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Çalik M, Erdoğanoğlu Y, Çalik M, Vural M. Shoulder proprioception changes in postmastectomy patients: an observational study. Support Care Cancer 2024; 32:444. [PMID: 38896143 DOI: 10.1007/s00520-024-08651-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 06/10/2024] [Indexed: 06/21/2024]
Abstract
PURPOSE Breast cancer surgery can cause changes in the anatomical structure of the shoulder and in shoulder mobility, leading to the increased possibility of long-term arm morbidity such as lymphedema. This study aims to evaluate the active shoulder joint position sense (AJPS) with and without lymphedema in postmastectomy patients. METHODS A total of 66 women, including 22 patients with lymphedema, 22 patients without lymphedema, and 22 healthy controls, were enrolled in the study. Pain severity was evaluated with the Numeric Pain Scale and edema severity was measured with circumferentially at 10 cm intervals. The normal range of motion of the shoulder joint was evaluated with the universal goniometer and the AJPS was assessed by active position repetition testing at 55°, 90°, and 125° shoulder flexion targets using the smartphone application "Clinometer." RESULTS AJPS at 55°, 90°, and 125° shoulder flexion target angles with and without lymphedema were different in all target angles compared to healthy controls (p < 0.01). There was a difference between the absolute error value of AJPS at 55° flexion (p < 0.05), and no difference at 90° and 125° flexion between the with and without lymphedema groups (p > 0.05). CONCLUSION This study shows that the AJPS was negatively affected in with and without lymphedema postmastectomy patients compared to healthy controls. This result emphasizes the importance of adding personalized methods for the restoration of joint position sense in addition to rehabilitation programs generally applied to the patient group.
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Affiliation(s)
- Meryem Çalik
- Bakırköy Dr Sadi Konuk Training Hospital, Physical Therapy and Rehabilitation Department, Lymphedema Unit, University of Health Sciences, Zuhuratbaba Mah. Tevfik Sağlam Cad. No:11, Bakırköy, Istanbul, Turkey.
| | - Yıldız Erdoğanoğlu
- Faculty of Health Sciences, Physiotherapy and Rehabilitation Department, Antalya Bilim University, Çıplaklı Mah. Akdeniz Bulvarı, No: 290/A, Döşemealtı, Antalya, Turkey
| | - Mahmut Çalik
- Faculty of Health Sciences, Physiotherapy and Rehabilitation Department İstanbul, Haliç University, Levent Mahallesi, 15 Temmuz Şehitler Caddesi, No: 14/12, Eyüpsultan, İstanbul, Turkey
| | - Meltem Vural
- Bakırköy Dr Sadi Konuk Training Hospital, Physical Therapy and Rehabilitation Department, Lymphedema Unit, University of Health Sciences, Zuhuratbaba Mah. Tevfik Sağlam Cad. No:11, Bakırköy, Istanbul, Turkey
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Yeo SM, Kim TK, Park SH, Lee CH. Optimal Cut-Off Value for Detecting Breast Cancer-Related Lymphedema Using Ultrasonography. Lymphat Res Biol 2024; 22:37-42. [PMID: 37971868 DOI: 10.1089/lrb.2023.0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
Background: We previously devised an ultrasonographic evaluation to calculate subcutaneous tissue cross-sectional area (△CSA). The reliability and accuracy of this method were demonstrated in healthy individuals and in patients with lymphedema. The purpose of this study was to estimate the optimal cut-off value of the ratio of the △CSA of the involved side (lesion side) to the contralateral side for detecting breast cancer-related lymphedema (BCRL) using ultrasonography. Methods and Results: Ultrasonographic measurements were performed 290 times in 150 patients. BCRLD was defined as a confirmed difference of >2 cm in arm circumference. BCRL confirmed by a clinician (BCRLC) was defined as the patient group that included not only BCRLD but also patients with subcutaneous thickening and abnormal findings on lymphoscintigraphy, even if the difference in arm circumference was <2 cm. The △CSAs of both upper arms and forearms were calculated by measuring the thickness of the subcutaneous tissue at four locations using ultrasonography (superior, medial, inferior, lateral) at 10 cm above the elbow and 10 cm below the elbow. With a 1.35 △CSA ratio as the cut-off value for detecting BCRLD, the sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) were 0.88, 0.87, and 0.95, respectively. With a 1.20 △CSA ratio as the cut-off value for detecting BCRLC, the sensitivity, specificity, and AUC were 0.92, 0.89, and 0.97, respectively. Conclusions: Our findings suggest that a 1.20 △CSA ratio as determined using ultrasonography, corresponding to a tape measurement of 1.05 cm, can be considered as a diagnostic criterion for lymphedema.
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Affiliation(s)
- Seung Mi Yeo
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Tae Kyung Kim
- Department of Physical Therapy, Youngsan University, Yangsan, Republic of Korea
| | - So Hyun Park
- Department of Physical Therapy, Youngsan University, Yangsan, Republic of Korea
| | - Chang-Hyung Lee
- Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea
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Vargo MM. Outcome Measures and Patient-Reported Metrics in Cancer Rehabilitation. Curr Oncol Rep 2023; 25:869-882. [PMID: 37148415 DOI: 10.1007/s11912-023-01412-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2023] [Indexed: 05/08/2023]
Abstract
PURPOSE OF REVIEW The current panorama of measurement tools for use in cancer rehabilitation is reviewed. For rehabilitation purposes, evaluating function is of the highest priority. RECENT FINDINGS From a patient-reported outcome (PRO) standpoint, SF-36 and EORTC-QLQ-C30 are in most common use in cancer rehabilitation research; these are quality of life measures that contain functional subdomains. Newer tools which are based on item response theory and have options for both computer assisted or short form (SF) administration, including the Patient-Reported Outcomes Measurement Information System (PROMIS) and Activity Measure for Post-acute Care (AMPAC) instruments, show increasing use, especially PROMIS Physical Function SF, and, recently, PROMIS Cancer Function Brief 3D, which has been validated in the cancer population, with domains of physical function, fatigue, and social participation, to track clinical rehabilitation outcomes. Evaluating objective measures of function in cancer patients is also crucial. Utilization of clinically feasible tools for cancer rehabilitation, to employ for both screening purposes and for monitoring of rehabilitation treatment efficacy, is an evolving area, much needed to promote further research and improved, consistent clinical care for cancer patients and survivors.
