Imaging techniques in the management and prevention of posttherapeutic upper limb edemas

BACKGROUND. Upper limb edema remains the most frequent complication after t reatments for breast carcinoma. Various imaging techniques can be used to p revent these complications, to manage them, and to diagnose the possible ly mphonodal evolution that may underlie these events. In the present paper, t hese techniques are reviewed. METHODS. Based on clinical experience as well as on the data from the liter ature, these imaging techniques are presented, and their contributions are analyzed. RESULTS, The pre- and post-operative imaging and research techniques of the so-called sentinel nodes (using blue dye, and/or lymphoscintigraphy, and/o r gamma probe) appear to be very promising for defining patients in whom ax illary node clearance either might be avoided or is indicated. Lymphoscinti graphic investigations also can be used after surgery andior radiation ther apy to define patients who either are at risk to develop upper limb edema o r present with latent edema. In patients with clinically obvious edema, eve n if it is limited, lymphoscintigraphic techniques can provide a morphologi c and functional definition of the condition. Venous echo Doppler can be us ed when abnormalities of the venous return are suspected, In diagnosing the lymphonodal evolution of the disease, techniques like immunoscintigraphy, positron emission tomography (using 18-fluoro-2-deoxy-D-glucose), X-ray com puted tomography, and nuclear magnetic resonance imaging can contribute. CONCLUSIONS. Various imaging techniques can be used to prevent and/or to ma nage the upper limb edema that may complicate the treatment(s) of the patie nts with breast carcinoma. Cancer 1998;83:2805-13. (C) 1998 Americnn Cancer Society.