Breast lymphedema after breast conserving treatment

Introduction The development of breast lymphedema (BLE) following breast/axillary surgery is poorly characterized. We prospectively evaluated clinical and surgical factors associated with development of BLE. Methods Patients undergoing unilateral breast-conserving surgery were prospectively enrolled preoperatively and followed for development of BLE. To augment the number of patients with BLE for evaluation of risk factors, postoperative patients identified in the clinic with signs and symptoms of BLE were also enrolled. Logistic regression with Firth’s penalized likelihood bias-reduction method was used for univariate and multivariate analysis. Results Of 144 women, 124 of them were enrolled preoperatively (38 of whom developed BLE) and 20 women with BLE were enrolled postoperatively. Any type of axillary surgery was the strongest factor associated with BLE (odds ratio 134, 95% CI: 18 to >1000). All 58 BLE events occurred in women with axillary surgery as compared to none of the 46 patients without axillary surgery (p<0.0001). Among 98 women who underwent axillary surgery, BLE did not occur more often after ALND versus SLN biopsy (p=0.38) and was not associated with total number of nodes removed (p=0.52). In multivariate analysis, factors associated with the development of BLE in the axillary surgery subgroup included baseline BMI (p=0.004), incision location (p=0.009), and prior surgical biopsy (p=0.01). Conclusions Risk of BLE is primarily related to performance of any axillary surgery but not extent of axillary surgery or number of lymph nodes removed. Other factors associated with BLE were increased BMI, incision location, and prior surgical excisional biopsy.

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“…Our finding contrasts with that of one other study where tumor location did not influence the prevalence of BLE. 3 …”

Section: Discussionmentioning

confidence: 99%

“…However, other studies have reported that BLE rates are higher after ALND than axillary sampling. 2,3 …”

Section: Discussionmentioning

confidence: 99%

Risk Factors Associated with Breast Lymphedema

et al. 2013

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“…A nyiroködéma kialakulásának gyakorisága daganatkezelés után számottevő. Egy prospektív, 160 betegen végzett vizsgálat szerint mellmegtartó műtét esetén a nyiroködé-ma kialakulásának gyakorisága a mellen 35-48% volt axillaris blokkdissectio után, míg sentinel-nyirokcsomó eltá-volítása után 23% [1]. Nyolcszázkettő, nőgyógyászati tumorkezelésen átesett nőbeteg kérdőíves vizsgálata alapján 25%-ban alakult ki panaszt okozó alsó végtagi ödéma, de a nyiroködéma diagnózisa csak az érintett betegek 40%-ában lett felállítva [2].…”

Section: A Szekunder Nyiroködéma Okai Daganatos Betegekbenunclassified

Daganatos betegekben kialakult másodlagos nyiroködéma ellátása

Wenczl¹

2016

Orvosi Hetilap

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A daganatos betegek számának emelkedésével és az onkológiai kezelések hatékonyságának növekedésével egyre gyakrabban találkozunk másodlagosan kialakult nyiroködémával. Ezért a nyiroködéma kezelése az onkológiai betegek gondozásának része. A nyiroködéma kezelésének alapja daganatos betegekben a komplex ödémamentesítő kezelés, amelyet bele kell ágyazni a beteg átfogó orvosi ellátásába és mindig egyénre szabva kell meghatározni. A kezelés eredménye függ az orvos és a gyógytornász nyiroködéma-kezelésben való jártasságától, a betegcompliance-től, a daganat viselkedésétől és a kísérő betegségektől. A nyiroködéma krónikus betegség, élethosszig tartó gondozást, kezelést igényel. Az ellátás javítása érdekében fontos a betegek felvilágosítása a nyiroködéma kockázatát illetően és az erre vonatkozó helyes életmóddal kapcsolatosan (például testsúlykontroll); törekedni kellene a diagnózis korai felál-lítására. A palliatív ellátásba is lényeges lenne beépíteni a nyiroködéma-kezelést. Időben elkezdett terápiával elkerül-hetők a szövődmények, az egészségügyi kiadások csökkenthetők és a beteg számára jobb életminőség biztosítható. Orv. Hetil., 2016, 157(13), 488-494.Kulcsszavak: nyiroködéma, onkológia, malignus nyiroködéma, komplex ödémamentesítő kezelés, palliatív ellátás Management of secondary lymphedema in patients with cancerDue to the increased number of cancer patients and the progress in cancer treatment, there are more cases with cancer-related lymphedema. Lymphedema treatment became part of oncological patients' care. Basic therapy for lymphedema is the complex decongestive therapy, which should be embedded into the patient's comprehensive medical care and should always be determined individually. Results of therapy are influenced by the experience of the doctor and the physiotherapist in lymphedema care, patient's complience, tumor behavior and the accompanying diseases. Lymphedema is a chronic disease, requires lifelong follow-up and treatment. For prevention and better care, it would be important to inform patients about lymphedema risk and appropriate life-style (e.g. weight control) preoperatively and during oncological follow-up. Early diagnosis is important. Lymphedema treatment should be integrated into palliative programmes. If therapy is started in time, complications may be avoided, healthcare costs may be reduced and better quality of life may be achieved.Keywords: lymphedema, oncology, malignant lymphedema, complex decongestive therapy, palliative careWenczl, E. [Management of secondary lymphedema in patients with cancer]. Orv. Hetil., 2016, 157(13), 488-494. (Beérkezett: 2016 elfogadva: 2016. Ritkán ismerjük fel, vesszük komolyan és kezeljük szakszerűen a nyiroködémát, pedig a várható élettartam emelkedésével megnőtt a nyiroködémás betegek száma. Az életkor előrehaladtával ugyanis fokozatosan csökken a nyirokszállítás kapacitása és egyre gyakoribbak a nyiroködéma rizikófaktorai. A különféle daganatok előfordu-lása is emelkedik, és az onkológiai kezeléseknek köszön-hetően hosszabb a túlélés, gyakoribb a...

