Breast Cancer-related Lymphedema Patients Research Articles

The correlation between bioimpedance and outcomes of lymphedema treatment in breast cancer patients

Bioimpedance can be used for lymphedema assessment. As lower as the frequency is, current passes through mostly extracellular fluid, considered to be major part of changes during treatment of lymphedema. The aim of this study is to evaluate responsiveness to treatment and prognosis by using bioimpedance and to indentify that the lower frequency impedance more reflects the actual volume changes during treatment. Among the subjects who visited outpatient clinic from December, 2015 to December, 2016 and underwent initial complex decongestive therapy (CDT) for 2 weeks with bioimpedance analysis before and after treatment, we included 64 unilateral breast cancer related lymphedema (BCRL) patients. The ratios of single frequency bioimpedance analysis (SFBIA) at 5 kHz, 1 kHz and the ratio of bioimpedance at 0 kHz were measured. The volume of the affected arm was estimated by integrating arm circumference for 4 cm intervals. The higher ratios of impedance at 0 kHz, 1 kHz, and 5 kHz before CDT were statistically significantly correlated with arm volume reduction in affected arm. Furthermore, as the frequency of SFBIA increases in order of 0 kHz, 1 kHz, and 5 kHz, the coefficient of correlation ( r ) showed tendency to increase. However, in the analysis of the relationship between changes in affected arm volume and impedance ratios, there was a statistically significant correlation only at 5 kHz impedance. The results are consistent with previous studies in that ratios of SFBIA before CDT are useful tools for predicting responsiveness to treatment in BCRL patients. Unexpectedly, SFBIA of low frequency did not predict the outcomes better than that of high. Similar results were obtained in the analysis of the relationship between changes in affected arm volume and impedance ratios, showing a statistically significant correlation only at 5 kHz impedance. Further study will be needed to find out other factors to be considered.

3D laser scanner sensor for upper limb volume measurement in breast cancer related lymphedema: Preliminary results of a reproducibility and reliability study

Upper limb volume assessment is the first step in lymphedema diagnosis and rehabilitative management. Circumferential method (CM), the most commonly used limb volumetric method, showed several limitations in common clinical rehabilitation practice and recently a new method using three-dimensional laser scanning (LS3D) has been proposed for limb volume measurement and validated by our group in healthy subjects. Aim of this study was to verify the reproducibility and reliability of LS3D compared to CM in upper limb volume measurement in women affected by breast cancer related lymphedema (BCRL). We included young women (aged > 18 and < 45 years) affected by BCRL, with normal weight (BMI > 18 and < 25 kg/m 2 ). Two raters randomly performed both LS3D and CM upper limb volume evaluation twice in each subject (the mean value of the two CM and LS3D evaluations was used) at baseline and at the end of the rehabilitative lymphedema treatment. CM assessments were performed by two expert lymphotherapists with more than 20 years of experience in lymphedema treatment and blinded to other rater's assessments. Ten BCRL patients, mean aged 54.3 ± 10.2 years have been enrolled. Both LS3D and CM showed a significant inter and intra-operator correlation in upper limb volume measurement ( r 2 = 0.99; P < 0.0001). LS3D showed a strong correlation with CM ( r 2 = 0.99; P < 0.0001); moreover LS3D was significantly quicker in upper limb volume measurement than CM (195 ± 24 s vs 258 ± 19 s; P < 0.0001). Results of this small pilot study suggest that LS3D seems to be a highly reproducible, reliable and easy to use method to evaluate upper limb volume in BCRL patients, as previously evidenced in healthy subjects. Our results suggest a potential implementation of LS3D as a useful tool in lymphedema common clinical rehabilitation practice. Future investigations should address its reliability and reproducibility in different stages of lymphedema.

