Preoperative assessment enables the early diagnosis and successful treatment of lymphedema

Stout, Nicole L.; Pfalzer, Lucinda; McGarvey, Charles L.; Springer, Barbara A.; Gerber, Lynn H.; Soballe, Peter W.

doi:10.1002/cncr.23494

Cited by 398 publications

(417 citation statements)

References 62 publications

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“…This latter recommendation is based on research published subsequent to the 2001 CPG, in which it was shown that volume measurements using an opto-electric volumeter were especially sensitive to subtle changes in upper limb volume. 67 If an opto-electric volumeter (perometer) is available, albeit not common in clinical practice, it should be used in place of arm circumference measures. Another measure that shows promise in measuring early, fluid-based changes is bioimpedance spectroscopy, which is described in the Australian lymphedema guideline.…”

Section: Syntheses Of Guideline Recommendationsmentioning

confidence: 99%

Clinical practice guidelines for breast cancer rehabilitation

Harris

Schmitz

Campbell

et al. 2012

Cancer

115

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BACKGROUND: Despite strides in early detection and management of breast cancer, the primary treatments for this disease continue to result in physical impairments for some of the nearly 3 million people diagnosed annually. Over the past decade, evidence‐based clinical practice guidelines (CPGs) have been developed with goals of preventing and ameliorating these impairments. However, translation of these guidelines into clinical practice needs to be accelerated. METHODS: Relevant health science databases (2001‐2011) were searched to identify CPGs on breast cancer rehabilitation for the following impairments: upper extremity restrictions, lymphedema, pain, fatigue, chemotherapy‐induced peripheral neuropathy, treatment‐related cardiotoxicity, bone health, and weight management. RESULTS: Recommendations from 19 relevant CPGs were first summarized by impairment within tables; commonalities across guidelines, within each impairment, were then synthesized within the article. The CPGs were rated using the Appraisal of Guidelines for Research and Evaluation II (AGREE II); wide variability was noted in rigor of development, clarity of presentation, and stakeholder involvement. The most rigorous and comprehensive of those rated was the adult cancer pain guideline from the Scottish Intercollegiate Guidelines Network. CONCLUSIONS: Based on a large body of evidence published in recent years, including randomized trials and systematic reviews, there is an urgent need for updating the guidelines on upper extremity musculoskeletal impairments and lymphedema. Furthermore, additional research is needed to provide an evidence base for developing rehabilitation guidelines on management of other impairments identified in the prospective surveillance model, eg, arthralgia. Cancer 2012;118(8 suppl):. © 2012 American Cancer Society.

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Section: Syntheses Of Guideline Recommendationsmentioning

confidence: 99%

Clinical practice guidelines for breast cancer rehabilitation

Harris

Schmitz

Campbell

et al. 2012

Cancer

115

View full text Add to dashboard Cite

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“…Traditionally, lymphedema has been clinically diagnosed by healthcare professionals' observations of swelling, and has often arbitrarily been defined in research as a 2-cm increase in limb girth, a 200-mL or more increase in limb volume, or a 5% or greater limb volume change Cormier et al, 2009;Stout et al, 2008). Inconsistency in the criteria defining lymphedema and the use of different measures has posed tremendous difficulty in accurately diagnosing lymphedema (Armer & Stewart, 2005).…”

Section: Diagnosis Of Breast Cancer-related Lymphedemamentioning

confidence: 99%

“…The advent of infra-red perometry (also called optoelectronic volumetry), such as the perometer 350S (Juzo, Cuyahoga Falls, OH), enables reliable and accurate detection of 3% limb volume change (LVC) (Cormier et al, 2009;Stout et al, 2008). The perometer works in much the same manner as computed tomography but uses infrared light instead of X-rays (Petlund, 1991).…”

Section: Infra-red Perometrymentioning

confidence: 99%

“…This optoelectronic method has a standard deviation of 8.9 ml (arm), less than 0.5% of LV with repeated measuring (Armer & Stewart, 2005;Cormier et al, 2009). Because the perometer is capable of measuring bilateral lymphedema and localization of swelling as well as detecting a 3% LVC that enables detectable differences in quality of life (QOL) and symptom reporting, the optimal measure for lymphedema is the evaluation of LVC by the perometer (Armer & Stewart, 2005;Cormier et al, 2009;Stout et al, 2008).…”

Section: Infra-red Perometrymentioning

confidence: 99%

“…To promote early intervention, it is imperative to implement screening and measurement for early detection of breast cancer-related lymphedema. In a prospective observational study on 196 women with newly diagnosed breast cancer over a five year period (Stout et al, 2008), the women were measured using infra-red Perometry prior to their surgery and in three-month intervals following their surgery for up to one year. During that time, researchers were able to identify the development of subclinical lymphedema in 43 women (22%).…”

