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Polat DS, Nguyen S, Karbasi P, Hulsey K, Cobanoglu MC, Wang L, Montillo A, Dogan BE. Machine Learning Prediction of Lymph Node Metastasis in Breast Cancer: Performance of a Multi-institutional MRI-based 4D Convolutional Neural Network. Radiol Imaging Cancer 2024; 6:e230107. [PMID: 38607282 PMCID: PMC11148663 DOI: 10.1148/rycan.230107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 12/31/2023] [Accepted: 02/29/2024] [Indexed: 04/13/2024]
Abstract
Purpose To develop a custom deep convolutional neural network (CNN) for noninvasive prediction of breast cancer nodal metastasis. Materials and Methods This retrospective study included patients with newly diagnosed primary invasive breast cancer with known pathologic (pN) and clinical nodal (cN) status who underwent dynamic contrast-enhanced (DCE) breast MRI at the authors' institution between July 2013 and July 2016. Clinicopathologic data (age, estrogen receptor and human epidermal growth factor 2 status, Ki-67 index, and tumor grade) and cN and pN status were collected. A four-dimensional (4D) CNN model integrating temporal information from dynamic image sets was developed. The convolutional layers learned prognostic image features, which were combined with clinicopathologic measures to predict cN0 versus cN+ and pN0 versus pN+ disease. Performance was assessed with the area under the receiver operating characteristic curve (AUC), with fivefold nested cross-validation. Results Data from 350 female patients (mean age, 51.7 years ± 11.9 [SD]) were analyzed. AUC, sensitivity, and specificity values of the 4D hybrid model were 0.87 (95% CI: 0.83, 0.91), 89% (95% CI: 79%, 93%), and 76% (95% CI: 68%, 88%) for differentiating pN0 versus pN+ and 0.79 (95% CI: 0.76, 0.82), 80% (95% CI: 77%, 84%), and 62% (95% CI: 58%, 67%), respectively, for differentiating cN0 versus cN+. Conclusion The proposed deep learning model using tumor DCE MR images demonstrated high sensitivity in identifying breast cancer lymph node metastasis and shows promise for potential use as a clinical decision support tool. Keywords: MR Imaging, Breast, Breast Cancer, Breast MRI, Machine Learning, Metastasis, Prognostic Prediction Supplemental material is available for this article. Published under a CC BY 4.0 license.
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Affiliation(s)
- Dogan S. Polat
- From the Department of Diagnostic Radiology (D.S.P., K.H., A.M.,
B.E.D.), Lyda Hill Department of Bioinformatics (S.N., P.K., M.C.C., L.W.,
A.M.), and Biomedical Engineering Department (A.M.), University of Texas
Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8585
| | - Son Nguyen
- From the Department of Diagnostic Radiology (D.S.P., K.H., A.M.,
B.E.D.), Lyda Hill Department of Bioinformatics (S.N., P.K., M.C.C., L.W.,
A.M.), and Biomedical Engineering Department (A.M.), University of Texas
Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8585
| | | | - Keith Hulsey
- From the Department of Diagnostic Radiology (D.S.P., K.H., A.M.,
B.E.D.), Lyda Hill Department of Bioinformatics (S.N., P.K., M.C.C., L.W.,
A.M.), and Biomedical Engineering Department (A.M.), University of Texas
Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8585
| | | | - Liqiang Wang
- From the Department of Diagnostic Radiology (D.S.P., K.H., A.M.,
B.E.D.), Lyda Hill Department of Bioinformatics (S.N., P.K., M.C.C., L.W.,
A.M.), and Biomedical Engineering Department (A.M.), University of Texas
Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8585
| | - Albert Montillo
- From the Department of Diagnostic Radiology (D.S.P., K.H., A.M.,
B.E.D.), Lyda Hill Department of Bioinformatics (S.N., P.K., M.C.C., L.W.,
A.M.), and Biomedical Engineering Department (A.M.), University of Texas
Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8585
| | - Basak E. Dogan
- From the Department of Diagnostic Radiology (D.S.P., K.H., A.M.,
B.E.D.), Lyda Hill Department of Bioinformatics (S.N., P.K., M.C.C., L.W.,
A.M.), and Biomedical Engineering Department (A.M.), University of Texas
Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8585
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Montagna G, Barrio AV. Managing the Morbidity: Individualizing Risk Assessment, Diagnosis, and Treatment Options for Upper Extremity Lymphedema. Surg Oncol Clin N Am 2023; 32:705-724. [PMID: 37714638 DOI: 10.1016/j.soc.2023.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Abstract
In the setting where breast cancer-related lymphedema (BCRL) remains a feared and common complication of breast cancer, here we review important factors for the development, diagnosis, prevention, and treatment of BCRL. We find that race/ethnicity affect BCRL development risk, that future studies should focus on understanding the biological reasons behind the increased susceptibility of certain racial minorities to BCRL, that surveillance, early detection, exercise programs, and arm compression can reduce the risk of BCRL, and that surgical techniques to preserve and restore lymphatic drainage being evaluated in randomized trials may become transformative in reducing BCRL risk for high-risk patients.
