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de Rezende LF, Piloni JPM, Kempa VL, Silva JFR, Vilas Boas VF, Carvalho RL, Marx ÂG. Ultrasonography as an instrument to evaluate lymphedema secondary to breast cancer: systematic review. J Vasc Bras 2023; 22:e20220144. [PMID: 38162983 PMCID: PMC10755892 DOI: 10.1590/1677-5449.202201441] [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: 06/16/2023] [Accepted: 10/02/2023] [Indexed: 01/03/2024] Open
Abstract
Lymphedema is a chronic and progressive disease characterized by fluid accumulation, causing tissue edema as a result of a compromised lymphatic system. Diagnostic ultrasound (DUS) is a method capable of assessing soft tissue characteristics that can be used reliably to diagnose lymphedema as well as for measuring tissue compliance in a clinical setting. This is a systematic review, aiming to evaluate articles that made use of DUS in management of lymphedema secondary to breast cancer. A total of 570 articles were selected, exported to the Rayyan QCRI review program, and then screened by two researchers. From this search, 25 articles were selected after the authors reached consensus and were catalogued as to their main results. Diagnostic ultrasound was identified as an advantageous method that is safe, minimally invasive, low cost, and radiation free and is useful for evaluating the efficacy of therapies used in lymphedema treatment.
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Affiliation(s)
| | | | - Vitória Livorato Kempa
- Centro Universitário das Faculdades Associadas de Ensino - FAE, São João da Boa Vista, SP, Brasil.
| | - Júlia Franco Ramos Silva
- Centro Universitário das Faculdades Associadas de Ensino - FAE, São João da Boa Vista, SP, Brasil.
| | | | - Regiane Luz Carvalho
- Centro Universitário das Faculdades Associadas de Ensino - FAE, São João da Boa Vista, SP, Brasil.
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Canales-Lachén E, Asunsolo Á, Manrique OJ, Blázquez J, Holguín P, Maldonado AA. The Use of Ultrasound Imaging for Upper Extremity Lymphedema after Breast Cancer: A Systematic Review. J Reconstr Microsurg 2023; 39:102-110. [PMID: 36162421 DOI: 10.1055/s-0042-1750824] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND The aim of this study was to analyze the different applications of ultrasound (US) in upper extremity lymphedema (UEL) after breast cancer. METHODS A systematic review of the literature was performed in line with the PRISMA statement using MEDLINE/PubMed databases from January 1970 to December 2021. Articles describing the application of US in patients with UEL after breast cancer were included. The quality of the study, the level of reproducibility, and the different applications and type of US technique were analyzed. RESULTS In total, 30 articles with 1,193 patients were included in the final review. Five different applications were found: (1) diagnosis of UEL (14 studies found a direct correlation between lymphedema and morphological and/or functional parameters); (2) staging/severity of UEL (9 studies found a direct correlation between the clinical stage and the soft-tissue stiffness/texture/thickness); (3) therapeutic assessment (3 studies found an improvement in the circulatory status or in the muscle/subcutaneous thickness after conservative treatments); (4) prognosis assessment of UEL (1 study found a correlation between the venous flow and the risk of UEL); and (5) surgical planning (3 studies determined the location of the lymphatic vessel for lymphovenous anastomosis [LVA] surgery). CONCLUSION Morphological and functional parameters have been correlated with the diagnosis, stage, therapeutic effect, prognosis of UEL, and surgical planning of LVA.
