound impacts in noninvasively characterizing and investigating the lymphatic system.

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Section: Introductionmentioning

confidence: 99%

Photoacoustic imaging of lymphatic pumping

2017

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“…4 The mechanisms that regulate its development remain largely unknown and so it remains unclear why some patients develop lymphedema and others who are identically treated do not. 5 Lymphedema often causes breast cancer survivors to experience severe limitations in their daily activities, measurably affecting their overall quality of life. Specifically, women with lymphedema are more disabled, report symptoms from the upper extremity (shoulder or arm pain) and difficulties in arm movement, pain and swelling from the operated breast, recurrent infections, and higher psychological distress.…”

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confidence: 99%

“…Specifically, women with lymphedema are more disabled, report symptoms from the upper extremity (shoulder or arm pain) and difficulties in arm movement, pain and swelling from the operated breast, recurrent infections, and higher psychological distress. 5,6 Treatment for lymphedema remains suboptimal and is in most cases palliative, with a goal of preventing disease progression rather than a cure. 5 Currently there are no pharmacologic treatments to improve lymphatic recovery following breast cancer surgery.…”

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confidence: 99%

“…5,6 Treatment for lymphedema remains suboptimal and is in most cases palliative, with a goal of preventing disease progression rather than a cure. 5 Currently there are no pharmacologic treatments to improve lymphatic recovery following breast cancer surgery. There are widely used noncurative approaches to manage the swelling after it appears, such as compression garments and manual lymphatic drainage therapy.…”

mentioning

confidence: 99%

“…There are widely used noncurative approaches to manage the swelling after it appears, such as compression garments and manual lymphatic drainage therapy. 5,7 It is important to recognize that the axillary dissection removes not only the axillary lymphatic vessels and their associated lymph nodes, but also an abundance of surrounding soft tissue, thereby producing a large cavity in the axilla. The surgery is performed in an effort to prevent tumor metastasis through the lymphatic system, remove tumorous cells residing within the lymphatic system, and to determine tumor staging for subsequent treatments.…”

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confidence: 99%

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The Multicomponent Medication Lymphomyosot Improves the Outcome of Experimental Lymphedema

Keim

Slis

Mendez

et al. 2013

Lymphatic Research and Biology

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Background: Secondary lymphedema is a life-long disease of painful tissue swelling that often follows axillary lymph node dissection to treat breast cancer. It is hypothesized that poor lymphatic regeneration across the obstructive scar tissue during the wound healing process may predispose the tissue to swell at a later date. Treatment for lymphedema remains suboptimal and is in most cases palliative. The purpose of this study was to evaluate the ability of Lymphomyosot to treat tissue swelling and promote lymphangiogenesis in experimental models of murine lymphedema. Methods: Experimental models of mouse lymphedema were injected with varied amounts of Lymphomyosot and saline as control. Measurements of tail swelling and wound closure were taken and compared amongst the groups. Three separate groups of mice were analyzed for lymphatic capillary migration, lymphatic vessel regeneration, and macrophage recruitment. Results: Lymphomyosot significantly reduced swelling and increased the rate of surgical wound closure. Lymphomyosot did not increase the migration of lymph capillaries in a mouse tail skin regeneration model or regeneration of lymph vessels following murine axillary lymph node dissection. Conclusions: Lymphomyosot may act through inflammatory and wound repair pathways to reduce experimental lymphedema. Its ability to regulate inflammation as well as assist in tissue repair and extracellular formation may allow for the production of a scar-free matrix bridge through which migrating cells and accumulated interstitial fluid can freely spread.

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Lymphedema After Breast Cancer Treatment—Not Just the Surgeon’s Fault

Vetto

2019

JAMA Surg

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Preventative Measures for Lymphedema: Separating Fact from Fiction

Cited by 125 publications

References 41 publications

Photoacoustic imaging of lymphatic pumping

Photoacoustic imaging of lymphatic pumping

The Multicomponent Medication Lymphomyosot Improves the Outcome of Experimental Lymphedema

Lymphedema After Breast Cancer Treatment—Not Just the Surgeon’s Fault

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