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Affiliation(s)
- Mary M Vargo
- Physical Medicine and Rehabilitation, MetroHealth Medical Center, Case Western Reserve University, 4229 Pearl Road, Cleveland, OH, 44109, USA.
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Yang WT, Zheng K, Ren HL, Wang SX, Sun MS, Gong C, Zhang WD, Li CM, Jiang HJ. Three-dimensional laser scanner as a new tool for measuring lower limb volume in patients with chronic venous diseases. J Vasc Surg Venous Lymphat Disord 2023; 11:127-135. [PMID: 35940450 DOI: 10.1016/j.jvsv.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 05/21/2022] [Accepted: 06/11/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Measurement of lower limb volume in patients with chronic venous disease (CVD) is necessary for assessing severity at the time of diagnosis and evaluating response to therapy administered. Existing methods have some limitations in clinical application and accuracy. The study aimed to investigate the reliability and validity of a three-dimensional laser scanner (3DLS) in measuring the lower limb volume of patients with CVD. METHODS A total of 30 patients with CVD (mean age, 55.6 ± 8.07 years; mean body mass index, 24.61 ± 1.87) were recruited in a vascular surgery clinic. The lower limb volumes of all participants were measured using the 3DLS and circumferential method (CM). Statistical analysis was conducted to compare the 3DLS and CM. RESULTS There was a strong correlation between the CM and 3DLS method (r2 = 0.9065). The 3DLS had a high intraoperator and interoperator reliability. A Bland-Altman plot showed satisfactory agreement between the two methods. The 3DLS demonstrated greater bilateral limb differences than CM. CONCLUSIONS There was satisfactory agreement between the two investigated methods. The 3DLS method was confirmed to be accurate, repeatable, and rapid in measuring the lower limb volume in patients with CVD and is, therefore, suitable for clinical use.
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Affiliation(s)
- Wen-Tao Yang
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Kai Zheng
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Hua-Liang Ren
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Sheng-Xing Wang
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Ming-Sheng Sun
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Chi Gong
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Wang-De Zhang
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Chun-Min Li
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
| | - Han-Jun Jiang
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China; School of Integrated Circuits, Tsinghua University.
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Muñoz-Alcaraz MN, Jiménez-Vílchez AJ, Santamaría-Peláez M, Pérula-de Torres LA, Olmo-Carmona MV, Muñoz-García MT, Jorge-Gutiérrez P, Serrano-Merino J, Romero-Rodríguez E, Rodríguez-Elena L, Refusta-Ainaga R, Lahoz-Sánchez MP, Miró-Palacios B, Medrano-Cid M, Magallón-Botaya R, Mínguez-Mínguez LA, González-Santos J, González-Bernal JJ. Activity-Oriented Antiedema Proprioceptive Therapy (TAPA) for Shoulder Mobility Improvement in Women with Upper Limb Lymphedema Secondary to Breast Cancer: A Multicenter Controlled Clinical Trial. J Clin Med 2022; 11:jcm11082234. [PMID: 35456327 PMCID: PMC9025521 DOI: 10.3390/jcm11082234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 03/31/2022] [Accepted: 04/12/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Lymphedema, secondary to breast cancer (BCRL), is the abnormal accumulation of protein-rich fluid in the interstitium caused by a malfunction of the lymphatic system. It causes swelling, deficiencies in upper limb functions and structures, sensory pain and emotional alterations, which have a chronic course and affect the upper limb’s functionality. This study aims to verify the efficacy and efficiency in the upper limb´s functionality of a protocolized experimental approach based on occupational therapy, TAPA (activity-oriented proprioceptive antiedema therapy), in the rehabilitation of BCRL in stages I and II, comparing it with the conservative treatment considered as the standard, complex decongestive therapy (CDT), through a multicenter randomized clinical trial. Methods: a randomized and prospective clinical trial was conducted with experimental and control groups. Women diagnosed with BCRL belonging to institutions in Córdoba and Aragon (Spain) participated. Sociodemographic variables and those related to the functionality of the affected upper limb were evaluated before and after the intervention. Results: The results showed statistically significant differences in the analysis of covariance performed for the variable joint balance of the shoulder´s external rotation (p = 0.045) that could be attributed to the intervention performed; however, the effect size was minimal (η2 ≤ 0.080). In the rest of the variables, no significant differences were found. Conclusions: TAPA may be an alternative to the conservative treatment of women with BCRL. It was shown to be just as effective for volume reduction and activity performance as CDT but more effective in improving external rotation in shoulder joint balance.
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Affiliation(s)
- María Nieves Muñoz-Alcaraz
- Inter-Level Clinical Management Unit of Physical Medicine and Rehabilitation, Córdoba and Guadalquivir Health District, Reina Sofía University Hospital, Andalusia Health Service, 14011 Cordoba, Spain; (M.N.M.-A.); (M.V.O.-C.); (M.T.M.-G.); (P.J.-G.)
- Maimonides Institute for Biomedical Research of Córdoba, Reina Sofía University Hospital, University of Córdoba, 14011 Cordoba, Spain; (J.S.-M.); (E.R.-R.)
| | | | - Mirian Santamaría-Peláez
- Department of Health Sciences, University of Burgos, 09001 Burgos, Spain; (M.S.-P.); (J.G.-S.); (J.J.G.-B.)
| | - Luis A. Pérula-de Torres
- Maimonides Institute for Biomedical Research of Córdoba, Reina Sofía University Hospital, University of Córdoba, 14011 Cordoba, Spain; (J.S.-M.); (E.R.-R.)
- Multiprofessional Teaching Unit for Family and Community Care, Córdoba and Guadalquivir Health District, 14011 Cordoba, Spain
- Correspondence: (L.A.P.-d.T.); (L.A.M.-M.)
| | - María Victoria Olmo-Carmona
- Inter-Level Clinical Management Unit of Physical Medicine and Rehabilitation, Córdoba and Guadalquivir Health District, Reina Sofía University Hospital, Andalusia Health Service, 14011 Cordoba, Spain; (M.N.M.-A.); (M.V.O.-C.); (M.T.M.-G.); (P.J.-G.)
| | - María Teresa Muñoz-García
- Inter-Level Clinical Management Unit of Physical Medicine and Rehabilitation, Córdoba and Guadalquivir Health District, Reina Sofía University Hospital, Andalusia Health Service, 14011 Cordoba, Spain; (M.N.M.-A.); (M.V.O.-C.); (M.T.M.-G.); (P.J.-G.)
| | - Presentación Jorge-Gutiérrez
- Inter-Level Clinical Management Unit of Physical Medicine and Rehabilitation, Córdoba and Guadalquivir Health District, Reina Sofía University Hospital, Andalusia Health Service, 14011 Cordoba, Spain; (M.N.M.-A.); (M.V.O.-C.); (M.T.M.-G.); (P.J.-G.)
| | - Jesús Serrano-Merino
- Maimonides Institute for Biomedical Research of Córdoba, Reina Sofía University Hospital, University of Córdoba, 14011 Cordoba, Spain; (J.S.-M.); (E.R.-R.)