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Affiliation(s)
- Giacomo Montagna
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY 10065, USA
| | - Andrea V Barrio
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY 10065, USA.
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Jeffers EJ, Wagner JL, Korentager SS, Larson KE, Balanoff CR, Baker J, Chollet-Hinton L, Kilgore LJ. Breast Cancer-Related Lymphedema (BCRL) and Bioimpedance Spectroscopy: Long-Term Follow-Up, Surveillance Recommendations, and Multidisciplinary Risk Factors. Ann Surg Oncol 2023; 30:6258-6265. [PMID: 37535267 DOI: 10.1245/s10434-023-13956-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 07/06/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Early detection and intervention for breast cancer-related lymphedema (BCRL) significantly decreases progression to persistent BCRL (pBCRL). We aimed to provide long-term follow-up on our early detection with bioimpedance spectroscopy (BIS) and early home intervention demonstrating reduced pBCRL to guide surveillance recommendations. PATIENTS AND METHODS In total, 148 female patients with breast cancer who had axillary lymph node dissection (ALND) from November 2014 to December 2017 were analyzed. Baseline BIS measurements and postoperative follow-up occurred every 3 months for 1 year, biannual for 1 year, and then annually. An elevated BIS triggered evaluation and initiation of at-home interventions with reassessment for resolution versus persistent BCRL (pBCRL). High-risk factors and timing were analyzed. RESULTS Mean follow-up was 55 months, and 65 (44%) patients had an abnormal BIS. Of these, 54 (82%) resolved with home intervention. The overall pBCRL rate was 8%. Average time to first abnormal BIS was 11.7 months. None of the stage 0 patients (0/34) and only 5/25 (20%) of stage 1 patients had pBCRL. All of stage 2 and stage 3 patients (7/7) had pBCRL. pBCRL correlated with number of positive nodes, percentage of positive nodes, stage of lymphedema at diagnosis, and recurring abnormal BIS measurements (p < 0.05). CONCLUSIONS We have shown that patients undergoing ALND with early BCRL identified by BIS who performed home interventions had an 8% pBCRL rate. Patients at high risk for pBCRL should have routine surveillance starting at 9 months postoperatively to identify an opportunity for early intervention.
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Affiliation(s)
- Elizabeth J Jeffers
- Division of Breast Surgical Oncology, Department of Surgery, University of Kansas Cancer Center, Kansas City, KS, USA
| | - Jamie L Wagner
- Division of Breast Surgical Oncology, Department of Surgery, University of Kansas Cancer Center, Kansas City, KS, USA
| | - Sabrina S Korentager
- Division of Breast Surgical Oncology, Department of Surgery, University of Kansas Cancer Center, Kansas City, KS, USA
| | - Kelsey E Larson
- Division of Breast Surgical Oncology, Department of Surgery, University of Kansas Cancer Center, Kansas City, KS, USA
| | - Christa R Balanoff
- Division of Breast Surgical Oncology, Department of Surgery, University of Kansas Cancer Center, Kansas City, KS, USA
| | - Jordan Baker
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS, USA
| | - Lynn Chollet-Hinton
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, KS, USA
| | - Lyndsey J Kilgore
- Division of Breast Surgical Oncology, Department of Surgery, University of Kansas Cancer Center, Kansas City, KS, USA.
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Donahue PMC, MacKenzie A, Filipovic A, Koelmeyer L. Advances in the prevention and treatment of breast cancer-related lymphedema. Breast Cancer Res Treat 2023; 200:1-14. [PMID: 37103598 DOI: 10.1007/s10549-023-06947-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 04/06/2023] [Indexed: 04/28/2023]
Abstract
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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Affiliation(s)
- Paula M C Donahue
- Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, 2201 21St Children's Way, Suite 1218, Nashville, TN, 37212, USA.
