Lymphedema: How Do We Diagnose and Reduce the Risk of This Dreaded Complication of Breast Cancer Treatment?

Abstract

Lymphedema is an under-recognized, progressive, life-long condition estimated to impact 2-3 million people in the United States. The incidence of breast cancer related lymphedema varies greatly in the literature largely due to different measurement techniques, competing thresholds for defining lymphedema, and variation in length of follow-up. Multiple imaging techniques have become useful for diagnosis. Lymphoscintigraphy is one of the most commonly used, as it can identify pathways of lymphatic drainage, quantify extent of dermal backflow, and help determine functional and morphologic changes in the lymphatic system. Early detection and intervention hold the greatest promise of reducing the incidence of lymphedema. Health care providers involved with cancer patients need to become more educated about lymphedema, aware of current riskreduction practices, and familiar with methods of diagnosis and assessment, so that patients with early swelling can be referred to lymphedema treatment specialists at a time when treatment is more effective.

Lymphedema: From diagnosis to treatment

“…In one study, it was reported that one-third of initial swelling attacks were transient (10). Since effective treatment of LE can be established in early stages, accurate and timely diagnosis is crucial (11). History of trauma or surgery must be addressed clearly.…”

Lymphedema: a mini-review on the pathophysiology, diagnosis and treatment

“…True LE is due to a swelling caused by the abnormality of the lymphatic system and it may occur with other diseases. Some diagnostic tests for LE include [6]: 1) History and physical examination has to be done with an experienced physician [7]; 2) Soft tissue imaging by magnetic resonance imaging (MRI), computed tomography (CT) and some types of ultrasound (US) to detect extra fluid in tissues [8]; 3) Lymph vessel and lymph node imaging by Lymphoscintigraphy to detect abnormalities in the lymphatic system. Technetium and Sulphur colloid are the radio-labelled particles of protein that are injected under the skin to be examined [9]; 4) Measures of volume are used to quantify the presence and severity of LE and the response to treatment.…”

A longitudinal analysis of chronic arm morbidity following breast cancer surgery

“…These measurements were converted into arm volumes (in milliliters) using a truncated cone formula. Arm volume change post-treatment was operationalized as the difference in arm volume between the ipsilateral and contralateral arms [51,52].…”