- Multiprofessional Teaching Unit for Family and Community Care, Córdoba and Guadalquivir Health District, 14011 Cordoba, Spain
| | - Esperanza Romero-Rodríguez
- Maimonides Institute for Biomedical Research of Córdoba, Reina Sofía University Hospital, University of Córdoba, 14011 Cordoba, Spain; (J.S.-M.); (E.R.-R.)
- Multiprofessional Teaching Unit for Family and Community Care, Córdoba and Guadalquivir Health District, 14011 Cordoba, Spain
| | - Lorena Rodríguez-Elena
- San Jose Health Center, Aragonese Health Service, 50013 Zaragoza, Spain; (L.R.-E.); (R.R.-A.); (M.P.L.-S.)
| | - Raquel Refusta-Ainaga
- San Jose Health Center, Aragonese Health Service, 50013 Zaragoza, Spain; (L.R.-E.); (R.R.-A.); (M.P.L.-S.)
| | - María Pilar Lahoz-Sánchez
- San Jose Health Center, Aragonese Health Service, 50013 Zaragoza, Spain; (L.R.-E.); (R.R.-A.); (M.P.L.-S.)
| | - Belén Miró-Palacios
- Association of People with Lymphedema in Aragon (ADPLA), 50007 Zaragoza, Spain;
| | - Mayra Medrano-Cid
- Lozano Blesa University Clinical Hospital, Aragonese Health Service, 50013 Zaragoza, Spain;
| | - Rosa Magallón-Botaya
- Institute for Health Research Aragon (IIS Aragon), University of Zaragoza, 50009 Zaragoza, Spain;
| | - Luis A. Mínguez-Mínguez
- Department of Educational Sciences, University of Burgos, 09001 Burgos, Spain
- Correspondence: (L.A.P.-d.T.); (L.A.M.-M.)
| | - Josefa González-Santos
- Department of Health Sciences, University of Burgos, 09001 Burgos, Spain; (M.S.-P.); (J.G.-S.); (J.J.G.-B.)
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Al-Sakkaf AM, Masia J, Auladell-Rispau A, Shamardal AI, Vasconcello-Castillo L, Sola I, Bonfill X. Evidence Mapping of the Treatments for Breast Cancer-related Lymphedema. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4045. [PMID: 35070599 PMCID: PMC8769095 DOI: 10.1097/gox.0000000000004045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 11/16/2021] [Indexed: 02/07/2023]
Abstract
Women treated for breast cancer are facing a lifetime risk of developing lymphedema, which occurs in up to 40% of this population. There is a lack of evidence and limited knowledge regarding the treatment of breast cancer-related lymphedema (BCRL). The aim of this study was to identify, describe, and organize the currently available evidence in the treatment of BCRL. METHODS We conducted an evidence mapping review study according to the methodology proposed by Global Evidence Mapping. We performed a systematic search in Medline, Embase, Central (Cochrane), and Epistemonikos, from 2000-2020. We included studies about all treatment types for BCRL, including surgical and nonsurgical treatment. Results were summarized in narrative and tabular forms. RESULTS A total of 240 studies were included in this mapping review, distributed as follows: 147 experimental studies [102 randomized clinical trials (RCTs) and 45 quasi-experimental clinical trials], 48 observational studies (34 prospective and 14 retrospective studies), and 45 systematic reviews (17 of them with metanalysis). Most of the RCTs were on nonsurgical interventions. Only two RCTs addressed surgical intervention. CONCLUSIONS In the last 20 years, there were an average of 12 publications per year on the treatment of BCRL. Recently this lack of attention has been partially corrected, as the majority were published in the past 5 years. However, most of them were on nonsurgical interventions. Well-designed RCTs on surgery are needed to measure the effectiveness of the applied interventions.
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Affiliation(s)
- Ali M. Al-Sakkaf
- From Department of Plastic Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jaume Masia
- From Department of Plastic Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | | | - Luis Vasconcello-Castillo
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
- International Physiotherapy Research Network (PhysioEvidence)
| | - Ivan Sola
- Health Education England-East Midlands, London, UK
- International Physiotherapy Research Network (PhysioEvidence)
| | - Xavier Bonfill
- Health Education England-East Midlands, London, UK
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), CIBERESP, Universitat Autònoma de Barcelona, Barcelona, Spain
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Laustsen-Kiel CM, Lauritzen E, Langhans L, Engberg Damsgaard T. Study protocol for a 10-year prospective observational study, examining lymphoedema and patient-reported outcome after breast reconstruction. BMJ Open 2021; 11:e052676. [PMID: 34873005 PMCID: PMC8650483 DOI: 10.1136/bmjopen-2021-052676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Over the last decades, treatment of breast cancer has become increasingly more effective. Consequently, an increasing number of women are living with late effects of breast cancer treatment, including disfiguring scars, deformity or asymmetry of the breast, secondary lymphoedema and other physical and psychosocial late effects. Data from this study will provide knowledge on how to guide breast reconstruction in the future towards outcomes with fewer complications, higher long-term quality of life (QoL) and satisfaction with the aesthetic outcome. The development of secondary lymphoedema, for which the effect of breast reconstruction has yet to be established, will be thoroughly examined. METHODS AND ANALYSIS Women receiving breast reconstruction (autologous and implant based) at the Department of Plastic Surgery and Burns Treatment, Rigshospitalet, will be invited to participate. The patients will be followed for 10 years postoperatively. Demographic, health-related, oncological characteristics and treatment data will be registered. Validated assessment tools, such as the BREAST-Q and Beck Depression Inventory, will be used to measure an extensive range of clinical outcomes, including QoL, life and aesthetic satisfaction and depression. Arm range of motion will be measured with a goniometer and lymphoedema by bioimpedance spectroscopy, compared with circular arm measurements. ETHICS AND DISSEMINATION This study will be conducted according to the 5th version of the Helsinki Declaration. The regional ethical committee for Capital Region Denmark did not find the study notifiable, according to the law of the committee § 1, part 4. All data will be anonymised before its publication. This study will be conducted according to the Danish data protection regulation and is catalogued and approved by the Capital Region Head of Knowledge Centre. According to the Danish health law § 46, part 2, this study does not need the Danish Patient Safety Authority's approval. The findings of this study will be submitted to international peer-reviewed journals.