- Dayani Center for Health and Wellness, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Adrien MacKenzie
- Osher Center for Integrative Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Louise Koelmeyer
- Faculty of Medicine, Health, and Human Sciences, Australian Lymphoedema Education, Research, and Treatment (ALERT), Macquarie University, Sydney, Australia
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Gandhi A, Xu T, DeSnyder SM, Smith GL, Lin R, Barcenas CH, Stauder MC, Hoffman KE, Strom EA, Ferguson S, Smith BD, Woodward WA, Perkins GH, Mitchell MP, Garner D, Goodman CR, Aldrich M, Travis M, Lilly S, Bedrosian I, Shaitelman SF. Prospective, early longitudinal assessment of lymphedema-related quality of life among patients with locally advanced breast cancer: The foundation for building a patient-centered screening program. Breast 2023; 68:205-215. [PMID: 36863241 PMCID: PMC9996356 DOI: 10.1016/j.breast.2023.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 02/08/2023] [Accepted: 02/21/2023] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND We examined how breast cancer-related lymphedema (BCRL) affects health-related quality of life (HRQOL), productivity, and compliance with therapeutic interventions to guide structuring BCRL screening programs. METHODS We prospectively followed consecutive breast cancer patients who underwent axillary lymph node dissection (ALND) with arm volume screening and measures assessing patient-reported health-related quality of life (HRQOL) and perceptions of BCRL care. Comparisons by BCRL status were made with Mann-Whitney U, Chi-square, Fisher's exact, or t tests. Trends over time from ALND were assessed with linear mixed-effects models. RESULTS With a median follow-up of 8 months in 247 patients, 46% self-reported ever having BCRL, a proportion that increased over time. About 73% reported fear of BCRL, which was stable over time. Further in time from ALND, patients were more likely to report that BCRL screening reduced fear. Patient-reported BCRL was associated with higher soft tissue sensation intensity, biobehavioral, and resource concerns, absenteeism, and work/activity impairment. Objectively measured BCRL had fewer associations with outcomes. Most patients reported performing prevention exercises, but compliance decreased over time; patient-reported BCRL was not associated with exercise frequency. Fear of BCRL was positively associated with performing prevention exercises and using compressive garments. CONCLUSIONS Both incidence and fear of BCRL were high after ALND for breast cancer. Fear was associated with improved therapeutic compliance, but compliance decreased over time. Patient-reported BCRL was more strongly associated with worse HRQOL and productivity than was objective BCRL. Screening programs must support patients' psychological needs and aim to sustain long-term compliance with recommended interventions.
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Affiliation(s)
- Anusha Gandhi
- Baylor College of Medicine, USA; Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, USA
| | - Tianlin Xu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, USA
| | - Sarah M DeSnyder
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, USA
| | - Grace L Smith
- Department of GI Radiation Oncology, The University of Texas MD Anderson Cancer Center, USA
| | - Ruitao Lin
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, USA
| | - Carlos H Barcenas
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, USA
| | - Michael C Stauder
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, USA
| | - Karen E Hoffman
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, USA
| | - Eric A Strom
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, USA
| | - Susan Ferguson
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, USA
| | - Benjamin D Smith
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, USA
| | - Wendy A Woodward
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, USA
| | - George H Perkins
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, USA
| | - Melissa P Mitchell
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, USA
| | - Desmond Garner
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, USA
| | - Chelain R Goodman
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, USA
| | - Melissa Aldrich
- Center for Molecular Imaging, UT Health Science Center at Houston, USA
| | - Marigold Travis
- Department of Rehabilitative Therapy, The University of Texas MD Anderson Cancer Center, USA
| | - Susan Lilly
- Department of Rehabilitative Therapy, The University of Texas MD Anderson Cancer Center, USA
| | - Isabelle Bedrosian
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, USA
| | - Simona F Shaitelman
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, USA.
