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This Article Full Text Full Text (PDF) All Versions of this Article: 583/1/271    most recent jphysiol.2007.130401v1 Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Modi, S. Articles by Levick, J. R. Search for Related Content PubMed PubMed Citation Articles by Modi, S. Articles by Levick, J. R. Related Collections Cardiovascular

¹ Cardiac and Vascular Sciences (Dermatology)
² Basic Medical Sciences (Physiology), St George's Hospital Medical School, University of London, London SW17 0RE, UK
³ Nuclear Medicine, Hammersmith Hospital, London W12 0HS, UK
⁴ Nuclear Medicine, Royal Sussex County Hospital, Brighton BN2 5BE, UK

Axillary surgery for breast cancer partially obstructs lymph outflow from the arm, chronically raising the lymphatic smooth muscle afterload. This may lead to pump failure, as in hypertensive cardiac failure, and could explain features of breast cancer treatment-related lymphoedema (BCRL) such as its delayed onset. A new method was developed to measure human lymphatic contractility non-invasively and test the hypothesis of contractile impairment. ^99mTc-human IgG (Tc-HIG), injected into the hand dermis, drained into the arm lymphatic system which was imaged using a gamma-camera. Lymph transit time from hand to axilla, t_transit, was 9.6 ± 7.2 min (mean ± S.D.) (velocity 8.9 cm min^–1) in seven normal subjects. To assess lymphatic contractility, a sphygmomanometer cuff around the upper arm was inflated to 60 mmHg (P_cuff) before ^99mTc-HIG injection and maintained for >> t_transit. When P_cuff exceeded the maximum pressure generated by the lymphatic pump (P_pump), radiolabelled lymph was held up at the distal cuff border. P_cuff was then lowered in 10 mmHg steps until ^99mTc-HIG began to flow under the cuff to the axilla, indicating P_pump P_cuff. In 16 normal subjects P_pump was 39 ± 14 mmHg. P_pump was 38% lower in 16 women with BCRL, namely 24 ± 19 mmHg (P = 0.014, Student's unpaired t test), and correlated negatively with the degree of swelling (12–56%). Blood radiolabel accumulation proved an unreliable measure of lymphatic pump function. Lymphatic congestion lymphoscintigraphy thus provided a quantitative measure of human lymphatic contractility without surgical cut-down, and the results supported the hypothesis of lymphatic pump failure in BCRL.

(Received 13 February 2007; accepted after revision 10 June 2007; first published online 14 June 2007)
Corresponding author A. W. B. Stanton: St George's Hospital Medical School, University of London, Cranmer Terrace, London SW17 0RE, UK. Email: astanton{at}sgul.ac.uk

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