Diagnostic Criteria for Breast Cancer-Related Lymphedema of the Upper Extremity: The Need for Universal Agreement

Kassamani, Yara W; Brunelle, Cheryl L.; Gillespie, Tessa C.; Bernstein, Madison C; Bucci, Loryn K; Nassif, Tracy; Taghian, Alphonse G.

doi:10.1245/s10434-021-10645-3

Cited by 27 publications

(17 citation statements)

References 60 publications

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“…Second, owing to the definition of lymphedema [ 19 ] and the retrospective nature of this study, lymphedema rates can be underestimated in cases of asymptomatic lymphedema. Although the definition of lymphedema varies across studies, both subjective and objective findings in longitudinal prospective evaluations should be incorporated in the future [ 20 ]. Furthermore, while a recent large cohort study of 5900 mastectomy patients showed a protective effect of immediate breast reconstruction in the development of lymphedema [ 21 ], our study cohort, which included only 291 mastectomy patients (20 % of the total population), was limited in its ability to evaluate the impact of reconstruction.…”

Section: Discussionmentioning

confidence: 99%

Incorporating axillary-lateral thoracic vessel juncture dosimetric variables improves model for predicting lymphedema in patients with breast cancer: A validation analysis

Chang¹,

Ko²,

Im³

et al. 2023

Clinical and Translational Radiation Oncology

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Section: Discussionmentioning

confidence: 99%

Incorporating axillary-lateral thoracic vessel juncture dosimetric variables improves model for predicting lymphedema in patients with breast cancer: A validation analysis

Chang¹,

Ko²,

Im³

et al. 2023

Clinical and Translational Radiation Oncology

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“…It is typically the case across many diseases that the earliest possible diagnosis and treatment are important for improving the prognosis. In the case of lymphedema, better outcomes are obtained when a diagnosis is made, and treatment commences, before physical change appears [ [9][10][11][12][13] ].…”

Section: Introductionmentioning

confidence: 99%

Static and dynamic analysis of in-vivo imaging for early-detection of lymphedema via near-infrared fluorescence indocyanine green lymphangiography

Cheon

Lee

Kim

et al. 2023

Preprint

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Background: Near-infrared fluorescence indocyanine green (NIRF-ICG) lymphangiography, a primary modality for detecting lymphedema, which is a disease due to lymphatic obstruction, enables real-time observations of lymphatic flow and reveals not only the spatial distribution of drainage (static analysis), but also information on the lymphatic contraction (dynamic analysis). Methods: We have produced lymphatic obstruction models in upper limbs through the dissection of proximal lymph nodes (LNs) and radiation (dissection limbs). After the model formation during 1 week, the static and dynamic analysis using NIRF-ICG lymphangiography were performed for six weeks. The drainage pattern and leakage of lymph fluid were observed and time-domain signals of lymphatic contraction were measured in the distal lymph vessels. The obtained signals were converted to the frequency-domain spectrums using the signal processing. Results: The results of both static and dynamic analyses proved to be effective in accurately identify the extent of lymphatic disruption in the dissection limbs. The static analysis showed abnormal drainage patterns and an increased leakage of lymph fluid to the periphery of the vessels compared to the control limbs. Meanwhile, the waveforms were changed and the frequency of the contractile signals was increased by 58% in the dynamic analysis. Specifically, our findings revealed that regular lymphatic contractions, observed at a frequency range of 0.08 ~ 0.13 Hz in the control limbs, were absent in the dissection limbs. The contractile regularity was not fully restored until the end of the follow-up, indicating a persistent lymphatic disruption in the dissected limbs. Conclusion: The dynamic analysis was consistent with the static analysis, and it could detect the abnormalities of lymphatic circulation by observing the characteristics of signals without the need for a control group. As NIRF-ICG lymphangiography is currently used in clinical practice, our findings may be useful for the early detection of the lymphatic circulation problem.

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“…No diagnostic method has been universally accepted for accurate detection of early changes in lymphatic function before the onset of irreversible BCRL tissue changes, yet early diagnosis may lead to the best chance of treatment efficacy [ 14 – 17 ]. Instead, the objective, albeit non-standardized, diagnostic criterion for cancer-acquired lymphedema is an increase in arm volume, which is typically measured no earlier than 3–6 months after locoregional treatment to avoid the transient swelling attributable to surgery and RT [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

Prediction of breast cancer-related lymphedema by dermal backflow detected with near-infrared fluorescence lymphatic imaging

Aldrich

Rasmussen

DeSnyder

et al. 2022

Breast Cancer Res Treat

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Purpose Mild breast cancer-related lymphedema (BCRL) is clinically diagnosed as a 5%–10% increase in arm volume, typically measured no earlier than 3–6 months after locoregional treatment. Early BCRL treatment is associated with better outcomes, yet amid increasing evidence that lymphedema exists in a latent form, treatment is typically delayed until arm swelling is obvious. In this study, we investigated whether near-infrared fluorescence lymphatic imaging (NIRF-LI) surveillance could characterize early onset of peripheral lymphatic dysfunction as a predictor of BCRL. Methods In a prospective, longitudinal cohort/observational study (NCT02949726), subjects with locally advanced breast cancer who received axillary lymph node dissection and regional nodal radiotherapy (RT) were followed serially, between 2016 and 2021, before surgery, 4–8 weeks after surgery, and 6, 12, and 18 months after RT. Arm volume was measured by perometry, and lymphatic (dys) function was assessed by NIRF-LI. Results By 18 months after RT, 30 of 42 study subjects (71%) developed mild–moderate BCRL (i.e., ≥ 5% arm swelling relative to baseline), all manifested by “dermal backflow” of lymph into lymphatic capillaries or interstitial spaces. Dermal backflow had an 83% positive predictive value and 86% negative predictive value for BCRL, with a sensitivity of 97%, specificity of 50%, accuracy of 83%, positive likelihood ratio of 1.93, negative likelihood ratio of 0.07, and odds ratio of 29.00. Dermal backflow appeared on average 8.3 months, but up to 23 months, before the onset of mild BCRL. Conclusion BCRL can be predicted by dermal backflow, which often appears months before arm swelling, enabling early treatment before the onset of edema and irreversible tissue changes.

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Diagnostic Criteria for Breast Cancer-Related Lymphedema of the Upper Extremity: The Need for Universal Agreement

Cited by 27 publications

References 60 publications

Incorporating axillary-lateral thoracic vessel juncture dosimetric variables improves model for predicting lymphedema in patients with breast cancer: A validation analysis

Incorporating axillary-lateral thoracic vessel juncture dosimetric variables improves model for predicting lymphedema in patients with breast cancer: A validation analysis

Static and dynamic analysis of in-vivo imaging for early-detection of lymphedema via near-infrared fluorescence indocyanine green lymphangiography

Prediction of breast cancer-related lymphedema by dermal backflow detected with near-infrared fluorescence lymphatic imaging

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