The affect of serum 25 (OH) D3 level of the breast cancer-related lymphedema

In this study, it was evaluate whether there was a correlation between the serum 25 (OH) D3 level and severity of lymphedema in patients with breast cancer. The study population was categorized two groups. Inclusion criteria of the first group were diagnosis with breast cancer-related lymphedema (BCRL) in unilateral upper extremity ( n : 31). Also, second group was consist of diagnosis with unilateral breast cancer without lymphedema ( n : 34). The patients in the second group were accepted as control group. The patients in the second group were not described any pain, weakness or limitation of their upper extremity secondary to breast carcinoma. Age, duration of malignancy diagnosis, side and type of malignancy, serum levels of the 25 (OH)Vit D3, calcium and phosphorus, the history of chemotherapy, radiotherapy, lymph node dissection, grade of breast carcinoma were recorded for both groups. In BCRL group, it was recorded education level, dominant extremity, side of lymphedema (right/left), duration of BCRL, lymphedema stage, body mass index (BMI) (body weight [kg]/height 2 [cm 2 ]), Visual Analog Scale (VAS), the Quick Disabilities of the Arm, Shoulder, and Hand questionnaire (Q-DASH) score, the diametric and volumetric differences between affected and unaffected extremities. Firstly, the serum levels of the 25 (OH)Vit D3 were compared between two groups. After this analysis, it was evaluated the correlations between the measurements in the BCRL group. Demographic data were similar between groups ( P > 0.05). In statistical analysis, it was found that the serum levels of the 25 (OH)Vit D3 were similar between groups ( P : 0.188). Also, 25 (OH)Vit D3 levels were not correlated with VAS, Q-DASH, BMI, the diametric and volumetric differences in BCRL group ( r < 0.3; P > 0.05). 25 (OH) D3 vitamin level seems to be not affect BCRL. In routine clinical practice, this vitamin may not important in BCRL patients.

Effects of physical exercise on breast cancer-related secondary lymphedema: a systematic review.

The aim of this systematic review isto assess the effect of different types of exercise on breast cancer-related lymphedema (BCRL) in order to elucidate the role of exercise in this patient group. A systematic data search was performed using PubMed (December 2016). The review is focused on the rehabilitative aspect of BCRL and undertaken according to the PRISMA statement with Levels of Evidence (LoE) assessed. 11 randomized controlled trials (9 with LoE 1a and 2 with LoE 1b) that included 458 women with breast cancer in aftercare were included. The different types of exercise consisted of aqua lymph training, swimming, resistance exercise, yoga, aerobic, and gravity-resistive exercise. Four of the studies measured a significant reduction in BCRL status based on arm volume and seven studies reported significant subjective improvements. No study showed adverse effects of exercise on BCRL. The evidence indicates that exercise can improve subjective and objective parameters in BCRL patients, with dynamic, moderate, and high-frequency exercise appearing to provide the most positive effects.

An Auto-Adjustable Night Garment to Control Early Rebound Effect of Edema Volume After Intensive Phase of Decongestive Lymphedema Therapy.

Lymphedema of the arm and/or hand is a well-established complication of breast cancer therapy. The objective of the study was to determine the interest of auto-adjustable MOBIDERM® Autofit night arm sleeve in controlling edema rebound effect in breast cancer-related lymphedema patients just after a successful intensive phase of decongestive lymphedema therapy (DLT). This is a subgroup analysis of MARILYN Study, conducted on 40 patients after completion of intensive DLT. Patients were randomized in Night-user group (fitted with MOBIDERM Autofit device) or No night-user group (no night compression). For subgroups analysis, patients were defined as high responders (HR) if their lymphedema volume reduction during DLT was ≥35% or as low responders (LR) if it was below 35%. In HR subgroups (n = 16), the mean lymphedema volume variation between Day 0 and 30 was 28.4 mL in the night-user group versus 181.4 mL in the no night-user group. When adjusted to the loss of volume during DLT, 89% of the DLT benefit is maintained in HR night-user versus 54% in no night-user group. Between LR (24 patients), this mean volume variation was by 65.1 mL versus 54.9 mL in night-user and no night-user groups respectively between Day 0 and 30. Wearing MOBIDERM Autofit, on top of the day time hosiery, appears a promising way to control the early rebound effect during the maintenance phase especially in DLT-HR.

