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Shen A, Li X, Zhao H, Ye J, Zhao H, Zhou Y, Wang Y, Zhang Z, Bian J, Zhang L, Wu P, Qiang W, Lu Q. Preoperative inter-arm differences and normative-based thresholds for lymphedema in Chinese breast cancer patients: Insights from a large cohort study. Asia Pac J Oncol Nurs 2024; 11:100567. [PMID: 39286531 PMCID: PMC11403264 DOI: 10.1016/j.apjon.2024.100567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Accepted: 07/31/2024] [Indexed: 09/19/2024] Open
Abstract
Objective Early detection and diagnosis of lymphedema are crucial for effective treatment and prevention of its progression. Normative-based diagnostic thresholds can enhance diagnostic accuracy in the absence of preoperative measurements. This study aimed to investigate preoperative inter-arm differences and the associated factors, as well as to determine normative-based thresholds for lymphedema in Chinese breast cancer patients. Methods This study utilized baseline data from a large cohort of Chinese breast cancer patients. Bilateral arm circumferences were measured at the wrist and at 10 cm intervals proximally up to 40 cm. Arm volumes were calculated using the truncated cone formula. Paired t test, repeated measures analysis of variance, and regression analysis were performed. Results A total of 1707 breast cancer patients were included. Paired t tests showed that the dominant arm circumferences and volumes were significantly larger than those of the nondominant arm (P < 0.001). Regression analysis and repeated measures analysis of variance revealed that hand dominance was the influencing factor of inter-arm differences (P < 0.05). Normative-based thresholds determined by two standard deviations above the mean inter-arm volume ratio were 1.057 for the dominant arm and 1.079 for the nondominant arm. Conclusions The absolute and relative normative-based thresholds for Chinese breast cancer patients differed slightly from the commonly used diagnostic criteria and those reported in Western populations and among Chinese healthy women. The normal variability and asymmetry associated with arm dominance underscore the importance of preoperative baseline assessments. Implementing normative-based diagnostic thresholds can facilitate more accurate lymphedema diagnosis when preoperative measurements are unavailable. Trial registration Registration No. ChiCTR2200057083.
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Affiliation(s)
- Aomei Shen
- Department of Nursing, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University Ministry of Education, Tianjin, China
- School of Nursing, Peking University, Beijing, China
| | - Xin Li
- Department of Nursing, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University Ministry of Education, Tianjin, China
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Hongmei Zhao
- Department of General Surgery, Peking University Third Hospital, Beijing, China
| | - Jingming Ye
- Department of Thyroid and Breast Surgery, Peking University First Hospital, Beijing, China
| | - Hongmeng Zhao
- The First Department of Breast Surgery, Tianjin Medical University Cancer Institute & Hospital, Tianjin, China
| | - Yujie Zhou
- Department of Nursing, Peking University Third Hospital, Beijing, China
| | - Yue Wang
- Department of Thyroid and Breast Surgery, Peking University First Hospital, Beijing, China
| | - Zhongning Zhang
- Department of Nursing, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University Ministry of Education, Tianjin, China
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Jingru Bian
- Department of Nursing, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University Ministry of Education, Tianjin, China
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Liyuan Zhang
- Department of Nursing, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University Ministry of Education, Tianjin, China
- School of Nursing, Tianjin Medical University, Tianjin, China
| | - Peipei Wu
- Department of Nursing, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University Ministry of Education, Tianjin, China
- Lymphedema Clinic, Tianjin Medical University Cancer Institute & Hospital, Tianjin, China
| | - Wanmin Qiang
- Department of Nursing, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Breast Cancer Prevention and Therapy, Tianjin Medical University Ministry of Education, Tianjin, China
| | - Qian Lu
- School of Nursing, Peking University, Beijing, China
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Suehiro K, Yamamoto S, Honda S, Morikage N, Harada E, Takemoto Y, Nagano H, Hamano K. Perioperative variations in indices derived from noninvasive assessments to detect postmastectomy lymphedema. J Vasc Surg Venous Lymphat Disord 2019; 7:562-569. [PMID: 31203860 DOI: 10.1016/j.jvsv.2019.02.