Can a practicing surgeon detect early lymphedema reliably?

Bland, Keiva L.; Perczyk, Rebecca; Du, Wei; Rymal, Christine; Koppolu, Prathima; McCrary, Ruthie; Carolin, Kathryn A; Kosir, Mary A.

doi:10.1016/j.amjsurg.2003.07.003

Cited by 31 publications

(21 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Although there are generally accepted criteria but not well-established guidelines to diagnose lymphoedema using circumferential measurements, there are no universally applied methods to quantitatively define lymphoedema and no standard degree of enlargement or consensus, what constitutes lymphoedema, thereby complicating interpretation of the literature [17]. There are reports citing that a greater than 2 cm difference from baseline (preoperative) measurements identifies lymphoedema [18]. On the other hand girth measurements do not always correlate with symptoms or quality of life [19].…”

Section: Discussionmentioning

confidence: 99%

Long-term outcomes of breast cancer patients after endoscopic axillary lymph node dissection: a prospective analysis of 52 patients

Langer

Kocher

Güller

et al. 2005

Breast Cancer Res Treat

View full text Add to dashboard Cite

SummaryBackground. Reports on long-term outcomes after endoscopic axillary lymph node dissection (ALND) of breast cancer patients are still lacking in the medical literature. The objective of this prospective study was to assess the oncological and functional outcomes in breast cancer patients after endoscopic ALND.Methods. Fifty-five breast cancer patients were prospectively enrolled, of whom 52 were available for follow-up with a median of 71.9 months (range 11-96). The following oncological and functional endpoints were evaluated during follow-up at several time points: occurrence of local, axillary and distant metastases, seroma or infection, shoulder mobility (range of motion), numbness, pain, presence of lymphoedema as well as restriction in activities of daily living.Results. In 52 patients endoscopic ALND of level I and II was successfully performed. Two port-site metastases (2/52, 4%) occurred, one of which in a patient with negative axillary lymph nodes. The same patient suffered from the only axillary recurrence (1/52, 2%). Three patients (3/52, 6%) developed lymphoedema. No other functional adverse events (shoulder mobility, pain, numbness, hypertrophic scar) were noticed at the end of the observation period.Conclusion. The present investigation with long-term follow-up after endoscopic ALND -the first one in the literature -reveals minor morbidity, good functional and cosmetic results. In contrary to conventional surgery, the endoscopic procedure is associated with the occurrence of port-site metastases, not seen in the open approach. Axillary recurrences do not appear more frequently when compared with results after conventional ALND. In the meantime the less invasive sentinel lymph node (SLN) biopsy is the established standard technique in evaluating the axillary lymph node status.

show abstract

Section: Discussionmentioning

confidence: 99%

Long-term outcomes of breast cancer patients after endoscopic axillary lymph node dissection: a prospective analysis of 52 patients

Langer

Kocher

Güller

et al. 2005

Breast Cancer Res Treat

View full text Add to dashboard Cite

show abstract

“…Although volumetry has the aim of measuring irregular edemas like lymphedema 17 , perimetry, when performed carefully, supplements the evaluation as it shows the most affected sites, because the lymphedema is not homogeneous 18 . In this study, data from the perimetry enabled the mathematical calculation of the limb volume.…”

Section: Discussionmentioning

confidence: 99%

Linfedema pós-mastectomia: um protocolo de tratamento

et al. 2013

View full text Add to dashboard Cite

| Lymphedema is still considered as one of the main sequela resulting from surgical treatment of breast cancer. The aim of this study was to evaluate the efficacy of a protocol that included use of a high-voltage electrical stimulation (HVES) associated with therapeutic exercises, self-massage, and self-care for the treatment of lymphedema of the upper limbs in women who underwent surgery for breast cancer treatment. This study included 17 volunteers (60.9_ +11.72 years of age) submitted to unilateral mastectomy, with lymphedema of the upper limb, ipsilateral to surgery. The treatment consisted of application of 14 HVES, to the patients, twice a week, supplemented by guidance on self-care, self-massage, and physical exercises. The evolution of this treatment was assessed by perimetry, calculation of the volume difference (VD) between the limbs, and calculation of the volume increase percentage (VIP) of the affected limb compared to the contralateral limb. Data were analyzed using the statistical method for paired T and dependent variables, which showed a significant reduction of 14.13% (p=0.0067) in VIP and 13.8% (p=0.0089) in VD, as well as perimetry at the following three points: 7 cm above the elbow (p=0.0138), 7 cm below the elbow (p=0.0282), and at the wrist (p=0.0476). It was concluded that the use of HVES associated with the exercises and guidance on self-care and self-massage was effective to reduce the lymphedema in the evaluated group. RESUMO | O linfedema ainda é uma das principais sequelas decorrentes do tratamento cirúrgico do cânc-er de mama. O objetivo do estudo foi avaliar a eficácia de um protocolo que inclui a utilização da estimulação elétrica de alta voltagem (EEAV) associada a exercícios terapêuticos, automassagem e autocuidados no tratamento do linfedema de membros superiores em mulheres submetidas a cirurgia para tratamento do câncer de mama. Participaram do estudo 17 voluntárias (60,9_ +11,72 anos) submetidas à mastectomia unilateral, portadoras de linfedema de membro superior, homolateral à cirurgia. O tratamento constituiu-se de 14 aplicações da EEAV, duas vezes por semana, complementadas por orientações quanto ao autocuidado, automassagem e exercícios físicos. A evolução do tratamento foi avaliada por perimetria, cálculo da diferença de volume (DV) entre os membros, e percentual de aumento do volume (PAV) do membro afetado em relação ao contralateral. Os dados foram analisados por meio do método estatís-tico T pareado para variáveis dependentes e revelaram redução significativa de 14,13% (p=0,0067) do PAV e de 13,8% (p=0,0089) da DV, bem como da perimetria em três pontos: sete centímetros acima do cotovelo (p=0,0138), sete centímetros abaixo do cotovelo (p=0,0282) e no punho (p=0,0476). Pôde-se concluir que a utilização da estimulação elétrica de alta voltagem associada a exercícios e orientações foi eficaz na redução do linfedema do grupo avaliado. Keywords | breast neoplasms; lymphedema; rehabilitationDescritores | neoplasias da mama; linfedema; reabilitação. Barros et al. ...

show abstract

“…However, because the sensitivity of this criterion is only 37%, the actual incidence may be much higher. [26] Therefore, reliable, easy-to-use, noninvasive, and cost-effective measurement methods are necessary. In addition, if the measurement method could provide information on the texture and shape of the affected arms, it would be more useful in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Optimal pressure for measuring objective lymphedema with postoperative ultrasonography in patients with breast cancer

Lim

Hwang

Park

et al. 2016

Computer Assisted Surgery

View full text Add to dashboard Cite

Objective: To examine the reliability of ultrasonographic thickness and compressibility along with real-time pressure monitoring to evaluate postmastectomy lymphedema and to suggest a reference range of appropriate pressure. Design: Measurement reliability study. Setting: Research laboratory. Participants: Fifteen patients with prior mastectomy for breast cancer who were diagnosed with secondary lymphedema, and 16 healthy control subjects. Methods: The thickness and compressibility of the subcutaneous layer in the arms of 15 postmastectomy patients with secondary lymphedema were measured using B-mode and M-mode ultrasonography. An ultrasound machine was equipped with a real-time pressure-monitoring device to monitor downward compression pressure on the arms at a constant velocity. The ratio of thickness change defined the compressibility index. Two different experienced examiners participated in the measurement of lymphedema. Intrarater reliability and inter-rater reliability were estimated using the intraclass correlation coefficient. Very good reliability was defined as an ICC of more than 0.8. Main outcome measurements: The thickness of the subcutaneous layer, the compressibility index, and the intrarater and inter-rater reliability were measured.Results: The measured thicknesses demonstrated very good intrarater and inter-rater reliability for the forearm and upper arm. For the compressibility index, the upper arm and forearm had very good intrarater and inter-rater reliability at over 2000 Pa of compression (>0.9). Conclusions: Ultrasonography with real-time pressure monitoring may be useful for evaluating the severity and characteristics of lymphedema, particularly at compression pressures more than 2000 Pa.

show abstract

Can a practicing surgeon detect early lymphedema reliably?

Cited by 31 publications

References 13 publications

Long-term outcomes of breast cancer patients after endoscopic axillary lymph node dissection: a prospective analysis of 52 patients

Long-term outcomes of breast cancer patients after endoscopic axillary lymph node dissection: a prospective analysis of 52 patients

Linfedema pós-mastectomia: um protocolo de tratamento

Optimal pressure for measuring objective lymphedema with postoperative ultrasonography in patients with breast cancer

Contact Info

Product

Resources

About