Ultrasound elastography as an objective diagnostic measurement tool for lymphoedema of the treated breast in breast cancer patients following breast conserving surgery and radiotherapy

Abstract

Background.Lymphoedema of the operated and irradiated breast is a common complication following early breast cancer treatment. There is no consensus on objective diagnostic criteria and standard measurement tools. This study investigates the use of ultrasound elastography as an objective quantitative measurement tool for the diagnosis of parenchymal breast oedema.Patients and methods.The elasticity ratio of the subcutis, measured with ultrasound elastography, was compared with high-frequency ultrasound parameters and subjective symptoms in twenty patients, bilaterally, prior to and following breast conserving surgery and breast irradiation.Results.Elasticity ratio of the subcutis of the operated breast following radiation therapy increased in 88.9% of patients, was significantly higher than prior to surgery, unlike the non operated breast and significantly higher than the non operated breast, unlike preoperative results. These results were significantly correlated with visibility of the echogenic line, measured with high-frequency ultrasound. Big preoperative bra cup size was a significant risk factor for the development of breast oedema.Conclusions.Ultrasound elastography is an objective quantitative measurement tool for the diagnosis of parenchymal breast oedema, in combination with other objective diagnostic criteria. Further research with longer follow-up and more patients is necessary to confirm our findings.

Diagnosis of Upper-Quadrant Lymphedema Secondary to Cancer: Clinical Practice Guideline From the Oncology Section of APTA

“…Validity studies of ultrasound elastography on breast tissue after radiation therapy demonstrated an increase in subcutis thickness as expected 101. An early study by Mellor et al100 found high correlations between ultrasound-measured skin thickness and arm circumference ( r = 0.95).…”

Vascularized Lymph Node Transfer for Treatment of Lymphedema

“…7 Ultrasound elastography is another new technique that quantitatively and objectively measures tissue elasticity, but further tests are warranted to determine validity. 41 The most used method of presenting limb circumference or volume change has been the circumference reduction rate calculation. 21 It compares the change in limb circumference while using the normal limb as a baseline, thereby taking into account changes in weight, which might skew results.…”

Skin and Subcutaneous Tissue Ultrasonography Features in Breast Cancer-Related Lymphedema

“…16) This blurring, however, was found only in 5% of the images analyzed in the current study, which was much less than the percentage of blurring seen in stage II leg LE (range: 24%-47%). 1) Increased SEG is considered a result of increased cell density and collagen content in the tissue, 17,18) which indicates the presence of nonspecific local inflammation. Since lymph stasis causes chronic inflammation due to uncontrolled responses of macrophages and CD4+ cells, 19,20) it may be reasonable to presume that SEG increases in the extremity with LE without exception.…”