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 02/12/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study aimed to clarify the variations in indices derived from noninvasive assessments for the early detection of postmastectomy lymphedema (LE) from 1 month preoperatively until 2 years postoperatively. METHODS In total, 120 patients who underwent surgery for breast cancer in our institution were prospectively followed up with a questionnaire for arm swelling as well as with tape measurements, bioimpedance analysis (BIA), and skin and subcutaneous tissue ultrasound at 1 month before and 3, 6, 12, 18, and 24 months after surgery. RESULTS Ninety-seven patients completed the study. Among 93 patients who did not present with LE, 9% complained of arm swelling even before surgery, and the incidence peaked at 17% at 6 months after surgery. There were no differences in the circumferences of the upper arm, forearm, and hand between sides throughout the study period. However, the postoperative circumference values of the upper arm only on the operation side were slightly increased compared with the preoperative values. The mean excess fluid in the arm on the operation side compared with the contralateral side, as assessed by BIA, was nearly zero throughout the study period. There were no differences in subcutaneous echogenicity or skin and subcutaneous thicknesses between the sides throughout the study period. However, time-dependent increases in subcutaneous thicknesses were noticed on both sides. Four patients (4.1%) developed LE. In three of these patients, abnormality in the BIA was recorded 6 to 12 months before presentation. Immediately after presentation, the common findings included BIA abnormality and increased subcutaneous echogenicity and skin thickness in the medial forearm. CONCLUSIONS In this study, a complaint of arm swelling was not sensitive enough for detection of the early onset of LE because a certain number of patients constantly complained of this symptom. Measurements of circumference might help in the diagnosis of LE onset, but this method is not specific enough because these measurements are also affected by various factors. However, BIA and skin and subcutaneous ultrasound were identified as potential tools for the early detection of LE.
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Affiliation(s)
- Kotaro Suehiro
- Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan.
| | - Shigeru Yamamoto
- Department of Gastroenterological, Breast, and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Saiko Honda
- Department of Nursing, Yamaguchi University Hospital, Ube, Yamaguchi, Japan
| | - Noriyasu Morikage
- Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Eijiro Harada
- Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Yoshihiro Takemoto
- Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Hiroaki Nagano
- Department of Gastroenterological, Breast, and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
| | - Kimikazu Hamano
- Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
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Hidding JT, Beurskens CH, De Vries MT, Nijhuis-van der Sanden MW, van Laarhoven HW, van der Wees PJ. Accuracy of a single measurement site for self-monitoring of patients with breast cancer at risk for lymphedema. Physiother Theory Pract 2018; 35:1322-1327. [DOI: 10.1080/09593985.2018.1474404] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- Janine T. Hidding
- Department of Orthopedics, Section of Physical Therapy, Radboud University Medical Center, Nijmegen, the Netherlands
- Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Nijmegen, the Netherlands
- Avans+, Breda, the Netherlands
| | - Carien H.G. Beurskens
- Department of Orthopedics, Section of Physical Therapy, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Maria W.G. Nijhuis-van der Sanden
- Department of Orthopedics, Section of Physical Therapy, Radboud University Medical Center, Nijmegen, the Netherlands
- Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Hanneke W.M. van Laarhoven
- Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Nijmegen, the Netherlands
- Academic Medical Center, Department of Medical Oncology, University of Amsterdam, Amsterdam, the Netherlands
| | - Philip J. van der Wees
- Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Nijmegen, the Netherlands
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Krok-Schoen JL, Oliveri JM, Kurta ML, Paskett ED. Breast cancer-related lymphedema: risk factors, prevention, diagnosis and treatment. BREAST CANCER MANAGEMENT 2015. [DOI: 10.2217/bmt.14.51] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY Lymphedema is one of the late effects of breast cancer treatment that affects many breast cancer survivors. Despite an increased focus on morbidity among this survivor population, our understanding of risk reduction, prevention, diagnosis and treatment of lymphedema remain poorly understood. This article provides an overview of the current state of the research (2009–2014) on breast cancer-related lymphedema and offers future directions for research. A greater emphasis must be placed on reducing the impact of lymphedema to improve the quality of life for breast cancer survivors.
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Affiliation(s)
- Jessica L Krok-Schoen
- Comprehensive Cancer Center, The Ohio State University, 1590 N High Street, Suite 525, Columbus, OH 43201, USA
| | - Jill M Oliveri
- Comprehensive Cancer Center, The Ohio State University, 1590 N High Street, Suite 525, Columbus, OH 43201, USA
| | | | - Electra D Paskett
- Comprehensive Cancer Center, The Ohio State University, 1590 N High Street, Suite 525, Columbus, OH 43201, USA
- Division of Cancer Prevention & Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH 43210, USA
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH 43210, USA
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