Development of a lymphatic stress test

There is a need for a test that will provide information on the lymphatic system of the upper extremity in women with breast cancer related lymphedema (BCRL) and this forms the basis of this research project. In order to determine an appropriate upper body exercise protocol that could be combined with lymphoscintigraphy to describe lymphatic function in women treated for breast cancer, a series of studies were completed in healthy, college-aged females. Collectively, these studies demonstrated the following: 1) arm cranking was superior to intermittent hand grip exercise in enhancing depot clearance rate (CR), 2) moderate intensity arm cranking exercise was superior to low intensity arm cranking exercise in enhancing CR and uptake of radiopharmaceuticals at the axillary lymph nodes (AX), 3) CR and AX were symmetrical between arms, 4) a lower coefficient of variation was demonstrated with moderate intensity exercise compared to low intensity exercise, and 5) high intra-subject reliability in arm cranking CR. Thus, an intermittent, moderate intensity arm cranking protocol was selected to evaluate lymphatic function in women treated for breast cancer with BCRL (BCRL), breast cancer survivors (no BCRL), and age-matched controls. Main findings of the final project were: 1) contralateral arm lymphatic function was similar between groups at rest or during exercise; 2) AX and uptake of radiopharmaceuticals in the forearm (FORE) in the ipsilateral arm relative to the contralateral arm was compromised in BCRL only; and 3) the addition of exercise increased ipsilateral CR and AX in breast cancer survivors and increased ipsilateral CR and FORE in BCRL subjects (an increase in FORE is not expected with exercise). These results indicate that despite the small sample size, lymphatic function (with the exception of CR) is impaired in BCRL at rest and during exercise compared to breast cancer survivors and controls but not different between breast cancer survivors and controls. Clinical applications of this study are that while breast cancer survivors have similar lymphatic function as controls, there is a highly variable response suggesting that some breast cancer survivors may be at risk for developing BCRL.Education, Faculty ofKinesiology, School ofGraduat