Histological Findings Compared with Magnetic Resonance and Ultrasonographic Imaging in Irreversible Postmastectomy Lymphedema: A Case Study

Abstract

Postmastectomy edema is a current complication after axillary lymph node dissection in cases of breast cancer treatment. Staging is important in order to select those patients who can benefit from complex physical therapy (CPT). Different imaging techniques can be used to evaluate the edema. Ultrasonography (US) is a harmless, cheap, and easily applicable technique to visualize the dermal and subcutaneous tissue, but interpretation of the obtained images is not always evident. The aim of this study was to compare ultrasound images of irreversible edema with tissue histology, magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS). Ultrasonographic images of the edematous dermis show an homogeneous hypoechogenic dermal layer that appears on tissue histology to be less compact, due to the excess of fluid in the interstitium separating the collagen fibres and making it more transparent on light microscopy. MRI of the dermis gives a hyperintense signal, indicating the presence of fluid. In the subcutis, increase of the adipose tissue could be observed on US, MRI, and tissue histology. In the case of lymphedema, the area and perimeter of fat cells is significantly (p < 0.05) increased. Hypoechogenic areas near the muscle fascia are registered on US corresponding with epifascial fluid on MRI, and hyperechogenic branches are embedded within the adipose tissue, on tissue histology seen as large fibrotic septa enclosing adipose cells. MRI has a honeycomb picture corresponding with fluid bound to fibrosis.

Real‐time in vivo imaging collagen in lymphedematous skin using multiphoton microscopy

“…4(b)). To our knowledge, a lot of research work regarding fibrosis in lymphedematous skin only emphasized the overproduction and deposition of collagen during lymphedema (Tassenoy et al ., 2009). Our results demonstrated that the morphology of collagen showed great changes during the development of lymphedema.…”

Quantitative and Morphologic Change Associated with Breast Cancer-Related Lymphedema. Comparison of 3.0T MRI to External Measures

“…It has been shown that the gain in volume is partly due to the growth of adipose tissue. 32 Therefore, conservative decongestive physical therapy (CPT) is not likely appropriate for this subgroup as CPT will not reduce hypertrophied adipose tissue. In patients where diffuse or honeycomb lymphedema patterns predominate on MRI, appropriate CPT can still ameliorate the volume of the edema.…”

“…In patients where diffuse or honeycomb lymphedema patterns predominate on MRI, appropriate CPT can still ameliorate the volume of the edema. 32 MR has the potential to recognize early evidence of fluid accumulation that may be overlooked by current standards of clinical assessment. Early diagnosis and nonpharmacologic interventions should be implemented as soon as possible after surgery when they are more likely to be effective.…”

“…32 Distinct patterns of structural change within the subcutaneous tissue are associated with breast cancer-related upper extremity lymphedema. Three specific patterns of structural change associated with breast cancer-related lymphedema have been characterized, including fluid in adipose tissue, fluid accumulation between fibrous septa and fat globules, and fat globule hypertrophy.…”

The Lymphaticovenous Spectrum of Edema

“…7 Their observations provide valuable insights into the relationship between in vivo imaging attributes of lymphedema, including dermal edema and subcuticular adipose signals, and their corresponding microscopic, histological confirmation. Insights of this type will continue to refine the clinicians' ability to diagnose and stratify the severity of the cutaneous response to lymphatic vascular insufficiency.…”