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Affiliation(s)
| | - Elisabeth Lauritzen
- Department of Plastic Surgery and Burns Treatment, Rigshospitalet, Copenhagen, Denmark
| | - Linnea Langhans
- Department of Plastic Surgery and Burns Treatment, Rigshospitalet, Copenhagen, Denmark
| | - Tine Engberg Damsgaard
- Department of Plastic Surgery and Burns Treatment, Rigshospitalet, Copenhagen, Denmark
- Institute of Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
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Borčinová M, Ragosch V, Jarkovský J, Bajsová S, Pilka R, Glickman A, Garrido-Mallach S, Raspagliesi F, Szatkowski W, Pakiz M, Snyman LC, Kocián R, Tamussino K, Kalist V, Michal M, Segovia MG, Poka R, Kipp B, Szewczyk G, Wydra D, Tóth R, Vinnytska A, Fischerová D, Siegler K, Cibula D. Challenges in lower limb lymphoedema assessment based on limb volume change: Lessons learnt from the SENTIX prospective multicentre study. Gynecol Oncol 2021; 164:76-84. [PMID: 34763939 DOI: 10.1016/j.ygyno.2021.10.089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/18/2021] [Accepted: 10/20/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Lower limb lymphoedema (LLL) is the most disabling adverse effect of surgical staging of pelvic lymph nodes. However, the lack of standardisation of volumetric LLL assessment hinders direct comparison between the studies and makes LLL reporting unreliable. The aim of our study is to report outcomes from a prospective trial that have implications for LLL assessment standardisation. METHODS In the prospective international multicentre trial SENTIX, a group of 150 patients with stage IA1-IB2 cervical cancer treated by uterine surgery with bilateral sentinel lymph node biopsy was prospectively evaluated by objective LLL assessment, based on limb volume change (LVC) using circumferrential limb measurements and subjective patient-reported swelling. The assessments were conducted in six-month periods over 24 months post-surgery. RESULTS Patient LVC substantially fluctuated in both positive and negative directions, which were comparable in frequency up to ±14% change. Thirty-eight patients experienced persistent LVC increase >10% classified as LLL, with nine months median time to onset. Some 34.2% of cases experienced onset later than one year after the surgery. Thirty-three patients (22%) experienced transient oedema characterised as LVC >10%, which resolved without intervention between two consequent follow-up visits. No significant correlation between LVC >10% and a patient-reported swelling was observed. CONCLUSIONS Given that we observed comparable fluctuations of the the lower-limb volumes after surgical treatment of cervical cancer in both positive and negative direction up to ±14%, the diagnostic threshold for LLL diagnosis based on LVC should be increased to >15% LVC. The distinction of transient oedema from persistent LLL requires repeated measurements. Also, as one-third of LLL cases are diagnosed >1-year post-surgery, a sufficient follow-up duration needs to be ensured. Patient-reported swelling correlated poorly with LVC and should only be used as an adjunct to objective LLL assessment. TRIAL REGISTRATION ClinicalTrials.gov: NCT02494063.
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Affiliation(s)
- Martina Borčinová
- Gynecologic Oncology Centre, Department of Obstetrics and Gynaecology, First Faculty of Medicine, Charles University and General University Hospital, Central and Eastern European Gynecologic Oncology Group, CEEGOG, Prague, Czech Republic
| | - Volker Ragosch
- Department of Special Operative and Oncologic Gynaecology, Asklepios-Clinic Hamburg, Hamburg, Germany
| | - Jiří Jarkovský
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Sylva Bajsová
- Department of Obstetrics and Gynecology, University Hospital Ostrava, Central and Eastern European Gynecologic Oncology Group, CEEGOG, Ostrava Poruba, Czech Republic
| | - Radovan Pilka
- Department of Obstetrics and Gynecology, Faculty of Medicine and Dentistry, Palacky University, University Hospital Olomouc, Central and Eastern European Gynecologic Oncology Group, CEEGOG, Olomouc, Czech Republic
| | - Ariel Glickman
- Unit of Gynecological Oncology, Institute Clinic of Gynaecology, Obstetrics, and Neonatology, Hospital Clinic-Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | | | | | | | - Maja Pakiz
- University medical Centre Maribor, Slovenia
| | | | - Roman Kocián
- Gynecologic Oncology Centre, Department of Obstetrics and Gynaecology, First Faculty of Medicine, Charles University and General University Hospital, Central and Eastern European Gynecologic Oncology Group, CEEGOG, Prague, Czech Republic
| | | | | | | | | | - Robert Poka
- Department of obstetrics and Gynecology, University of Debrecen, Hungary
| | - Barbara Kipp
- Neue Freuenklinik, Luzerner Kantonsspital, Switzerland
| | | | | | - Róbert Tóth
- Oncology Institute of East Slovakia, Košice, Slovakia
| | | | - Daniela Fischerová
- Gynecologic Oncology Centre, Department of Obstetrics and Gynaecology, First Faculty of Medicine, Charles University and General University Hospital, Central and Eastern European Gynecologic Oncology Group, CEEGOG, Prague, Czech Republic
| | - Kathrin Siegler
- Department of Special Operative and Oncologic Gynaecology, Asklepios-Clinic Hamburg, Hamburg, Germany
| | - David Cibula
- Gynecologic Oncology Centre, Department of Obstetrics and Gynaecology, First Faculty of Medicine, Charles University and General University Hospital, Central and Eastern European Gynecologic Oncology Group, CEEGOG, Prague, Czech Republic.