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Brunelle CL, Taghian AG. Breast Cancer–Related Lymphedema: the Prospective Surveillance Model, Early Intervention Strategies, and Role of Complete Decongestive Therapy. CURRENT BREAST CANCER REPORTS 2023. [DOI: 10.1007/s12609-023-00471-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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7
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Cobb A, DeSnyder SM. Risk Factors for Breast Cancer-Related Lymphedema, Risk Reduction, and Myths about Precautionary Behaviors. CURRENT BREAST CANCER REPORTS 2023. [DOI: 10.1007/s12609-023-00474-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Risk factors of unilateral breast cancer-related lymphedema: an updated systematic review and meta-analysis of 84 cohort studies. Support Care Cancer 2022; 31:18. [PMID: 36513801 DOI: 10.1007/s00520-022-07508-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 12/02/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE To review and update the incidence and risk factors for breast cancer-related lymphedema based on cohort studies. METHODS The study was guided by the Joanna Briggs Institute methodology and the Cochrane handbook for systematic reviews. PubMed, EMBASE, CINAHL, Scopus, Web of Science, The Cochrane Library, CNKI, SinoMed, and Wan Fang Database were searched from inception to November 15, 2021. Cohort studies reported adjusted risk factors were selected. PRISMA guideline was followed. Study quality were evaluated using the Newcastle-Ottawa scale. Random-effects models were adopted. The robustness of pooled estimates was validated by meta-regression and subgroup analysis. Lymphedema incidence and adjusted risk factors in the multivariable analyses with hazard / odds ratios and 95% CIs were recorded. RESULTS Eighty-four cohort studies involving 58,358 breast cancer patients were included. The pooled incidence of lymphedema was 21.9% (95% CI, 19.8-24.0%). Fourteen factors were identified including ethnicity (black vs. white), higher body mass index, higher weight increase, hypertension, higher cancer stage (III vs. I-II), larger tumor size, mastectomy (vs. breast conservation surgery), axillary lymph nodes dissection, more lymph nodes dissected, higher level of lymph nodes dissection, chemotherapy, radiotherapy, surgery complications, and higher relative volume increase postoperatively. Additionally, breast reconstruction surgery, and adequate finance were found to play a protective role. However, other variables such as age, number of positive lymph nodes, and exercise were not correlated with risk of lymphedema. CONCLUSION Treatment-related factors still leading the development of breast cancer-related lymphedema. Other factors such as postoperative weight increase and finance status also play a part. Our findings suggest the need to shift the focus from treatment-related factors to modifiable psycho-social-behavioral factors.
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Hendrickx AA, Küthe SW, van der Schans CP, Krijnen WP, Mouës-Vink CM, Damstra RJ. Early Referral for Breast-Cancer-Related Lymphedema: Do We Follow the Evidence? A Two-Year Prospective Multicenter Cohort Study. Cancers (Basel) 2022; 14:cancers14236016. [PMID: 36497495 PMCID: PMC9738967 DOI: 10.3390/cancers14236016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/28/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
The early detection of breast-cancer-related lymphedema and referral for therapy has the potential to reduce lymphedema-related morbidity. Although research shows the benefits, a gap is observed between evidence and daily practice. We aimed to determine whether the early detection of lymphedema and referral for treatment is adequate following the current guidelines. Women with primary breast cancer treated with breast-conserving therapy or ablative treatment were included. Demographic-, general health-, tumor-, and treatment-related data were recorded. Bilateral arm volume measurements were performed preoperatively and 3, 6, 12, and 24 months post-surgery. A 5% or greater Relative Volume Change was considered the cutoff point for lymphedema and as an indication for therapy referral. After 24 months post-surgery, the main outcomes show that among the patients with early signs of lymphedema, based on a Relative Volume Change ≥5%, a nonreferral for therapy was noted in 83%. Additionally, we observed a significant improvement of the mean Relative Volume Change at 24 months within this group, which might implicate that nonreferral was an adequate choice and that watchful waiting is appropriate when lymphedema is detected within the first year post-surgery.
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Affiliation(s)
- Ad A. Hendrickx
- Center of Expertise for Lymphovascular Medicine, Nij Smellinghe Hospital, Compagnonsplein 1, 9202 NN Drachten, The Netherlands
- Research Group Healthy Ageing Allied Health Care and Nursing, Hanze University of Applied Sciences, 9747 AS Groningen, The Netherlands
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, 9712 CP Groningen, The Netherlands
- Correspondence:
| | - Saskia W. Küthe
- Research Group Healthy Ageing Allied Health Care and Nursing, Hanze University of Applied Sciences, 9747 AS Groningen, The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, Medical Center Leeuwarden, 8934 AD Leeuwarden, The Netherlands
| | - Cees P. van der Schans
- Research Group Healthy Ageing Allied Health Care and Nursing, Hanze University of Applied Sciences, 9747 AS Groningen, The Netherlands
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, 9712 CP Groningen, The Netherlands