Donor-Site Lymphedema Following Lymph Node Transfer for Breast Cancer-Related Lymphedema: A Systematic Review of the Literature.

A PubMed bibliographic search was performed for published studies evaluating donor-site complications following LNT in BCRL patients. We recorded demographic data of the patients, the type of flap used, the follow-up, the donor-site morbidity, and the diagnostic tests performed pre- and postoperatively. Statistical analysis was conducted to document any correlation between the incidence of DSL and the abovementioned recorded parameters. According to our results, 11 studies met the inclusion criteria. From a total of 189 patients, three cases with DSL of the lower limb were reported (1.6%). No statistically significant correlations were found. ALNT has become increasingly popular and is considered an effective surgical option for treating BCRL of the upper limb. Although the incidence of postoperative DSL is low, insufficient data on patients' demographics, surgical details, and postoperative assessment do not allow extracting significant correlations. Meticulous technique of lymph node harvesting should be seriously considered to further minimize this infrequent but debilitating complication.

Translation and Validation of the Turkish Version of Lymphedema Quality of Life Tool (LYMQOL) in Patients with Breast Cancer Related Lymphedema.

Breast cancer related lymphedema (BCRL) is a drastic situation that affects patients who have undergone breast cancer surgery. The impact of this condition on individuals' quality of life should be investigated in more detail to obtain better treatment results. In total, 65 patients with BCRL participated in this study. Nottingham Health Profile (NHP) was used to evaluate the validity of associated domains in Lymphedema Quality of Life Tool (LYMQoL). Both the LYMQoL and NHP were filled out by BCRL patients. To evaluate its test-retest reliability, the LYMQoL was subsequently performed seven days following its initial application. Measurement properties such as internal consistency, test-retest reliability, criterion validity and factor structure were tested. The internal consistency was assessed via Cronbach's alpha; test-retest reliability was assessed by the intra-class correlation coefficient (ICC). Cronbach's alpha values ranged from 0.74 to 0.91 for the LYMQoL total and domain scores. Test-retest reliability was excellent (ICC=0.92-0.99). When the relation between LYMQoL and NHP was investigated, 'good' to 'very good' correlations were obtained (r=0.539-0.643, p<0.05) for all domains of LYMQoL. Exploratory factor analyses demonstrated a four-factor structure. Turkish version of LYMQoL is a valid and reliable measurement tool to evaluate the quality of life in patients with BCRL.

Frequency of Breast Cancer Surgery Related Arm Lymphedema at King Abdulaziz University Hospital 2008 – 2015, a Tertiary Center Experience, Jeddah, Saudi Arabia

The purpose of this retrospective study was to investigate the frequency of breast cancer-related lymphedema at King Abdulaziz University Hospital and factors associated with it. Eighty-four breast cancer-related lymphedema patients were recruited from Plastic and Reconstruction Surgery Unit, King Abdulaziz University Hospital, Jeddah, Saudi Arabia after breast cancer treatment during the period from 2008 till 2015. According to the circumference difference between healthy and affected arm, lymphedema degree was categorized into mild (&gt; 5-10%), moderate (&gt; 10-15%) and severe (&gt; 15%). From a total of 598 patients who underwent breast cancer resection, 84 (14.05%) patients developed breast cancer-related lymphedema. In out of the 84 patients who developed arm lymphedema, the treatment was mostly modified radical mastectomy and radiotherapy (n = 59, 70.24%); followed by lumpectomy plus axillary lymph node dissection and radiotherapy (n = 18, 21.43%), simple mastectomy (n = 5, 5.95%) and lumpectomy with sentinel lymph node dissection and radiotherapy (n = 2, 2.38%) with statistical significant difference between them (P = 0.0001). The frequency of lymphedema in our institution is 14.05%. It is mostly moderate, appears during the 1st year after surgery in patients who underwent modified radical mastectomy and radiotherapy, aged more than 60 years and obese.