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“…No início dos anos 90 iniciaram-se os estudos sobre a técnica do linfonodo sentinela (TLNS), o que diminuiu muito a morbidade cirúrgica e as seqüelas 2,3 . Menos de 25% das pacientes submetidas à TLNS apresentam sintomas relacionados à drenagem linfática, sendo a ocorrência de linfedema limitante, desprezível 4 .…”

Section: Introductionunclassified

Desempenho da ultra-sonografia na detecção das metástases em linfonodos axilares em mulheres com câncer de mama

Jales¹,

Marussi²,

Andrade³

et al. 2005

Rev. Bras. Ginecol. Obstet.

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Objetivos: avaliar o desempenho de diversas características ultra-sonográficas morfológicas (12) e doplervelocimétricas (7), para detecção de metástases linfonodais em mulheres com câncer de mama. Métodos: foram incluídas 179 mulheres (181 axilas), entre janeiro e dezembro de 2004. Os exames ultra-sonográficos foram realizados com transdutor linear em tempo real (Toshiba-Power Vision-6000 (modelo SSA-370A)). Para o estudo de parâmetros morfológicos foram utilizadas freqüências entre 7,5 e 12 MHz. Para os parâmetros Doppler foi utilizada freqüência de 5 MHz. Subsequentemente, as pacientes foram submetidas a axilectomia dos níveis I, II e III (158) ou à técnica do linfonodo sentinela (23). Foram calculadas a sensibilidade, a especificidade e os valores preditivos positivo e negativo para cada parâmetro. Para a associação de parâmetros foi utilizada a árvore de decisão. Foram estabelecidos os valores de corte para as variáveis contínuas por meio da curva ROC. Resultados: ao exame ultra-sonográfico foi identificado pelo menos um linfonodo axilar em 173 (96%) exames. O exame histológico detectou metástase linfonodal em 87 mulheres (48%). As melhores sensibilidades dos critérios morfológicos foram encontradas com o volume (62%), diâmetro ântero-posterior (62%) e local do centro ecogênico (56%). Embora a especificidade da invasão da gordura adjacente (100%), regularidade das margens (92%) e da ecotextura do parênquima (99%) tenham sido elevadas, a sensibilidade destes parâmetros foi muito baixa. Nenhum critério dopplervelocimétrico alcançou 50% de sensibilidade. A árvore de decisão selecionou a localização do centro ecogênico, a ecotextura do parênquima e a regularidade das margens como melhor associação de parâmetros. Conclusão: o estadiamento dos linfonodos axilares por método não invasivo ainda é um objetivo não alcançado no tratamento das pacientes com câncer de mama. PALAVRAS-CHAVE:Neoplasias mamárias/diagnóstico; Ultrasonografia; Linfonodos/anatomia & histologia; Morfologia; Fluxometria por laser-doppler; Axila ABSTRACT Purpose: to evaluate the role of morphological (12) and Doppler velocimetry (17) ultrasonographic features, in the detection of lymph node metastases in breast cancer patients. Methods: 179 women (181 axillary cavities) were included in the study from January to December 2004. The ultrasonographic examinations were performed with a real-time linear probe (ToshibaPower Vision-6000 (model SSA-370A)). The morphological parameters were studied with a frequency of 7.5-12 MHz. A frequency of 5 MHz was used for the Doppler velocimetry parameters. Subsequently, the women were submitted to level I, II and III axillary dissection (158), or to the sentinel lymph node technique (23). Sensitivity, specificity, and positive and negative predictive values were calculated for each parameter. The decision tree test was used for parameter association. The cutoff points were established by the ROC curve. Results: at least one lymph node was detected in 173 (96%) of the women by the ultrasonographic examinations. His...

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Breast lymphedema after breast conserving treatment

Cited by 75 publications

References 14 publications

Risk Factors Associated with Breast Lymphedema

Risk Factors Associated with Breast Lymphedema

Daganatos betegekben kialakult másodlagos nyiroködéma ellátása

Desempenho da ultra-sonografia na detecção das metástases em linfonodos axilares em mulheres com câncer de mama

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