Longitudinal, Long-Term Comparison of Single- versus Multipoint Upper Limb Circumference Periodical Measurements as a Tool to Predict Persistent Lymphedema in Women Treated Surgically for Breast Cancer: An Optimized Strategy to Early Diagnose Lymphedema and Avoid Permanent Sequelae in Breast Cancer Survivors.

Autor: Furlan C; Department of Obstetrics and Gynecology, Division of Gynecologic and Breast Oncology, Women's Hospital (CAISM), State University of Campinas (Unicamp), Campinas , SP, Brazil.; Division of Gynecologic and Breast Oncology, Women's Hospital (CAISM), Unicamp, Campinas, SP, Brazil., Matheus CN; Department of Physical Therapy, Einstein Integrated Colleges (FIEL), Limeira, Brazil., Jales RM; Imaging Sector, Women's Hospital (CAISM), Unicamp, Campinas, SP, Brazil., Derchain SFM; Department of Obstetrics and Gynecology, Division of Gynecologic and Breast Oncology, Women's Hospital (CAISM), State University of Campinas (Unicamp), Campinas , SP, Brazil.; Division of Gynecologic and Breast Oncology, Women's Hospital (CAISM), Unicamp, Campinas, SP, Brazil., Bennini JR Jr; Department of Obstetrics and Gynecology, Division of Gynecologic and Breast Oncology, Women's Hospital (CAISM), State University of Campinas (Unicamp), Campinas , SP, Brazil.; Division of Gynecologic and Breast Oncology, Women's Hospital (CAISM), Unicamp, Campinas, SP, Brazil., Sarian LO; Department of Obstetrics and Gynecology, Division of Gynecologic and Breast Oncology, Women's Hospital (CAISM), State University of Campinas (Unicamp), Campinas , SP, Brazil. sarian@unicamp.br.; Division of Gynecologic and Breast Oncology, Women's Hospital (CAISM), Unicamp, Campinas, SP, Brazil. sarian@unicamp.br.
Jazyk: angličtina
Zdroj: Annals of surgical oncology [Ann Surg Oncol] 2021 Dec; Vol. 28 (13), pp. 8665-8676. Date of Electronic Publication: 2021 Jun 14.
DOI: 10.1245/s10434-021-10290-w
Abstrakt: Purpose: We aim to evaluate whether upper limb (UL) circumference (ULC) and UL swelling sensation (ULSS) performed shortly after surgery or later on during follow-up can predict long-term/persistent forms of lymphedema in women who underwent surgery for breast cancer.
Patients and Methods: Eighty-five women completed at least 24 months of follow-up. At each follow-up visit (1, 3, 6, 12, and 24 months after surgery), patients were tested for lymphedema using ULC and ULSS. Two different approaches to ULC were compared: (1) a "positive" lymphedema diagnosis if a difference ≥ 2 cm between the affected and contralateral UL was detected in at least two contiguous measurement points (MPs) and (2) a "positive" result if just one MP ≥ 2 cm. Patients were also questioned about their perception of weight, swelling, and/or tension (ULSS). The gold standard for long-term lymphedema was a water displacement difference between the UL ≥ 200 mL 24 months after surgery (ULWD).
Results: Twenty-four months after surgery, 19 (22.4%) women were diagnosed with long-term lymphedema. Using 24-month data, comparison of log-likelihoods denoted a clear superiority of the ULC approach 1 compared with 2 for the diagnosis of long-term lymphedema (p < 0.001). Using approach 1, the best prediction of a woman developing long-term lymphedema if she had a positive ULC in the follow-up was obtained at 6 months after surgery (posterior probability of 60%).
Conclusions: Our study reveals that performing ULC 6 months after surgery, regarding as "positive" only women with a difference ≥ 2 cm at two contiguous MPs, is the best strategy to identify women at increased risk of later developing permanent forms of lymphedema.
(© 2021. Society of Surgical Oncology.)
Databáze: MEDLINE
Externí odkaz: