Cellulitis Is Associated with Severe Breast Cancer-Related Lymphedema: An Observational Study of Tissue Composition.

Mads Gustaf Jørgensen,Jørn Bo Thomsen,Anne Pernille Hermann,Jens Ahm Sørensen,Anette Riis Madsen,Kim Gordon Ingwersen,Steffanie Christensen

doi:10.3390/cancers13143584

Mads Gustaf Jørgensen, Jørn Bo Thomsen + Show 5 more

Open Access

https://doi.org/10.3390/cancers13143584

Copy DOI

Abstract

Simple SummaryCellulitis is a common complication in Breast Cancer-Related Lymphedema (BCRL); however, it is not known whether cellulitis is associated with the severity and biocompositon of BCRL. This study showed that cellulitis was associated with more excess volume, fat, and lean arm mass. Treatments should aim to prevent cellulitis in BCRL to possibly avoid the condition exacerbating.Cellulitis is a common complication in Breast Cancer-Related Lymphedema (BCRL). The excess amount of fat and lean mass in BCRL is a vital factor in patient stratification, prognosis, and treatments. However, it is not known whether cellulitis is associated with the excess fat and lean mass in BCRL. Therefore, this prospective observational study was designed to fundamentally understand the heterogonous biocomposition of BCRL. For this study, we consecutively enrolled 206 patients with unilateral BCRL between January 2019 and February 2020. All patients underwent Dual-Energy X-Ray Absorptiometry scans, bioimpedance spectroscopy, indocyanine green lymphangiography comprehensive history of potential risk factors, and a clinical exam. Multivariate linear and beta regression models were used to determine the strength of association and margins effect. Sixty-nine patients (33%) had at least one previous episode of cellulitis. Notably, a previous episode of cellulitis was associated with 20 percentage points more excess fat and 10 percentage points more excess lean mass compared to patients without cellulitis (p < 0.05). Moreover, each 1 increase in the patients BMI was associated with a 0.03 unit increase in the fat mass proportion of the lymphedema arm. Cellulitis was associated with more excess fat and lean arm mass in BCRL. In addition, patients BMI affect the proportion of fat mass in the arm.

Highlights

Arm lymphedema is one of the most common and feared side effects of breast cancer treatment with lymph node involvement and affects up to one in three breast cancer survivors [1,2]
This study found that a previous episode of cellulitis was associated with more excess fat and lean mass in the arm (Figure 5)
Our analysis showed a clear association between lymphedema lean mass and fluid-related variables derived from the bioimpedance spectroscopy measurement

Summary

Introduction

Arm lymphedema is one of the most common and feared side effects of breast cancer treatment with lymph node involvement and affects up to one in three breast cancer survivors [1,2]. BCRL is associated with increased fluid and fat accumulation, and patients are at an increased risk of developing episodes of cellulitis [4]. Conservative treatments such as compression and microsurgical treatments aim to drain the fluid component of BCRL. Both of these treatments have shown inconsistent results [5,6], which can be due to interindividual differences in the excess amount of fat and fluid in the arm [7,8]. It is critical to assess if BCRL patients with a previous episode of cellulitis have a different biocomposition profile to BCRL patients without cellulitis

Objectives

Methods

Results