Physiotherapeutic stimulation: Early prevention of lymphedema following axillary lymph node dissection for breast cancer treatment

Abstract

The aim of this study was to confirm the effectiveness of early physiotherapeutic stimulation for lymphatic flow progression in patients with breast cancer undergoing axillary dissection. This was a randomized experimental study on 22 patients who underwent lymphoscintigraphy in their arms on two different occasions, firstly without stimulation and secondly after randomization into two groups: without physiotherapeutic stimulation (WOPS; n=10) and with physiotherapeutic stimulation (WPS; n=12). The lymphoscintigraphy scan was performed with (99m)Tc-phytate administered into the second interdigital space of the hand, ipsilaterally to the dissected axilla, in three phases: dynamic, static, and delayed whole body imaging. Physiotherapeutic stimulation was carried out using Földi's technique. In both groups, images from the two examinations of each patient were compared. Flow progression was considered positive when, on the second examination, the radiopharmaceutical reached areas more distant from the injection site. Statistical analysis was used to evaluate frequencies, percentages and central trend measurements, and non-parametric tests were conducted. Descriptive analysis showed that the WPS and WOPS groups were similar in terms of mean age, weight, height, body mass index and number of lymph nodes removed. There were statistically significant associations between physiotherapeutic stimulation and radiopharmaceutical progression at all three phases of the study (p<0.0001). Early physiotherapeutic stimulation in breast cancer patients undergoing radical axillary dissection is effective, and can therefore be indicated as a preventive measure against lymphedema.

Figure 1.

Qualitative analysis: sequential ordinal classification of upper limb. 0, injection site; 1, distal third of forearm; 2, middle third of forearm; 3, proximal third of forearm; 4, distal third of upper arm; 5, middle third of upper arm; 6, proximal third of upper arm; 7, axilla without lymph nodes; 8, axillary lymph nodes; 9, lymph nodes in dorsolateral part of upper arm; 10, apical lymph nodes; 11, central lymph nodes; 12, internal thoracic lymph nodes; 13, lymph nodes in contralateral axilla; 14, spleen.

Figure 2.

Lymphoscintigraphy of the WOPS group (left) and WPS group (right) showing the three phases of examination. (A and B) Dynamic images of the first (a) and second (b) examination with linear derivation graph (c). (C and D) Static images of the arms (a) and thoracic region (b) from the first examination, and of the arms (c) and thoracic region (d) from the second examination. (E and F) Whole body scan, anterior (a) and posterior (b) from the first examination, and anterior (c) and posterior (d) from the second examination. In the WOPS group, no progression between the two examinations was observed. The arrival of the radiopharmaceutical in the axillary region was only apparent in the whole body scan (E) (arrow). There was no evidence of velocity variation in lymphatic flow (Ac). In the WPS group, lymphatic progression was observed in the three phases of the examination, with arrival of radiopharmaceutical in the axilla in the dynamic (Bb) and the static (Dc and d) phase. More lymph nodes were identified in the whole body scan from the second examination (Fc and d) (arrowhead), with linear derivation showing increased lymphatic flow velocity after physiotherapeutic stimulation (Bc).