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9
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Erdinç Gündüz N, Dilek B, Şahin E, Ellidokuz H, Akalın E. Diagnostic Contribution of Ultrasonography in Breast Cancer-Related Lymphedema. Lymphat Res Biol 2021; 19:517-523. [PMID: 33601960 DOI: 10.1089/lrb.2020.0068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Background: Many assessments have been reported and used in evaluating lymphedema. The aim of this study was to investigate the diagnostic contribution of ultrasonography in unilateral breast cancer-related lymphedema. Methods and Results: Upper extremity circumferences were measured with a measuring tape from ulnar styloid at the wrist to the axilla at 4 cm intervals. The point with the highest difference between the upper extremities and the control point with no difference between the lower extremities were marked. Skin and subcutaneous thicknesses were measured from four quadrants (volar medial-lateral and dorsal medial-lateral) at the marked points and also subcutaneous tissue changes were graded according to the subcutaneous echogenicity grade (SEG) scale ultrasonographically. The correlations between circumferential and ultrasonographic measurements were investigated. Receiver operating characteristic curve analysis was made to estimate the diagnostic accuracy of the difference in ultrasonographic subcutaneous thickness measurements between the two arms. The study was completed with 34 female patients. Circumferential and subcutaneous tissue thickness measurements were moderately positively correlated in the volar quadrants and strongly positively correlated in the dorsal quadrants of the affected extremity. In the unaffected extremity, a strong positive correlation was identified in all quadrants. The clinical stages of lymphedema and SEG were weakly positively correlated in the volar medial quadrant. The difference between the two upper extremities was found to have a high (0.83%) sensitivity, and an acceptable (0.75%) specificity in the differentiation of Grade II and Grade III lymphedema. Conclusion: A correlation was established between circumferential measurements and ultrasonographic measurements. Ultrasonography can be used complementary to circumferential measurements in diagnosing lymphedema. Clinical trial registration number: NCT04213001.
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Affiliation(s)
- Nihan Erdinç Gündüz
- Department of Physical Medicine and Rehabilitation, Izmir Tepecik Training and Research Hospital, Health Science University, Izmir, Turkey
| | - Banu Dilek
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Ebru Şahin
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Hülya Ellidokuz
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Elif Akalın
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
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10
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Mayrovitz HN, Patel A, Kavadi R, Khan Z, Bartolone S. An Approach Toward Assessing Head-and-Neck Lymphedema Using Tissue Dielectric Constant Ratios: Method and Normal Reference Values. Lymphat Res Biol 2021; 19:562-567. [PMID: 33529086 DOI: 10.1089/lrb.2020.0107] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: There are multiple methods to quantitatively assess limb lymphedema, but quantitative methods to assess external lymphedema in persons with head-and-neck lymphedema are quite limited. Quantification in this difficult condition currently uses multiple time-consuming head, face, and neck metric measurements, the accuracy of which is unclear. Thus, there is an important need for a new approach that is sufficiently convenient yet accurate to quantify head-and-neck lymphedema. The approach adopted was to use tissue dielectric constant (TDC) measurements that depend on tissue water, at neck and a submental area, and normalize these to TDC values at the forearm as a way to develop subject-independent indices. Methods and Results: TDC was measured in 60 self-reported healthy nonlymphedematous adults (34 female, 18-81 years, 18.5-45.7 Kg/m2) at two neck sites and one arm site bilaterally and at a submental area. Neck-to-arm-index (NAI) and submental-to-arm-index (SAI) ratios were calculated. TDC values (mean ± standard deviation [SD]) for neck, submental, and arm were, respectively, 37.4 ± 6.9, 35.9 ± 7.7, and 30.1 ± 4.6. Mean NAI and SAI values were 1.253 ± 0.222 and 1.214 ± 0.296 respectively. Head-and-neck lymphedema thresholds calculated as mean + 2.5 SD were for NAI and SAI 1.80 and 1.95, respectively. Conclusions: An approach to help quantify and track head-and-neck lymphedema using TDC neck and/or submental values normalized to a person's forearm TDC values indicates threshold values between 1.80 and 1.95. These ratios, denoted as NAI and SAI, are suggested for use to detect and track changes in lymphedema status based on a patient's changing indices associated with lymphedema treatment.
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Affiliation(s)
- Harvey N Mayrovitz
- Division of Physiology, Department of Medical Education, Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University (NSU), Ft. Lauderdale, Florida, USA
| | - Ashini Patel
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University (NSU), Ft. Lauderdale, Florida, USA
| | - Raj Kavadi
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University (NSU), Ft. Lauderdale, Florida, USA
| | - Zara Khan
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University (NSU), Ft. Lauderdale, Florida, USA
| | - Samantha Bartolone
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University (NSU), Ft. Lauderdale, Florida, USA
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Muñoz-Alcaraz MN, Pérula-de-Torres LÁ, Serrano-Merino J, Jiménez-Vílchez AJ, Olmo-Carmona MV, Muñoz-García MT, Bartolomé-Moreno C, Oliván-Blázquez B, Magallón-Botaya R. Efficacy and efficiency of a new therapeutic approach based on activity-oriented proprioceptive antiedema therapy (TAPA) for edema reduction and improved occupational performance in the rehabilitation of breast cancer-related arm lymphedema in women: a controlled, randomized clinical trial. BMC Cancer 2020; 20:1074. [PMID: 33167921 PMCID: PMC7652582 DOI: 10.1186/s12885-020-07558-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 10/22/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Breast cancer (BC) is a major public health issue. More than one out of five women treated for breast cancer will develop lymphedema in an upper extremity. Current evidence advocates transdisciplinary oncological rehabilitation. Therefore, research in this area is necessary since limited consensus having been reached with regard to the basic essential components of this rehabilitation. Consensus has, however, been reached on the use of decongestive lymphedema therapy (DLT), but due to a lack of tests, the necessary dosages are unknown and its level is moderately strong. This study attempts to verify both the efficacy of activity-oriented proprioceptive antiedema therapy (TAPA), as compared to conventional treatments such as DLT or Complex Physical Therapy (CPT), as well as its efficiency in terms of cost-effectiveness, for patients affected by breast cancer-related arm lymphedema. METHODS Controlled, randomized clinical trial with dual stratification, two parallel arms, longitudinal and single blind. 64 women with breast cancer-related arm lymphedema will take part in the study. The experimental group intervention will be the same for stage I and II, and will consist of neuro-dynamic exercises oriented to the activity, proprioceptive neuromuscular facilitation activities and proprioceptive anti-edema bandaging. The control group intervention, depending on the stage, will consist of preventive measures, skin care and exercise-prescribed training in the lymphedema workshop as well as compression garments (Stage I) or conservative Complex Decongestive Therapy treatment (skin care, multi-layer bandaging, manual lymphatic drainage and massage therapy) (Stage II). RESULTS Sociodemographic and clinical variables will be collected for the measurement of edema volume and ADL performance. Statistical analysis will be performed on intent to treat. DISCUSSION It has been recommended that patient training be added to DLT, as well as a re-designing of patient lifestyles and the promotion of health-related aspects. In addition, clinical trials should be undertaken to assess neural mobilization techniques and proprioceptive neuromuscular facilitation should be included in the therapy. Cohesive bandaging will also be performed as an early form of pressotherapy. The proposed study combines all of these aspects in order to increased comfort and promote the participation of individuals with lymphedema in everyday situations. LIMITATIONS The authors have proposed the assessment of the experimental treatment for stages I and II. One possible limitation is the lack of awareness of whether or not this treatment would be effective for other stages as well as the concern for proper hand cleansing during use of bandages, given the current COVID-19 pandemic situation. TRIAL REGISTRATION This trial was registered in ClinicalTrials.gov ( NCT03762044 ). Date of registration: 23 November 2018. Prospectively Registered.