Far infrared ray (FIR) therapy: An effective and oncological safe treatment modality for breast cancer related lymphedema

BackgroundThe incidence of breast cancer related lymphedema is approximately 5%. Far infrared ray (FIR) treatment can potentially reduce fluid volume and extremity circumference as well as the frequency of dermato-lymphangitis (DLA). However, there is no published data on the oncological safety of FIR and the potential for activation of any residual breast cancer cells. The aim of this study is to investigate the safety of far infrared ray (FIR) treatment of postmastectomy lymphedema, clinically and in vitro. MethodsPatients who underwent mastectomy more than 5years ago complicated by upper extremity lymphedema for more than 1year were included. The enrolled patients were divided into an FIR treatment group and a control group (conservative treatment using bandage compression). Outcome measures included tumor markers (CA153, CA125), ultrasonography of relevant structures and monitoring for adverse reactions 1year after treatment. For the in vitro part of the study, the effects of FIR on human breast adenocarcinoma cell lines (MCF7, MDA-MB231) compared to the effects of FIR on human dermal fibroblasts as a control were considered. The viability, proliferation, cell cycle and apoptotic statistics of the adenocarcinoma and human dermal fibroblast cell lines were analyzed and compared. ResultsResults demonstrated that after treatment with FIR, tumor marker (CA153, CA125) concentrations in both the FIR and control groups were not elevated. There was no statistically significant difference between FIR and control group marker expression (p>0.05). Furthermore, no patients were diagnosed with lymphadenectasis or newly enlarged lymph nodes in these two groups. Importantly, there were no adverse events in either group. The in vitro experiment indicated that FIR radiation does not affect viability, proliferation, cell cycle and apoptosis of fibroblasts, MCF-7 and MDA-MB-231 cells. ConclusionsFIR should be considered as feasible and safe for the treatment of breast cancer related lymphedema patients 5years after mastectomy. FIR does not promote recurrence or metastasis of breast cancer and is a well-tolerated therapy with no adverse reactions.

Nighttime Bandaging to Reduce Lymphedema Swelling

Multilayer compression bandaging (MLB) for breast cancer-related lymphedema (BCRL) patients may be easier to apply during nighttime sleep. Little is known about the specific effects of nighttime multilayer bandaging (NMLB) alone. In the present study, we examined whether NMLB alone significantly improved the negative symptoms of BCRL such as excessive swelling and an unpleasant feeling. A pre–post study was conducted as a basis for the development of efficient self-care treatment. Eight middle-aged female patients with unilateral upper extremity BCRL voluntarily participated in this study. During the first 2 weeks, the participants were educated and trained in the self-bandaging technique. The participants then wore MLB on the affected extremity for the following seven nights at home from bedtime to the next morning (hereafter referred to as the intervention). We measured the segmental total body water (STBW) volume on the affected upper extremity using bioimpedance spectroscopy and subjective symptoms using a visual analog scale. Each parameter was measured at the beginning and end of the intervention periods. It was found that the STBW volume on the affected upper extremity decreased significantly during intervention. The mean STBW volume reduction was 0.088 L (p = .047, 95% CI [0.001, 0.175] L]). Subjective symptoms related to swelling (i.e., tightness, heaviness, and fullness) decreased significantly during intervention (p < .05). In conclusion, decrease in the STBW volume and subjective symptoms on the affected upper extremity were observed at the end of the intervention. These results suggest that NMLB reduces both swelling and swelling-related symptoms of BCRL.