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, 9712 CP Groningen, The Netherlands
| | - Wim P. Krijnen
- Research Group Healthy Ageing Allied Health Care and Nursing, Hanze University of Applied Sciences, 9747 AS Groningen, The Netherlands
| | - Chantal M. Mouës-Vink
- Department of Plastic, Reconstructive and Hand Surgery, Medical Center Leeuwarden, 8934 AD Leeuwarden, The Netherlands
| | - Robert J. Damstra
- Center of Expertise for Lymphovascular Medicine, Nij Smellinghe Hospital, Compagnonsplein 1, 9202 NN Drachten, The Netherlands
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Chang JY, Wang W, Shen JL, Zhang Y, Cai HF. Impact of sentinel lymph node biopsy through the axillary cribriform fascia approach on intraoperative indicators and postoperative complications. Updates Surg 2022; 75:757-767. [PMID: 36385610 DOI: 10.1007/s13304-022-01417-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 10/31/2022] [Indexed: 11/17/2022]
Abstract
The aim of this study was to compare intraoperative indicators and postoperative complications of sentinel lymph node biopsy (SLNB) via the axillary cribriform membrane and traditional axillary fold with blue dye to make a priority choice. This single-center, retrospective cohort study enrolled 330 eligible breast cancer patients with stage of cTis ~ 2N0M0 in our hospital from August 2018 to July 2021. Multiple linear and binary logistic regression were used to evaluate the effects of different surgical approaches on intraoperative indicators (drainage volume, tube time, intraoperative bleeding, operative time and the number of sentinel lymph nodes (SLNs)) and postoperative complications (upper limb edema and dysfunction). All statistical tests were two sided. Multiple linear and logistic regression results after adjusting the covariate showed that the axillary cribriform fascia approach could render more greater intraoperative indictors and reduce the risk of upper limb dysfunction (P = 0.038, OR 0.32, 95%CI 0.11-0.94). High BMI could increase the drainage volume, tube time and operative time. There was no significant difference in the number of SLNs between the two approaches and it also had no relationship with intraoperative indicators and postoperative complications. Overall, 6 (1.8%) experienced upper limb edema and 18 (5.5%) experienced upper limb dysfunction. Univariate logistic regression analysis showed that radiotherapy increased the risk of upper limb edema (P = 0.032, OR = 12.76, 95%CI 1.25-130.06). SLNB through the axillary cribriform fascia approach produces more satisfied intraoperative indictors, a lower risk of upper limb dysfunction.
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Affiliation(s)
- Jin-Yi Chang
- Department of Breast Surgery, Tangshan People's Hospital, North China University of Science and Technology, Tangshan, China
- School of Clinical Medicine, North China University of Science and Technology, Tangshan, China
| | - Wei Wang
- Department of Breast Surgery, Tangshan People's Hospital, North China University of Science and Technology, Tangshan, China
- School of Clinical Medicine, North China University of Science and Technology, Tangshan, China
| | - Jiang-Lun Shen
- Department of Breast Surgery, Tangshan People's Hospital, North China University of Science and Technology, Tangshan, China
| | - Yang Zhang
- Department of Breast Surgery, Tangshan People's Hospital, North China University of Science and Technology, Tangshan, China
| | - Hai-Feng Cai
- Department of Breast Surgery, Tangshan People's Hospital, North China University of Science and Technology, Tangshan, China.
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11
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Zhuang L, Chen H, Zheng X, Wu S, Yu Y, Lan L, Xu L, Xu J, Fan H. Bioelectrical impedance analysis for early screening of upper limb subclinical lymphedema: A case–control study. PLoS One 2022; 17:e0274570. [PMID: 36121834 PMCID: PMC9484636 DOI: 10.1371/journal.pone.0274570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 08/30/2022] [Indexed: 11/18/2022] Open
Abstract
Breast cancer-related lymphedema is a treatment-related chronic disease that causes great distress and medical burden. Early screening and precautionary measures for lymphedema could improve well-being and decrease medical costs. Herein, we used bioelectrical impedance analysis for early screening of lymphedema. We set up a verifiable standardized subclinical standard to screen subclinical lymphedema in postoperative breast cancer patients using bioelectrical impedance. The first part determined the criteria of subclinical lymphedema. Among the 424 female participants, 127 were healthy women, whereas 297 were postoperative breast cancer survivors. Subclinical standard boundaries were determined by the 95% confidence interval of the healthy women. The screening rate of patients with subclinical lymphedema was inferred by comparing the subclinical standard boundaries and the postoperative patient values. A total of 14.81–20.87% of postoperative breast cancer survivors were identified as patients with subclinical lymphedema. The second part provided the results of the verification test of this subclinical standard. The data of the verification test from 30 healthy women and 30 screened patients met the subclinical standard, and 30 breast cancer survivors with lymphedema verified the utility and feasibility of the subclinical standard. Therefore, this standard could provide a screening tool for early the identification of subclinical breast cancer survivors. Early detection helps implement personal and precise medical precautions for patients with subclinical lymphedema.