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Affiliation(s)
- María Nieves Muñoz-Alcaraz
- Córdoba and Guadalquivir health district, Andalusia Health Service, Córdoba, Spain
- Andalusia Health Service, Maimonides Institute of Biomedical Research of Cordoba (IMIBIC)/Universidad de Cordoba, Córdoba, Spain
| | - Luis Ángel Pérula-de-Torres
- Córdoba and Guadalquivir health district, Andalusia Health Service, Córdoba, Spain
- Andalusia Health Service, Maimonides Institute of Biomedical Research of Cordoba (IMIBIC)/Universidad de Cordoba, Córdoba, Spain
| | - Jesús Serrano-Merino
- Córdoba and Guadalquivir health district, Andalusia Health Service, Córdoba, Spain
- Andalusia Health Service, Maimonides Institute of Biomedical Research of Cordoba (IMIBIC)/Universidad de Cordoba, Córdoba, Spain
| | | | | | | | - Cruz Bartolomé-Moreno
- Institute for Health Research Aragon (IIS Aragon), Zaragoza, Spain
- Aragones Heath Service, Zaragoza, Spain
| | - Bárbara Oliván-Blázquez
- Institute for Health Research Aragon (IIS Aragon), Zaragoza, Spain.
- University of Zaragoza, Zaragoza, Spain.
| | - Rosa Magallón-Botaya
- Institute for Health Research Aragon (IIS Aragon), Zaragoza, Spain
- University of Zaragoza, Zaragoza, Spain
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12
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The effect of limb position on the reliability of leg circumference measurements in patients diagnosed with lower limb lymphoedema. Support Care Cancer 2020; 29:3183-3189. [PMID: 33089370 DOI: 10.1007/s00520-020-05835-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/15/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To establish the intrarater reliability of lower limb circumference measures in a sample of individuals who are diagnosed with lower limb lymphoedema and to evaluate if change in limb position has an effect on the reliability of circumferential measures. METHOD A sample of forty-one adults diagnosed with a lower limb lymphoedema were recruited. Participants had their affected leg measured three times by a qualified therapist during a standard outpatient appointment: twice in a lying position and once in sitting with knee flexed at 90°. To examine the intrarater reliability, interclass correlation coefficients (ICC) with 95% confident intervals were calculated. RESULTS Excellent intrarater reliability was established at each measurement point and for the sum of circumferential measures when the limb remeasured in the same position by the same therapist. Changing the position of the limb resulted in lower intrarater reliability values at 10 and 30 cm from the base of the foot. CONCLUSIONS The current study provides evidence for the intrarater reliability of lower limb circumference measures and highlights the need for consistency when remeasuring and monitoring the limb of those diagnosed with lower limb lymphoedema. IMPLICATIONS FOR CANCER SURVIVORS Lymphoedema is a significant problem for breast cancer survivors but also provides lifetime risk to all survivors of lymph node surgery for solid tumours. The monitoring and surveillance of leg circumference measures of people diagnosed with lower limb lymphoedema has been a valuable instrument when reviewing progress of this chronic condition.
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13
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De Vrieze T, Vos L, Gebruers N, De Groef A, Dams L, Van der Gucht E, Nevelsteen I, Devoogdt N. Revision of the Lymphedema Functioning, Disability and Health Questionnaire for Upper Limb Lymphedema (Lymph-ICF-UL): Reliability and Validity. Lymphat Res Biol 2019; 17:347-355. [DOI: 10.1089/lrb.2018.0025] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
- Tessa De Vrieze
- Department of Rehabilitation Sciences, KU Leuven—University of Leuven, Research Group for Rehabilitation in Internal Disorders, Leuven, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, MOVANT, Antwerp, Belgium
| | - Lore Vos
- Department of Rehabilitation Sciences, KU Leuven—University of Leuven, Research Group for Rehabilitation in Internal Disorders, Leuven, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, MOVANT, Antwerp, Belgium
| | - Nick Gebruers
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, MOVANT, Antwerp, Belgium
- Multidisciplinary Oedema Clinic, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
| | - An De Groef
- Department of Rehabilitation Sciences, KU Leuven—University of Leuven, Research Group for Rehabilitation in Internal Disorders, Leuven, Belgium
| | - Lore Dams
- Department of Rehabilitation Sciences, KU Leuven—University of Leuven, Research Group for Rehabilitation in Internal Disorders, Leuven, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, MOVANT, Antwerp, Belgium
| | - Elien Van der Gucht
- Department of Rehabilitation Sciences, KU Leuven—University of Leuven, Research Group for Rehabilitation in Internal Disorders, Leuven, Belgium
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, MOVANT, Antwerp, Belgium
| | - Ines Nevelsteen
- Multidisciplinary Breast Centre, UZ Leuven—University Hospitals Leuven, Leuven, Belgium
| | - Nele Devoogdt
- Department of Rehabilitation Sciences, KU Leuven—University of Leuven, Research Group for Rehabilitation in Internal Disorders, Leuven, Belgium
- Departments of Vascular Surgery and Physical Medicine and Rehabilitation, Lymphovenous Centre, UZ Leuven—University Hospitals Leuven, Leuven, Belgium
