Manual Lymphatic Drainage and Active Exercise Effects on Lymphatic Function Do Not Translate Into Morbidities in Women Who Underwent Breast Cancer Surgery.

OBJECTIVE: To evaluate manual lymphatic drainage (MLD) and active exercise effects on lymphatic alterations of the upper limb (UL), range of motion (ROM) of shoulder, and scar complications after breast cancer surgery. DESIGN: Clinical trial. SETTING: Health care center. PARTICIPANTS: Women (N=105) undergoing radical breast cancer surgery who were matched for staging, age, and body mass index. INTERVENTIONS: Women (n=52) were submitted to MLD and 53 to active exercises for UL for 1 month and followed up. MAIN OUTCOME MEASURES: Shoulder ROM, surgical wound inspection and palpation, UL circumference measurements, and lymphoscintigraphy were performed in preoperative and postoperative periods. RESULTS: There was no significant difference between groups with regard to wound healing complications, ROM, and UL circumferences. After surgery, 25 (48.1%) of the MLD group and 19 (35.8%) of the active exercise group showed worsening in radiopharmaceutical uptake velocity, whereas 9 (17.3%) of the MLD group and 11 (20.8%) of the active exercise group showed improved velocity (P=.445). With regard to uptake intensity, 27 (51.9%) of the MLD group and 21 (39.6%) of the active exercise group showed worsening whereas 7 (13.5%) of the MLD group and 7 (13.2%) of the active exercise group showed some improvement (P=.391). The presence of collateral circulation was similar in both groups at both time points evaluated. The active exercise group had a significant increase in postoperative liver absorption (P=.005), and the MLD group had a significant increase in postoperative dermal backflow (P=.024). CONCLUSIONS: MLD and active exercise effects are equivalent with regard to morbidity. Minor changes in lymphatic function associated with either MLD or active exercises were not related to patients' symptoms or signs.

Lymphatic Function in the Early Postoperative Period of Breast Cancer Has No Short-Term Clinical Impact.

OBJECTIVE: To evaluate by lymphoscintigraphy the lymphatic function in the preoperative period up to 2 months after surgery for breast cancer, and the relationship between the lymphatic function with clinical features and physical complications. METHODS: One hundred and five women were studied before and 2 months after surgery to treat breast cancer. On each occasion, inspection and palpation of surgical wound, upper limb circumference, and lymphoscintigraphy were performed. Lymphatic function analysis consisted of velocity of axillary lymph node (LN) visualization; intensity of LN uptake; collateral circulation; dermal backflow; and hepatic uptake. RESULTS: In the postoperative period, there was a significant worsening of the degree of LN uptake (p = 0.0003) and in the velocity of LN visualization (p = 0.01). No significant differences in dermal backflow (p = 0.4) and collateral circulation (p = 0,07) were observed. There was a significant increase in liver absorption (p = 0.0002). 37.1% of the patients developed seroma, 11.2% dehiscence, and 25.8% infection. No relationship was found between lymphoscintigraphy changes and postoperative complications or clinical characteristics. CONCLUSION: Lymphoscintigraphy, performed 60 days post surgery for breast cancer, can detect a worsening in lymphatic drainage and some sign of lymphatic changes. These changes are not related to clinical characteristics and physical complications.

68Ga-DOTATATE PET/CT, 99mTc-HYNIC-octreotide SPECT/CT, and whole-body MR imaging in detection of neuroendocrine tumors: a prospective trial.

UNLABELLED: There are different metabolic imaging methods, various tracers, and emerging anatomic modalities to stage neuroendocrine tumor (NET). We aimed to compare NET lesion detectability among (99m)Tc-hydrazinonicotinamide (HYNIC)-octreotide (somatostatin receptor scintigraphy [SSRS]) SPECT/CT, (68)Ga-DOTATATE PET/CT, and whole-body diffusion-weighted MR imaging (WB DWI). METHODS: Nineteen consecutive patients (34-77 y old; mean, 54.3 ± 10.4 y old; 10 men and 9 women) underwent SSRS SPECT/CT, (68)Ga-DOTATATE PET/CT, and WB DWI. Images were acquired with a maximum interval of 3 mo between them and were analyzed with masking by separate teams. Planar whole-body imaging and SPECT/CT were performed from thorax to pelvis using a double-head 16-slice SPECT/CT scanner 4 h after injection of 111-185 MBq of (99m)Tc-HYNIC-octreotide. (68)Ga-DOTATATE PET/CT was performed from head to feet using a 16-slice PET/CT scanner 45 min after injection of 185 MBq of tracer. WB DWI was performed in the coronal plane using a 1.5-T scanner and a body coil. The standard method of reference for evaluation of image performance was undertaken: consensus among investigators at the end of the study, clinical and imaging follow-up, and biopsy of suggestive lesions. RESULTS: McNemar testing was applied to evaluate the detectability of lesions using (68)Ga-DOTATATE PET/CT in comparison to SSRS SPECT/CT and WB DWI: a significant difference in detectability was noted for pancreas (P = 0.0455 and P = 0.0455, respectively), gastrointestinal tract (P = 0.0455 and P = 0.0455), and bones (P = 0.0082 and P = 0.0082). Two unknown primary lesions were identified solely by (68)Ga-DOTATATE PET/CT. (68)Ga-DOTATATE PET/CT, SSRS SPECT/CT, and WB DWI demonstrated, respectively, sensitivities of 0.96, 0.60, and 0.72; specificities of 0.97, 0.99, and 1.00; positive predictive values of 0.94, 0.96, and 1.00; negative predictive values of 0.98, 0.83, and 0.88; and accuracies of 0.97, 0.86, and 0.91. CONCLUSION: (68)Ga PET/CT seems to be more sensitive for detection of well-differentiated NET lesions, especially for bone and unknown primary lesions. NET can be staged with (68)Ga-DOTATATE PET/CT. WB DWI is an efficient new method with high accuracy and without ionizing radiation exposure. SSRS SPECT/CT should be used only when (68)Ga-DOTATATE PET/CT and WB DWI are not available.