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Affiliation(s)
- Linli Zhuang
- Department of Head and Neck Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Huaying Chen
- Department of Head and Neck Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xuemei Zheng
- Department of Head and Neck Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Shaoyong Wu
- Department of Head and Neck Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
- * E-mail:
| | - Youhui Yu
- Department of Head and Neck Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Lu Lan
- Department of Head and Neck Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Liang Xu
- Department of Head and Neck Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jumei Xu
- Department of Head and Neck Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Hongying Fan
- Department of Head and Neck Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
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Aldrich MB, Rasmussen JC, DeSnyder SM, Woodward WA, Chan W, Sevick-Muraca EM, Mittendorf EA, Smith BD, Stauder MC, Strom EA, Perkins GH, Hoffman KE, Mitchell MP, Barcenas CH, Isales LE, Shaitelman SF. Prediction of breast cancer-related lymphedema by dermal backflow detected with near-infrared fluorescence lymphatic imaging. Breast Cancer Res Treat 2022; 195:33-41. [PMID: 35816269 PMCID: PMC9272652 DOI: 10.1007/s10549-022-06667-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 06/21/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Mild breast cancer-related lymphedema (BCRL) is clinically diagnosed as a 5%-10% increase in arm volume, typically measured no earlier than 3-6 months after locoregional treatment. Early BCRL treatment is associated with better outcomes, yet amid increasing evidence that lymphedema exists in a latent form, treatment is typically delayed until arm swelling is obvious. In this study, we investigated whether near-infrared fluorescence lymphatic imaging (NIRF-LI) surveillance could characterize early onset of peripheral lymphatic dysfunction as a predictor of BCRL. METHODS In a prospective, longitudinal cohort/observational study (NCT02949726), subjects with locally advanced breast cancer who received axillary lymph node dissection and regional nodal radiotherapy (RT) were followed serially, between 2016 and 2021, before surgery, 4-8 weeks after surgery, and 6, 12, and 18 months after RT. Arm volume was measured by perometry, and lymphatic (dys) function was assessed by NIRF-LI. RESULTS By 18 months after RT, 30 of 42 study subjects (71%) developed mild-moderate BCRL (i.e., ≥ 5% arm swelling relative to baseline), all manifested by "dermal backflow" of lymph into lymphatic capillaries or interstitial spaces. Dermal backflow had an 83% positive predictive value and 86% negative predictive value for BCRL, with a sensitivity of 97%, specificity of 50%, accuracy of 83%, positive likelihood ratio of 1.93, negative likelihood ratio of 0.07, and odds ratio of 29.00. Dermal backflow appeared on average 8.3 months, but up to 23 months, before the onset of mild BCRL. CONCLUSION BCRL can be predicted by dermal backflow, which often appears months before arm swelling, enabling early treatment before the onset of edema and irreversible tissue changes.
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Affiliation(s)
- Melissa B Aldrich
- Brown Foundation Institute of Molecular Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, 1825 Pressler, 330D, Houston, TX, 77030, USA.
| | - John C Rasmussen
- Brown Foundation Institute of Molecular Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, 1825 Pressler, 330D, Houston, TX, 77030, USA
| | - Sarah M DeSnyder
- University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1502, Houston, TX, 77030, USA
| | - Wendy A Woodward
- University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1502, Houston, TX, 77030, USA
| | - Wenyaw Chan
- Brown Foundation Institute of Molecular Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, 1825 Pressler, 330D, Houston, TX, 77030, USA
| | - Eva M Sevick-Muraca
- Brown Foundation Institute of Molecular Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, 1825 Pressler, 330D, Houston, TX, 77030, USA
| | - Elizabeth A Mittendorf
- Dana Farber/Brigham and Women's Cancer Center, 450 Brookline Avenue, Boston, MA, 02115, USA
| | - Benjamin D Smith
- University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1502, Houston, TX, 77030, USA
| | - Michael C Stauder
- University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1502, Houston, TX, 77030, USA
| | - Eric A Strom
- University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1502, Houston, TX, 77030, USA
| | - George H Perkins
- University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1502, Houston, TX, 77030, USA
| | - Karen E Hoffman
- University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1502, Houston, TX, 77030, USA
| | - Melissa P Mitchell
- University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1502, Houston, TX, 77030, USA
| | - Carlos H Barcenas