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14
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Gao C, Yang M, Su N, Li XW, Yang EL, Huang JZ, Yu NZ, Long X. Sonographic Assessment of the Terminal Thoracic Duct in Patients with Lymphedema. Chin Med J (Engl) 2018; 130:613-616. [PMID: 28229995 PMCID: PMC5339937 DOI: 10.4103/0366-6999.200546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Affiliation(s)
- Chao Gao
- Department of Plastic Surgery and Reconstructive Surgery, Peking Union Medical College Hospital, Beijing 100005, China
| | - Meng Yang
- Department of Ultrasonography, Peking Union Medical College Hospital, Beijing 100005, China
| | - Na Su
- Department of Plastic Surgery and Reconstructive Surgery, Peking Union Medical College Hospital, Beijing 100005, China
| | - Xiong-Wei Li
- Department of Plastic Surgery and Reconstructive Surgery, Peking Union Medical College Hospital, Beijing 100005, China
| | - E-Lan Yang
- Department of Plastic Surgery and Reconstructive Surgery, Peking Union Medical College Hospital, Beijing 100005, China
| | - Jiu-Zuo Huang
- Department of Plastic Surgery and Reconstructive Surgery, Peking Union Medical College Hospital, Beijing 100005, China
| | - Nan-Ze Yu
- Department of Plastic Surgery and Reconstructive Surgery, Peking Union Medical College Hospital, Beijing 100005, China
| | - Xiao Long
- Department of Plastic Surgery and Reconstructive Surgery, Peking Union Medical College Hospital, Beijing 100005, China
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15
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Yang EJ, Kim SY, Lee WH, Lim JY, Lee J. Diagnostic Accuracy of Clinical Measures Considering Segmental Tissue Composition and Volume Changes of Breast Cancer-Related Lymphedema. Lymphat Res Biol 2018; 16:368-376. [PMID: 29338541 PMCID: PMC6104249 DOI: 10.1089/lrb.2017.0047] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: If we use only volumetry for measuring lymphedema, we could underdiagnose lymphedema with characteristics of biomechanical changes without definite volume change, especially in the medial forearm. Methods and Results: In total, 158 breast cancer patients participated in this study. Arm volume was measured by water displacement volumetry, and segmental volumes were calculated from circumferences by using the truncated cone method. Subcutaneous ultrasound echogenicities were assessed on the medial side of the upper arm and forearm of both arms and graded by subcutaneous echogenicity grade (SEG) and revised SEG (rSEG). The standards for diagnosing secondary lymphedema were according to the volume change and clinical stage. Sensitivity, specificity, receiver-operating characteristic (ROC) curve, and area under the curve (AUC) were used. Analysis of ROC curves yielded AUCs of 0.875–0.933 (p < 0.001). Volume differences in each segment were significantly different among the grades by SEG. The highest AUC was found for volume difference (AUC = 0.919, 95% confidence interval [CI] = 0.860–0.978) in the upper arm near the elbow; however, in the medial forearm, the highest AUC was found for rSEG (AUC = 0.948, 95% CI = 0.923–0.965 in the proximal forearm; AUC = 0.940, 95% CI = 0.923–0.965 in the distal forearm). Conclusions: Our findings support the use of SEG by ultrasound in the assessment of lymphedema, especially in the medial region of the forearm. Subcutaneous ultrasound echogenicities may improve the accuracy of diagnosis of lymphedema in the forearm.
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Affiliation(s)
- Eun Joo Yang
- 1 Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital , Seongnam-si, Korea
| | - Seoung Yeon Kim
- 2 Department of Rehabilitation Medicine, Seoul National University Hospital , Jongno-gu, Korea
| | - Woo Hyung Lee
- 2 Department of Rehabilitation Medicine, Seoul National University Hospital , Jongno-gu, Korea
| | - Jae-Young Lim
- 1 Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital , Seongnam-si, Korea
| | - Jaebong Lee
- 2 Department of Rehabilitation Medicine, Seoul National University Hospital , Jongno-gu, Korea.,3 Medical Research Collaborating Center, Seoul National University Bundang Hospital , Seongnam-si, Korea
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16
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Tassenoy A, De Strijcker D, Adriaenssens N, Lievens P. The Use of Noninvasive Imaging Techniques in the Assessment of Secondary Lymphedema Tissue Changes as Part of Staging Lymphedema. Lymphat Res Biol 2017; 14:127-33. [PMID: 27631582 DOI: 10.1089/lrb.2016.0011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Too often, in clinical settings, the diagnosis and evolution of lymphedema is determined by limb circumference measurements and/or volume calculations. Besides the unrecognition of small lymphedemas, these techniques provide little to no information concerning the stage of the lymphedema. This latter is important in choosing appropriate treatment modalities and making an accurate prognosis. Different imaging techniques are described in literature giving insights in tissue changes due to lymphedema. The aim of this article is giving an overview of possible texture changes linked to the different edema stages, visualized with noninvasive imaging procedures like ultrasonography, computed tomography, dual-energy x-ray absorptiometry, or magnetic resonance imaging.
