counter-intuitive result requires explanation:the less +lymphnodes themore lymphedema

[Lani]

ABSTRACT: Lymph Node Status and Breast Cancer-related Lymphedema [Annals of Oncology]
Objective: This study examines the association between nodal positivity and risk of developing breast cancer-related lymphedema (BCRL) in patients who underwent axillary lymph node dissection (ALND).
Summary Background Data: The pathophysiology of BCRL is poorly understood. It has been assumed that one of the factors predisposing to the development of BCRL is nodal positivity, although retrospective series have produced contradictory findings. As these studies have included treatment regimens known to cause BCRL, such as axillary radiotherapy, any relationship between nodal positivity and the development of BCRL remains speculative.
Methods: A total of 212 patients who had undergone ALND for invasive breast cancer had arm volume measurements preoperatively, and at intervals postoperatively. No patient received axillary radiotherapy. Arm volumes were obtained by measuring serial arm circumferences every 4 cm up the arm and then calculated by using the formula for the volume of a truncated cone. Robust regression techniques were used to analyze the effects of node positivity, age, preoperative body mass index, and wound infection on arm volume excess.
Results: In all, 64 of 212 (30%) patients were node positive. Contrary to previous assumptions, positive node status was significantly inversely associated with arm volume after adjusting for tumor size, time since operation, and allowing for correlated observations within subjects. Furthermore, the number of positive nodes also correlated inversely with arm volume.
Conclusion: These results are counterintuitive to the conventional understanding of the pathophysiology of BCRL. A possible explanation is that patients who develop disease in axillary lymph nodes and subsequently undergo ALND have more time and ability to develop lymphatic collaterals, which may provide adequate lymphatic drainage following surgery, thereby reducing the risk of developing BCRL.

[Gina]

I had 14 lymph nodes removed with 6 positive for cancer back in 1997. Although I did, as expected, go on to Stage IV in 1999, to this day, I have never had one bit of lymphedema...does this concur with what the study is trying to say??? and have other folks on this site noticed this correlation?

Every one always says it, but your posts are great!!1

Take care,
Gina

[Audrey]

Interesting post--I was diagnosed in 2001 with 11+ lymph nodes and have not experienced any lymphedema, either. I always assumed that the more positive lymph nodes one had, the greater the risk of lymphadema, but I guess this may not be the case. Maybe I can stop wearing the arm sleeve when I fly now??

[lilyecuadorian]

from 23 lymph node removed 4 was positive and so far no lymphedema I was diagnost on april/06 ....