Evaluation of Simplified Lymphatic Microsurgical Preventing Healing Approach (SLYMPHA) for the prevention of breast cancer-related lymphedema after axillary lymph node dissection using bioimpedance spectroscopy

Özmen, Tolga; Layton, Christina; Friedman-Eldar, Orli; Melnikau, Siarhei; Kesmodel, Susan B.; Möller, Mecker G.; Avisar, Eli

doi:10.1016/j.ejso.2022.04.023

Cited by 10 publications

(10 citation statements)

References 27 publications

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“…Methods such as ARM and LYMPHA at the time of surgery have been shown to be effective in reducing BCRL incidence but come with their own risks and are not always feasible. Newer surgical methods for immediate lymphatic reconstruction will likely play an increasingly important role in BCRL prevention [ 69 , 134 , 135 ].…”

Section: Discussionmentioning

confidence: 99%

“…A 2021 study reported that 85% of breast surgeons reported not offering LYMPHA [ 68 ]. A simplified version of LYMPHA not requiring microsurgery has been described (SLYMPHA), with the procedure lowering BCRL incidence from 32 to 16% in one study [ 69 ]. Further surgical development for addressing lymphatic impairments is warranted along with algorithms for identifying best surgical candidates for the various interventions along with long-term surgical outcomes.…”

Section: Bcrl Preventionmentioning

confidence: 99%

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Advances in the prevention and treatment of breast cancer-related lymphedema

Donahue¹,

MacKenzie²,

Filipović³

et al. 2023

Breast Cancer Res Treat

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Purpose Breast cancer-related lymphedema (BCRL) represents a lifelong risk for breast cancer survivors and once acquired becomes a lifelong burden. This review summarizes current BCRL prevention and treatment strategies. Findings Risk factors for BCRL have been extensively studied and their identification has affected breast cancer treatment practice, with sentinel lymph node removal now standard of care for patients with early stage breast cancer without sentinel lymph node metastases. Early surveillance and timely management aim to reduce BCRL incidence and progression, and are further facilitated by patient education, which many breast cancer survivors report not having adequately received. Surgical approaches to BCRL prevention include axillary reverse mapping, lymphatic microsurgical preventative healing (LYMPHA) and Simplified LYMPHA (SLYMPHA). Complete decongestive therapy (CDT) remains the standard of care for patients with BCRL. Among CDT components, facilitating manual lymphatic drainage (MLD) using indocyanine green fluorescence lymphography has been proposed. Intermittent pneumatic compression, nonpneumatic active compression devices, and low-level laser therapy appear promising in lymphedema management. Reconstructive microsurgical techniques such as lymphovenous anastomosis and vascular lymph node transfer are growing surgical considerations for patients as well as liposuction-based procedures for addressing fatty fibrosis formation from chronic lymphedema. Long-term self-management adherence remains problematic, and lack of diagnosis and measurement consensus precludes a comparison of outcomes. Currently, no pharmacological approaches have proven successful. Conclusion Progress in prevention and treatment of BCRL continues, requiring advances in early diagnosis, patient education, expert consensus and novel treatments designed for lymphatic rehabilitation following insults.

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Section: Discussionmentioning

confidence: 99%

Section: Bcrl Preventionmentioning

confidence: 99%

Advances in the prevention and treatment of breast cancer-related lymphedema

Donahue¹,

MacKenzie²,

Filipović³

et al. 2023

Breast Cancer Res Treat

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“…Short of this, additional surgical approaches may be performed to minimize the risk of lymphedema including axillary reverse mapping (ARM) and immediate lymphatic reconstruction 46 . Additionally, lymphatic‐venous anastomoses and vascular LN transfer are reconstructive surgeries that aim to restore normal lymphatic flow, and are being investigated as preventative procedures immediately following breast cancer surgery 47,48 . A noninvasive imaging strategy with improved sensitivity for LN metastasis would be beneficial to enhance cancer prognosis and guide these emerging interventions.…”

Section: Discussionmentioning

confidence: 99%

“…46 Additionally, lymphatic-venous anastomoses and vascular LN transfer are reconstructive surgeries that aim to restore normal lymphatic flow, and are being investigated as preventative procedures immediately following breast cancer surgery. 47,48 A noninvasive imaging strategy with improved sensitivity for LN metastasis would be beneficial to enhance cancer prognosis and guide these emerging interventions. Current diagnostic imaging may be performed pre-operatively in patients with high grade cancers using contrast-enhanced MRI and more recently FDG-PET.…”

Section: Diagnostic Lymphatic Imaging and Relevance For Lymphadenectomymentioning

confidence: 99%

In vivo lymph node CEST‐Dixon MRI in breast cancer patients with metastatic lymph node involvement

