Função linfática do membro superior no pré-operatório de câncer de mama

Evaluation of the Upper Limb Lymphatic System: A Prospective Lymphoscintigraphic Study in Melanoma Patients and Healthy Controls

BACKGROUND

Current research on the upper limb lymphatic system mainly studies breast cancer patients with unilateral lymphedema. Without preoperative lymphoscintigraphy, the contralateral limb is used as a control, assuming that it is functionally intact. Few lymphoscintigraphic studies investigate patients before any axillary surgery. The purpose of this study was to evaluate, through lymphoscintigraphy, the preoperative condition of the upper limb lymphatic system in melanoma patients and healthy controls.

METHODS

Two groups were studied: the study group (16 patients with trunk/upper limb melanoma candidates for axillary sentinel lymph node biopsy) and the control group (10 healthy volunteers). All subjects underwent upper limb lymphoscintigraphy. Lymphoscintigraphic images were classified into three patterns based on the tracer appearance time in the axillary nodes. Type I, 20 minutes; type II, 60 minutes; and type III, 120 minutes. Statistical analysis was used to assess the relationship between lymphoscintigraphic patterns and clinical variables and to compare patterns of distribution.

RESULTS

Lymphoscintigraphic patterns were asymmetric in 37.5 percent (study group) and 50 percent (control group). Type III was the most common pattern. There was no significant association between lymphoscintigraphic patterns and considered clinical variables. There was no significant difference in the lymphoscintigraphic pattern distribution of the two groups (p = 0.870).

CONCLUSION

The authors' findings show wide differences and an often "slow" tracer appearance time in patients with intact lymphatic system, questioning the use of contralateral limb as control and transportation time greater than 30 minutes as criteria for identification of lymphatic alterations.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Diagnostic, IV.

Acute cardiovascular responses to a session of Manual Lymphatic Drainage

Introduction Manual Lymphatic Drainage (MLD) creates pressure differentials to promote the movement of lymph and interstitial fluid, for their relocation into the bloodstream and can thus act on the variables responsible for determining blood pressure (BP). Objective To investigate the behavior of hemodynamic parameters, such as BP and Heart Rate (HR) during and immediately after a session of MLD. Materials and methods 23 healthy young volunteers with a mean age of 22 ± 2.97 years (18-29), underwent a session of MLD and evaluation of systolic BP, diastolic BP and HR after 10 minutes of initial rest, at the end of the implementation of the protocol in SP, PP and after 15 minutes of final rest. Results No changes were found in systolic BP or diastolic BP before, during and immediately after the MLD session (p = 0.57, p = 0.20, respectively). There was increased heart rate after the final 15 minute rest when compared to the HR after MLD in SP (72 ± 1.9 vs. 76 ± 1.9, p = 0.002), however, without clinical relevance. Conclusion During a session of MLD with healthy young women, no significant hemodynamic changes occurred, demonstrating that this technique is safe from the cardiovascular point of view.