Abstract
BackgroundBreast cancer survivors are at risk of developing breast cancer-related lymphedema (BCRL) after surgical treatment, which may have a negative effect on quality of life. The purpose of this study was to investigate the clinical role of bioelectrical impedance analysis (BIA) and the relationship between the development of BCRL in breast cancer survivors who have undergone axillary surgery.MethodsA total of 228 patients with breast cancer were enrolled in the study between May 2016 and January 2017. BCRL was assessed by measuring the circumference of both arms at 15 cm below the acromion process and the olecranon process. Patients were classified as BCRL (n = 22) and non-BCRL (n = 206) based on the difference of the arm circumference of 2 cm. Data including lymphedema, anthropometry, BIA measurements, food frequency questionnaire, type of surgery, total number of dissected lymph nodes, and post-operative treatment were collected.ResultsOf the breast cancer survivors, 10.4% had BCRL by the definition. The BCRL group contained 22 patients, while the non-BCRL group contained 206 patients. Compared to the non-BCRL group, the BCRL group had a higher body mass index, a larger percentage of ideal body weight, more dissected lymph nodes, and higher single frequency BIA (SFBIA) ratio (P = 0.027, P = 0.031, P < 0.001, and P < 0.001, respectively). The SFBIA ratio provided 63.64% sensitivity and 95.15% specificity in estimating the risk of BCRL.ConclusionOur data provides evidence to support that the use of SFBIA ratio can serve as an alternative method to monitor and/or diagnose BCRL.Trial registrationThis trial was retrospectively registered at Clinicaltrials.gov identifier (NCT03391206) on the 5 January 2018.
Highlights
Breast cancer survivors are at risk of developing breast cancer-related lymphedema (BCRL) after surgical treatment, which may have a negative effect on quality of life
No significant differences between the non-BCRL group and BCRL group were found in terms of age or physical activity level
Body fat percentage, body mass index (BMI), and percent of ideal body weight (PIBW) were significantly different in patients who underwent Sentinel lymph node biopsy (SLNB). These findings suggest that the occurrence of lymphedema is associated with obesity and that patients who undergo SLNB procedures should pay attention to maintaining normal weight
Summary
Breast cancer survivors are at risk of developing breast cancer-related lymphedema (BCRL) after surgical treatment, which may have a negative effect on quality of life. Definitive diagnosis of lymphedema is difficult, because most would suggest that lymphatic dysfunction imaged by lymphoscintigraphy or indocyanine green lymphography is required. The clinical diagnosis of lymphedema includes the observation that the bilateral difference in limb circumference is 2 cm or more [1], the difference of pre and post operation in volume of the limb is more than 200 ml [2], or the bilateral difference in volume of the limb change is 10% [3]. Ultrasound, computed tomography, and magnetic resonance imaging are used to diagnose lymphedema. The ultrasound can measure volumetric and structural changes in the dermis, subcutaneous layer, and muscle, but information on the truncal anatomy of the lymphatic system can not be confirmed [4]. The magnetic resonance imaging can distinguish lymphedema, lipedema, and phlebedema, and can confirm the circumferential measurement edema, thickened dermis, and increased subcutaneous compartment [4, 5]
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