- University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1502, Houston, TX, 77030, USA
| | - Lynn E Isales
- University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1502, Houston, TX, 77030, USA
| | - Simona F Shaitelman
- University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1502, Houston, TX, 77030, USA
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Czerniec S. Critically appraised paper: For women at high risk of breast cancer-related lymphoedema, prophylactic compression sleeve usage reduces and delays occurrence of arm swelling [commentary]. J Physiother 2022; 68:205. [PMID: 35644809 DOI: 10.1016/j.jphys.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 05/06/2022] [Indexed: 11/19/2022] Open
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Blom KY, Johansson KI, Nilsson-Wikmar LB, Brogårdh CB. Early intervention with compression garments prevents progression in mild breast cancer-related arm lymphedema: a randomized controlled trial. Acta Oncol 2022; 61:897-905. [PMID: 35657063 DOI: 10.1080/0284186x.2022.2081932] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Early diagnosis and compression treatment are important to prevent progression in breast cancer-related arm lymphedema (BCRAL). However, some mild BCRAL can be reversible, and therefore, compression treatment may not be needed. The aim of this study was to investigate the proportion of women with mild BCRAL showing progression/no progression of lymphedema after treatment with or without compression garments, differences in changes of lymphedema relative volume (LRV), local tissue water and subjective symptoms during 6 months. Also, adherence to self-care was examined. MATERIAL AND METHODS Seventy-five women diagnosed with mild BCRAL were randomized to a compression group (CG) or noncompression group (NCG). Both groups received self-care instructions, and the CG were treated with a standard compression garment (ccl 1). Women in the NCG who progressed in LRV ≥2%, or exceeded 10% dropped out, and received appropriate treatment. The proportion showing progression/no progression of LRV, and changes in LRV was measured by Water Displacement Method. Changes in local tissue water were measured by Tissue Dielectric Constant (TDC), subjective symptoms by Visual Analogue Scale, and self-care by a questionnaire. RESULTS A smaller proportion of LRV progression was found in the CG compared to the NCG at 1, 2 and 6 months follow-up (p ≤ 0.013). At 6 months, 16% had progression of LRV in the CG, compared to 57% in the NCG, (p = 0.001). Thus, 43% in the NCG showed no progression and could manage without compression. Also, CG had a larger reduction in LRV, at all time-points (p ≤ 0.005), and in the highest TDC ratio, when same site followed, at 6 months (p = 0.025). Subjective symptoms did not differ between the groups, except at 1 month, where the CG experienced more reduced tension (p = 0.008). There were no differences in adherence to self-care. CONCLUSION Early treatment with compression garment can prevent progression in mild BCRAL. Trial registration: ISRCT nr ISRCTN51918431.
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Affiliation(s)
- Katarina Y. Blom
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
- Physiotherapy Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Karin I. Johansson
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Lena B. Nilsson-Wikmar
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
| | - Christina B. Brogårdh
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
- Department of Neurology, Rehabilitation Medicine, Memory Disorders and Geriatrics, Skåne University Hospital, Lund, Sweden
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Impact of hand lymphedema on pain and grip strength of the hand in women with breast cancer. Int J Health Sci (Qassim) 2022. [DOI: 10.53730/ijhs.v6ns4.6193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: It is not clear to what extent signs and symptoms other than arm swelling, including pain, grip strength differ between women with hand lymphedema and without hand lymphedema in breast cancer–related lymphedema (BCRL)Aim of Study: To estimate the extent to which the impairments associated with hand lymphedema on pain and grip strength in women with breast cancer related lymphedema (BCRL) and to see the association between severity of hand edema and each of independent variables ( pain and hand grip strength )Methods: sixty women experiencing lymphedema after breast surgery participated in this study. They were recruited from Kasr Al-ainy , between 40: 60 years old were assigned into two equal groups, group (A) women with hand edema (HE+, n = 30) and without hand edema (HE−, n = 30) after breast cancer treatment .Pain and grip strength were evaluated Results: inter group difference showed that there is a there was significant difference in pain difference between the group A and group B (p = 0.04)And there was a significant increase in median value of strength difference of the group A compared with that of group B (p = 0.001).