Donahue,

Jones

et al. 2023

Magnetic Resonance in Med

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PurposeAxillary lymph nodes (LNs) often present a reservoir for metastatic breast cancer, yet metastatic LN involvement cannot be discerned definitively using diagnostic imaging. This study investigated whether in vivo CEST may discriminate LNs with versus without metastatic involvement.Methods3T MRI was performed in patients with breast cancer before clinically‐indicated mastectomy or lumpectomy with LN removal, after which LN metastasic involvement was determined using histological evaluation. Non‐contrast anatomical imaging, as well as B0 and B1 field maps, were acquired in sequence with three‐point CEST‐Dixon (3D turbo‐gradient‐echo; factor = 25; TR/TE1/ΔTE = 851/1.35/1.1 ms; spatial‐resolution = 2.5 × 2.5 × 6 mm; slices = 10; four sinc‐gauss pulses with duty‐cycle = 0.5, total saturation duration = 701.7 ms; B1 = 1.5 μT; saturation offsets = −5.5 to +5.5 ppm; stepsize = 0.2 ppm; scan duration = 6 min 30 s). The mean z‐spectrum from LNs with (n = 20) versus without (n = 22) metastatic involvement were analyzed and a Wilcoxon rank‐sum test (significance: p < 0.05) was applied to evaluate differences in B0, B1, and magnetization transfer ratio (MTR) in differing spectral regions of known proton exchange (nuclear Overhauser effect [NOE], amide, amine, and hydroxyl) between cohorts.ResultsNo difference in axillary B1 (p = 0.634) or B0 (p = 0.689) was observed between cohorts. Elevated MTR was observed for the NOE (−1.7 ppm; MTR = 0.285 ± 0.075 vs. 0.248 ± 0.039; p = 0.048), amine (+2.5 ppm; MTR = 0.284 ± 0.067 vs. 0.234 ± 0.31; p = 0.005), and hydroxyl (+1 ppm; MTR = 0.394 ± 0.075 vs. 0.329 ± 0.055; p = 0.002) protons in LNs from participants with versus without metastatic involvement.ConclusionsFindings are consistent with a unique metastatic LN microenvironment detectable by CEST‐Dixon and suggest that CEST MRI may have potential for mapping LN metastasis non‐invasively in vivo.

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“…The item in the therapeutic approach block that yielded the lowest percentage agreement was Item 20 (immediate lymphatic reconstruction in patients with ALND if there is a demonstrable interruption to lymphatic drainage in the arm), most likely reflecting the complexity of lymphatic reconstruction surgery and the small number of surgeons who are trained to perform it. However, the past decade has seen advances in surgical techniques for the prevention of lymphedema (Boccardo et al, 2014; Johnson et al, 2021; Ozmen et al, 2022), and the latest data are promising as regards the possibility of reducing the incidence of BCRL (Coriddi et al, 2021; Weinstein et al, 2022). Nevertheless, as some panellists highlighted in their comments, there is a need for randomised controlled trials to determine the effectiveness of immediate lymphatic reconstruction.…”

Section: Discussionmentioning

confidence: 99%

Multidisciplinary preventive intervention for breast cancer‐related lymphedema: An international consensus

Martínez-Jaimez

Linares

Piller

et al. 2022

European J Cancer Care

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Objective: To establish a consensus regarding the multidisciplinary prevention of breast cancer-related lymphedema (BCRL), taking into account the expert opinion of professional groups from across the world involved in the identification and treatment of breast cancers.Methods: International consensus study involving a modified nominal group and Delphi process. A total of 50 preventive strategies representing those used by a range of health disciplines involved in breast cancer care were identified by the nominal group. These strategies were categorised into four subgroups (general recommendations, therapeutic approach, rehabilitation medicine and physiotherapy and dietary recommendations) and presented in survey format to a multidisciplinary panel of experts in a two-round Delphi process. Eleven specialist areas and 15 countries were represented on the panel.Results: Twenty-seven experts responded to both Delphi rounds, and the mean overall agreement after Round 2 was 85.7%. Of the 50 proposed strategies for preventing BCRL, 48 yielded consensus among experts. Conclusion:We report an international consensus for the multidisciplinary prevention of BCRL, setting out recommendations aimed at systematising the care of women with breast cancer. The consensus could provide a platform for the development of standardised clinical guidelines.

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Evaluation of Simplified Lymphatic Microsurgical Preventing Healing Approach (SLYMPHA) for the prevention of breast cancer-related lymphedema after axillary lymph node dissection using bioimpedance spectroscopy

Cited by 10 publications

References 27 publications

Advances in the prevention and treatment of breast cancer-related lymphedema

Advances in the prevention and treatment of breast cancer-related lymphedema

In vivo lymph node CEST‐Dixon MRI in breast cancer patients with metastatic lymph node involvement

Multidisciplinary preventive intervention for breast cancer‐related lymphedema: An international consensus

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