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Affiliation(s)
- An Tassenoy
- Department of Rehabilitation Research, Free University Brussels , Brussels, Belgium
| | - Dorien De Strijcker
- Department of Rehabilitation Research, Free University Brussels , Brussels, Belgium
| | - Nele Adriaenssens
- Department of Rehabilitation Research, Free University Brussels , Brussels, Belgium
| | - Pierre Lievens
- Department of Rehabilitation Research, Free University Brussels , Brussels, Belgium
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17
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Yeung W, Semciw AI. Aquatic Therapy for People with Lymphedema: A Systematic Review and Meta-analysis. Lymphat Res Biol 2017; 16:9-19. [PMID: 28346851 DOI: 10.1089/lrb.2016.0056] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Aquatic therapy has several proposed benefits for people with lymphedema. A systematic review of the evidence for aquatic therapy in lymphedema management has not been conducted. METHOD AND RESULTS Systematic review and meta-analysis were conducted. Five electronic databases were searched to identify randomized controlled trials (RCTs) of people with lymphedema, which compared aquatic therapy with other lymphedema interventions. Qualitative analysis was undertaken where quantitative analysis was not possible. Study quality was assessed using physiotherapy evidence database (PEDro) scores. The strength of evidence was evaluated using the Grades of Recommendations Assessment, Development and Evaluation (GRADE) approach. Four RCTs of moderate quality (average PEDro score 6.5/10) were included in the review. Two studies provided results for inclusion in meta-analysis. There was moderate-level evidence of no significant short-term differences in lymphedema status (as measured by lymphedema relative volume) between patients who completed aqua lymphatic therapy (ALT) compared to land-based standard care (standardized mean difference [SMD]: 0.14; 95% confidence interval [CI]: -0.37 to 0.64, I2 = 0%, p = 0.59); and low-quality evidence of no significant difference between ALT and standard care for improving upper limb (UL) physical function (SMD -0.27, 95% CI: -0.78 to 0.23, I2 = 0%, p = 0.29). No adverse events reported. CONCLUSIONS Current evidence indicates no significant benefit of ALT over standard land-based care for improving lymphedema status or physical function in people with UL lymphedema. Patient preference should guide the choice of care to facilitate adherence. Further research is required to strengthen the evidence from four studies in people with UL lymphedema, and to establish the efficacy of this intervention in people with lower limb lymphedema. Review registration: PROSPERO (CRD42015019900).
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Affiliation(s)
- Wai Yeung
- 1 Department of Physiotherapy, Princess Alexandra Hospital , Brisbane, Australia
| | - Adam I Semciw
- 1 Department of Physiotherapy, Princess Alexandra Hospital , Brisbane, Australia .,2 School of Health and Rehabilitation Sciences, The University of Queensland , Brisbane, Australia .,3 Centre for Functioning and Health Research , Metro South Health, Brisbane, Australia
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18
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Three-dimensional stereophotogrammetry as an accurate tool for analyzing lymphedema of the hand. JPRAS Open 2016. [DOI: 10.1016/j.jpra.2016.07.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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19
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Hameeteman M, Verhulst AC, Vreeken RD, Maal TJJ, Ulrich DJO. 3D stereophotogrammetry in upper-extremity lymphedema: An accurate diagnostic method. J Plast Reconstr Aesthet Surg 2015; 69:241-7. [PMID: 26590631 DOI: 10.1016/j.bjps.2015.10.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 10/02/2015] [Accepted: 10/06/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND Upper-extremity lymphedema is a frequent complication in patients treated for breast cancer. Current diagnostic methods for the upper-extremity volume measurements are cumbersome or time consuming. The purpose of this study was to assess the validity and reliability of three-dimensional (3D) stereophotogrammetry for volume measurements in patients with upper-extremity lymphedema. METHOD Patients with unilateral upper-extremity lymphedema were included. The water displacement volume measurement of both arms was performed using a standardized method. In addition, 3D stereophotogrammetry volume measurements were conducted. RESULTS Eleven patients (22 arms) were included. The mean volumes obtained by 3D stereophotogrammetry and water displacement show a high correlation, with a Pearson's correlation coefficient of 0.99 (p = 0.01). The variance calculated by 3D stereophotogrammetry measurements (205 mL) was statistically significant less than that obtained via water displacement measurements (1540 mL) (p < 0.001). CONCLUSION 3D stereophotogrammetry is an accurate method for measuring upper-extremity volume in patients with lymphedema and gives a lower variance value compared to that of the water displacement measurements. We recommend the use of this method in the diagnosis and follow-up of patients with lymphedema.
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Affiliation(s)
- Marijn Hameeteman
- Department of Plastic, Reconstructive and Hand Surgery, Radboud University, Nijmegen Medical Center, Nijmegen, The Netherlands.
| | - Arico C Verhulst
- Department of Oral and Maxillofacial Surgery, Radboud University, Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Rinaldo D Vreeken
- Department of Oral and Maxillofacial Surgery, Radboud University, Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Thomas J J Maal
- Department of Plastic, Reconstructive and Hand Surgery, Radboud University, Nijmegen Medical Center, Nijmegen, The Netherlands; Department of Oral and Maxillofacial Surgery, Radboud University, Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Dietmar J O Ulrich
- Department of Plastic, Reconstructive and Hand Surgery, Radboud University, Nijmegen Medical Center, Nijmegen, The Netherlands
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20
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Killaars R, Penha TRL, Heuts EM, van der Hulst R, Piatkowski AA. Biomechanical Properties of the Skin in Patients with Breast Cancer-Related Lymphedema Compared to Healthy Individuals. Lymphat Res Biol 2015; 13:215-21. [DOI: 10.1089/lrb.2014.0049] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
- R.C. Killaars
- Department of Plastic and Reconstructive Surgery, Maastricht University Medical Centre+ (MUMC+), Maastricht, The Netherlands
| | - T. R. Lopez Penha
- Department of Plastic and Reconstructive Surgery, Maastricht University Medical Centre+ (MUMC+), Maastricht, The Netherlands
- Department of General Surgery, Maastricht University Medical Centre+ (MUMC+), Maastricht, The Netherlands
| | - E. M. Heuts
- Department of General Surgery, Maastricht University Medical Centre+ (MUMC+), Maastricht, The Netherlands
| | - R.R.J.W. van der Hulst
- Department of Plastic and Reconstructive Surgery, Maastricht University Medical Centre+ (MUMC+), Maastricht, The Netherlands
| | - A. A. Piatkowski
- Department of Plastic and Reconstructive Surgery, Maastricht University Medical Centre+ (MUMC+), Maastricht, The Netherlands
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21
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Beek MA, te Slaa A, van der Laan L, Mulder PG, Rutten HJ, Voogd AC, Luiten EJ, Gobardhan PD. Reliability of the Inverse Water Volumetry Method to Measure the Volume of the Upper Limb. Lymphat Res Biol 2015; 13:126-30. [DOI: 10.1089/lrb.2015.0011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | | | - Paul G.H. Mulder
- Department of Amphia Academy, Amphia Hospital, Breda, The Netherlands
| | - Harm J.T. Rutten
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
- Department of Surgery, Maastricht University, Maastricht, The Netherlands
| | - Adri C. Voogd
- Department of Epidemiology, Faculty of Health Medicine and Life Sciences, Research Institute Growth and Development (GROW), Maastricht University, Maastricht, The Netherlands
- Research Department, Comprehensive Cancer Centre the Netherlands, Eindhoven, The Netherlands
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