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Affiliation(s)
| | - Ángel Asunsolo
- Department of Surgery, Medical and Social Science, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain.,Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain
| | - Oscar J Manrique
- Deparment of Plastic Surgery, University of Rochester Medical Center, Rochester, New York
| | - Javier Blázquez
- Department of Radiology, University Hospital Ramón y Cajal, Madrid, Spain.,Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain
| | | | - Andrés A Maldonado
- Department of Surgery, Medical and Social Science, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain.,Ramón y Cajal Health Research Institute (IRYCIS), Madrid, Spain.,Department of Plastic Surgery, University Hospital Getafe, Madrid, Spain.,Department of Plastic, Hand and Reconstructive Surgery, BG Trauma Center Frankfurt am Main, Academic Hospital of the Goethe University Frankfurt am Main, Frankfurt am Main, Germany
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Sanderson J, Tuttle N, Laakso L. Acoustic Radiation Force Impulse Elastography Assessment of Lymphoedema Tissue: An Insight into Tissue Stiffness. Cancers (Basel) 2022; 14:cancers14215281. [PMID: 36358699 PMCID: PMC9656697 DOI: 10.3390/cancers14215281] [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: 09/27/2022] [Revised: 10/21/2022] [Accepted: 10/26/2022] [Indexed: 11/16/2022] Open
Abstract
Palpation remains essential for evaluating lymphoedema to detect subtle changes that may indicate progression. As palpation sense is not quantifiable, this study investigates the utility of ultrasound elastography to quantify stiffness of lymphoedema tissue and explore the influence of the pitting test on tissue stiffness. Fifteen women with unilateral arm lymphoedema were scanned using a Siemens S3000 Acuson ultrasound (Siemens, Germany) with 18 MHz and 9 MHz linear transducers to assess tissue structure and tissue stiffness with Acoustic Radiation Force Impulse elastography. Ninety sites were assessed, three on each of the lymphoedema-affected and contralateral unaffected arms. A subgroup of seven lymphoedema-affected sites included additional elastography imaging after a 60-s pitting test. Dermal tissue stiffness was greater than subcutaneous tissue stiffness regardless of the presence of pathology (p < 0.001). Lymphoedematous tissue exhibited a higher dermal to subcutaneous tissue stiffness ratio than contralateral sites (p = 0.005). Subgroup analysis indicated that the pitting test reduces dermal tissue stiffness (p = 0.018) and may alter the stiffness of the subcutaneous tissue layer. Elastography demonstrates potential as a complement to lymphoedema palpation assessment. The novel pre-test and post-pitting elastography imaging protocol yielded information representative of lymphoedema tissue characteristics that could not be ascertained from pre-test elastography images alone.
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Affiliation(s)
- Jennifer Sanderson
- School of Allied Health and Social Work, Griffith University, Gold Coast, QLD 4215, Australia
- Correspondence:
| | - Neil Tuttle
- School of Allied Health and Social Work, Griffith University, Gold Coast, QLD 4215, Australia
- School of Health Sciences, University of Tasmania, Newham, TAS 7005, Australia
| | - Liisa Laakso
- School of Allied Health and Social Work, Griffith University, Gold Coast, QLD 4215, Australia
- Mater Research Institute, The University of Queensland, South Brisbane, QLD 4101, Australia
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Perez CS, Mestriner C, Ribeiro LTN, Grillo FW, Lemos TW, Carneiro AA, Guirro RRDJ, Guirro ECO. Relationship between lymphedema after breast cancer treatment and biophysical characteristics of the affected tissue. PLoS One 2022; 17:e0264160. [PMID: 35442985 PMCID: PMC9020674 DOI: 10.1371/journal.pone.0264160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 02/04/2022] [Indexed: 12/24/2022] Open
Abstract
The treatment of breast cancer is often complicated by lymphedema of the upper limbs. Standard lymphedema evaluation methodologies are not able to measure tissue fibrosis. The ultrasound aspects related to tissue microstructures of lymphedema are neglected in clinical evaluations. The objective of this study was to identify and measure the degree of impairment, topography, and biophysical alterations of subcutaneous lymphedema tissue secondary to the treatment of breast cancer by ultrasonography. Forty-two women at a mean age of 58 (±9.7) years, with unilateral lymphedema due to breast cancer treatment, were evaluated. The upper limbs were divided into affected (affected by lymphedema) and control (contralateral limb). Each limb was subdivided into seven areas, defined by perimetry, evaluated in pairs. The biophysical characteristics thickness, entropy, and echogenicity were evaluated by ultrasonography. The results showed a significant difference in the echogenicity and thickness variables between the affected and unaffected upper limb, in all the extent of the upper limb, while entropy showed no significant difference. The findings indicate that the data presented were consistent both in identifying and measuring the degree of impairment and biophysical changes in the subcutaneous tissue of lymphedema secondary to the treatment of breast cancer.