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Paramanandam VS, Dylke E, Clark GM, Daptardar AA, Kulkarni AM, Nair NS, Badwe RA, Kilbreath SL. Prophylactic Use of Compression Sleeves Reduces the Incidence of Arm Swelling in Women at High Risk of Breast Cancer-Related Lymphedema: A Randomized Controlled Trial. J Clin Oncol 2022; 40:2004-2012. [PMID: 35108031 DOI: 10.1200/jco.21.02567] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
PURPOSE To determine whether prophylactic use of compression sleeves prevents arm swelling in women who had undergone axillary lymph node dissection for breast cancer surgery. METHODS Women (n = 307) were randomly assigned to either a compression or control group. In addition to usual postoperative care, the compression group received two compression sleeves to wear postoperatively until 3 months after completing adjuvant treatments. Arm swelling was determined using bioimpedance spectroscopy (BIS) thresholds and relative arm volume increase (RAVI). Incidence and time free from arm swelling were compared using Kaplan-Meier analyses. Hazard ratios (HRs) were estimated from Cox regression models for BIS and RAVI thresholds independently. In addition, time to documentation of the first minimally important difference (MID) in four scales of the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and the breast cancer-specific (BR23) questionnaire was analyzed. RESULTS The HR for developing arm swelling in the compression group relative to the control group was 0.61 (95% CI, 0.43 to 0.85; P = .004) on the basis of BIS and 0.56 (95% CI, 0.33 to 0.96; P = .034) on the basis of RAVI. The estimated cumulative incidence of arm swelling at 1 year was lower in the compression group than the control group on the basis of BIS (42% v 52%) and RAVI (14% v 25%). HRs for time from baseline to the first change of the minimally important difference were not statistically significant for any of the four scales of EORTC QLQ-30 and BR23 questionnaires. CONCLUSION Prophylactic use of compression sleeves compared with the control group reduced and delayed the occurrence of arm swelling in women at high risk for lymphedema in the first year after surgery for breast cancer.
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Affiliation(s)
- Vincent S Paramanandam
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Tata Memorial Hospital, Parel, Mumbai, India
| | - Elizabeth Dylke
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Gary M Clark
- Gary Clark Statistical Consulting LLC, Superior, CO
| | | | | | - Nita S Nair
- Tata Memorial Hospital, Parel, Mumbai, India
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Rafn BS, Christensen J, Larsen A, Bloomquist K. Prospective Surveillance for Breast Cancer-Related Arm Lymphedema: A Systematic Review and Meta-Analysis. J Clin Oncol 2022; 40:1009-1026. [PMID: 35077194 DOI: 10.1200/jco.21.01681] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE The call to integrate prospective surveillance for lymphedema into cancer care pathways is building momentum to enable early intervention and prevent the progression of the condition. We offer a critical evaluation of the literature on prospective surveillance and early management for cancer-related lymphedema and evaluate the effect of such programs in preventing chronic lymphedema (CRD42019137965). METHODS Five databases and two registries were searched for randomized controlled trials or observational studies that assessed the incidence or prevalence of lymphedema associated with participation in a prospective surveillance program, published until February 26, 2021. Numbers triggered for early lymphedema management, resolved, and chronic lymphedema were extracted. Pooled relative risk (trials) and pooled rate (cumulative incidence; observational studies) of chronic lymphedema was calculated. Subgroup analyses assessed the effect of study design, length of follow-up, and extent of axillary surgery. RESULTS Twenty-three studies were included, of which 21 studies evaluated breast cancer-related arm lymphedema (BCRaL). Participation in prospective surveillance with early management reduced the risk of chronic BCRaL versus usual care (relative risk 0.31; 95% CI, 0.10 to 0.95; two randomized controlled trials; N = 106). The pooled rate of chronic BCRaL was 4% (95% CI, 3 to 6; 15 observational studies; N = 3,545), and 6% (95% CI, 4 to 9) when restricted to participants with axillary lymph node dissection (12 studies; N = 1,527). CONCLUSION The findings suggest that participation in prospective surveillance with early management reduces the risk of chronic BCRaL. Only a minority of patients at high risk of lymphedema because of axillary surgery developed chronic lymphedema. More robust research is needed to determine whether prospective surveillance with early management can reduce the risk of chronic lymphedema, particularly among cancer survivors other than breast cancer.
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Affiliation(s)
- Bolette S Rafn
- Cancer Survivorship and Treatment Late Effects Research Unit (CASTLE), Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Jan Christensen
- Department of Occupational Therapy and Physiotherapy, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Anders Larsen
- University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Kira Bloomquist
- University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Rigshospitalet, Denmark
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Abstract
An estimated 250 million people worldwide suffer from lymphedema. In the past, the firstline option for treatment was nonsurgical management, either in the form of compression garments or wrapping, or comprehensive decongestive therapy, with debulking surgery reserved for the more advanced cases. However, with improvements in microsurgical techniques and imaging modalities, surgical intervention is increasingly being utilized. This review highlights recent advancements in the surgical treatment of lymphedema, specifically focusing on improvements in imaging, surgical techniques, and prevention of lymphedema.
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Bucci LK, Taghian AG. ASO Author Reflections: The Promising Potential of Early Intervention for Subclinical Lymphedema in Women Who Underwent Nodal Surgery for Breast Cancer. Ann Surg Oncol 2021; 28:8634-8635. [PMID: 34036427 DOI: 10.1245/s10434-021-10176-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 04/12/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Loryn K Bucci
- Radiation Oncology, Massachusetts General Hospital, Boston, USA
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