Section: Risk Reductionmentioning

confidence: 99%

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Preparing for and Coping with Breast Cancer-Related Lymphedema

Radina¹,

Fu²

2012

Novel Strategies in Lymphedema

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Lymphedema is a swelling caused by the abnormal accumulation of lymphatic fluid in the skin. Lymphedema can be caused by burns, injury, surgery, radiation therapy or cancer treatment that cancer survivors undergo. Risk of developing lymphedema is high especially in those with breast or prostate cancer. It is hereditary and can appear without warning at any time of life and is related to obesity and circulatory problems. If not treated, lymphedema can be painful and lead to life-threatening infections. This book will help physicians who deal with lymphedema. It will help you understand how the lymphatic system works, how lymphedema is diagnosed, how to cope with the challenges of lymphedema, how to find treatment, and how to deal with insurance issues.Novel Strategies in Lymphedema is for those with, or at risk of, developing lymphedema, and the healthcare professionals who care for them.

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Feasibility and Clinical Utility of Prediction Models for Breast Cancer–Related Lymphedema Incorporating Racial Differences in Disease Incidence

et al. 2023

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ImportanceBreast cancer–related lymphedema (BCRL) is a common complication of axillary lymph node dissection (ALND) but can also develop after sentinel lymph node biopsy (SLNB). Several models have been developed to predict the risk of disease development before and after surgery; however, these models have shortcomings that include the omission of race, inclusion of variables that are not readily available to patients, low sensitivity or specificity, and lack of risk assessment for patients treated with SLNB.ObjectiveTo create simple and accurate prediction models for BCRL that can be used to estimate preoperative or postoperative risk.Design, Setting, and ParticipantsIn this prognostic study, women with breast cancer who underwent ALND or SLNB from 1999 to 2020 at Memorial Sloan Kettering Cancer Center and the Mayo Clinic were included. Data were analyzed from September to December 2022.Main Outcomes and MeasuresDiagnosis of lymphedema based on measurements. Two predictive models were formulated via logistic regression: a preoperative model (model 1) and a postoperative model (model 2). Model 1 was externally validated using a cohort of 34 438 patients with an International Classification of Diseases diagnosis of breast cancer.ResultsOf 1882 included patients, all were female, and the mean (SD) age was 55.6 (12.2) years; 80 patients (4.3%) were Asian, 190 (10.1%) were Black, 1558 (82.8%) were White, and 54 (2.9%) were another race (including American Indian and Alaska Native, other race, patient refused to disclose, or unknown). A total of 218 patients (11.6%) were diagnosed with BCRL at a mean (SD) follow-up of 3.9 (1.8) years. The BCRL rate was significantly higher among Black women (42 of 190 [22.1%]) compared with all other races (Asian, 10 of 80 [12.5%]; White, 158 of 1558 [10.1%]; other race, 8 of 54 [14.8%]; P &lt; .001). Model 1 included age, weight, height, race, ALND/SLNB status, any radiation therapy, and any chemotherapy. Model 2 included age, weight, race, ALND/SLNB status, any chemotherapy, and patient-reported arm swelling. Accuracy was 73.0% for model 1 (sensitivity, 76.6%; specificity, 72.5%; area under the receiver operating characteristic curve [AUC], 0.78; 95% CI, 0.75-0.81) at a cutoff of 0.18, and accuracy was 81.1% for model 2 (sensitivity, 78.0%; specificity, 81.5%; AUC, 0.86; 95% CI, 0.83-0.88) at a cutoff of 0.10. Both models demonstrated high AUCs on external (model 1: 0.75; 95% CI, 0.74-0.76) or internal (model 2: 0.82; 95% CI, 0.79-0.85) validation.Conclusions and RelevanceIn this study, preoperative and postoperative prediction models for BCRL were highly accurate and clinically relevant tools comprised of accessible inputs and underscored the effects of racial differences on BCRL risk. The preoperative model identified high-risk patients who require close monitoring or preventative measures. The postoperative model can be used for screening of high-risk patients, thus decreasing the need for frequent clinic visits and arm volume measurements.

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Preoperative assessment enables the early diagnosis and successful treatment of lymphedema

Abstract: A short trial of compression garments effectively treated subclinical LE.

Cited by 398 publications

References 62 publications

Clinical practice guidelines for breast cancer rehabilitation

Clinical practice guidelines for breast cancer rehabilitation

Preparing for and Coping with Breast Cancer-Related Lymphedema

Feasibility and Clinical Utility of Prediction Models for Breast Cancer–Related Lymphedema Incorporating Racial Differences in Disease Incidence

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