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Affiliation(s)
- Carla S. Perez
- Programa de Pós-Graduação em Reabilitação e Desempenho Funcional, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brasil
- Departamento de Ciências das Saúde, Faculdade de Medicina de Ribeirão Preto, Universidade de são Paulo, Ribeirão Preto, São Paulo, Brasil
- * E-mail: , (CSP); (ECOG)
| | - Carolina Mestriner
- Programa de Pós-Graduação em Reabilitação e Desempenho Funcional, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brasil
| | - Leticia T. N. Ribeiro
- Departamento de Física, Faculdade de Filosofia, ciências e Letras de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brasil
| | - Felipe W. Grillo
- Departamento de Física, Faculdade de Filosofia, ciências e Letras de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brasil
| | - Tenysson W. Lemos
- Departamento de Ciências das Saúde, Faculdade de Medicina de Ribeirão Preto, Universidade de são Paulo, Ribeirão Preto, São Paulo, Brasil
| | - Antônio A. Carneiro
- Departamento de Física, Faculdade de Filosofia, ciências e Letras de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brasil
| | - Rinaldo Roberto de Jesus Guirro
- Programa de Pós-Graduação em Reabilitação e Desempenho Funcional, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brasil
- Departamento de Ciências das Saúde, Faculdade de Medicina de Ribeirão Preto, Universidade de são Paulo, Ribeirão Preto, São Paulo, Brasil
| | - Elaine C. O. Guirro
- Programa de Pós-Graduação em Reabilitação e Desempenho Funcional, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brasil
- Departamento de Ciências das Saúde, Faculdade de Medicina de Ribeirão Preto, Universidade de são Paulo, Ribeirão Preto, São Paulo, Brasil
- * E-mail: , (CSP); (ECOG)
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Forte AJ, Huayllani MT, Boczar D, Cinotto G, Ciudad P, Manrique OJ, Lu X, McLaughlin SA. The basics of ultrasound elastography for diagnosis, assessment, and staging breast cancer-related lymphedema: a systematic review of the literature. Gland Surg 2020; 9:589-595. [PMID: 32420294 DOI: 10.21037/gs.2020.02.08] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Breast cancer-related lymphedema (BCRL) incidence has been increasing overtime. Currently, there is not a preferred imaging tool for diagnosis, staging, and assessment of the disease. We aim to review the use of ultrasound elastography (UE) in BCRL patients. A systematic review was performed by querying PubMed, EMBASE, Ovid Healthstar, and Ovid Medline databases for studies that evaluated the use of UE in BCRL. The keywords "elastography" AND "lymphedema" in titles and abstracts were used for the search. The search retrieved 12, 12, 5 and 6 articles in each database, respectively. From these, only 4 met the inclusion criteria. UE methods included two-dimensional strain imaging, shear wave elastography (SWE), and global UE. Two of the studies evaluated the use of UE in the assessment of BCRL, while only 1 considered its use for diagnosis and staging. Based on our systematic review, UE appears to be a great tool in the assessment of BCRL to differentiate affected from non-affected arms.
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Affiliation(s)
- Antonio J Forte
- Division of Plastic Surgery and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, FL, USA
| | - Maria T Huayllani
- Division of Plastic Surgery and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, FL, USA
| | - Daniel Boczar
- Division of Plastic Surgery and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, FL, USA
| | - Gabriela Cinotto
- Division of Plastic Surgery and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, FL, USA
| | - Pedro Ciudad
- Department of Plastic, Reconstructive and Burn Surgery, Arzobispo Loayza National Hospital, Lima, Peru
| | | | - Xiaona Lu
- Division of Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, CT, USA
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