Effects of Scapular Stabilizing Exercise on Resting Scapular Position of Breast Cancer-related Lymphedema Patients

PURPOSE: The purpose of this study was to confirm the effect of exercise combined with scapular stabilizing on resting scapular position (RSP) in breast cancer-related lymphedema patients. METHODS: A total of 20 patients with lymphedema after mastectomy participated in the study. All assessments of the patients edema sides (ES) and non-edema sides (NES) were evaluated. The assessment tools used wad RSP. RSP are; 1) scapular index, 2) 8th thoracic spines process (T8S) to inferior angle of scapular (IA) distance, 3) standing pectoralis minor (PM) distance, and 4) PM index (PMI). All patients carried out a scapular stabilizing exercise seven times a week for 8 weeks. The collected data were analyzed with PASW 18.0. The statistical significance () was 0.05. RESULTS: According to the results, all the variable between the ES and NES for RSP were statistically significant (p

PT726. Effect of group rehabilitation program on cardiopulmonary function, quality of life in breast cancer related lymphedema patients

PT726. Effect of group rehabilitation program on cardiopulmonary function, quality of life in breast cancer related lymphedema patients

Comparison of effectiveness between complex decongestive therapy and stellate ganglion block in breast cancer related lymphedema patients: A prospective randomized study.

e21619Background: The aim of this study was to compare the effectiveness between the stellate ganglion block (SGB) and complex decongestive therapy (CDT) in patients with breast cancer related lymp...

Dermal Structure in Lymphedema Patients with History of Acute Dermatolymphangioadenitis Evaluated by Histogram Analysis of Ultrasonography Findings: A Case-Control Study.

Acute dermatolymphangioadenitis (ADLA) is a risk factor for increasing of edema and worsening severity. Reducing ADLA frequency is an important objective of lymphedema management because ADLA episodes are strongly associated with poor quality of life. Lymphedema changes dermal and subcutaneous structure, favoring ADLA; ADLA recurrence may be caused by structural change of the dermis. However, the structure of the skin following ADLA episodes has not been studied in depth. The aim of this study was to examine changes in the skin after episodes of ADLA in breast cancer-related lymphedema (BCRL) using histogram analysis of ultrasonography findings. This was a case-control study with matching for the duration of lymphedema. We compared 10 limbs (5 BCRL patients, Cases) with a history of ADLA and 14 limbs (7 BCRL patients, Controls) without. Ultrasonography was performed using a 20-MHz probe, and measurements were made at a site 10 cm proximal to the ulnar styloid process. We compared "skewness" of the images in the dermis from the histogram analysis. This study was approved by the Ethics Committee of Kanazawa University. Skewness was significantly different between the affected and unaffected limbs (p = 0.02). Cases showed a positive value (median 0.74, range -0.18 to 1.26), whereas Controls showed a negative value (median -0.21, range -0.45 to 0.31). Episodes of ADLA changed the distribution of echogenicity on imaging, which indicates a change in the collagen fibers in the dermis. These findings might contribute to improving the management of lymphedema and prevention of recurrent ADLA.

A randomized control study of treating secondary stage II breast cancer-related lymphoedema with free lymph node transfer.

Microsurgical techniques are increasingly used for treating severe lymphoedema cases. The purpose of this study was to evaluate the effectiveness of free vascularized lymph node transfer (LNT) in stage II breast cancer-related lymphoedema patients in comparison with non-surgical management. During the last 3 years, 83 female patients were examined at our lymphoedema clinic. Finally, 36 cases were included in this study and randomly divided in two groups: group A patients (n = 18, mean age 47 years) underwent microsurgical LNT; followed by 6 months of physiotherapy and compression, while group B patients (n = 18, mean age 49 years) were managed by physiotherapy and compression alone for 6 months. Patients of both groups removed their elastic garments after 6 months and were re-examined 1 year later. All the 36 patients had detailed evaluation of the affected extremity including limb volume measurement, infection episodes and scale scoring of pain, feeling of heaviness and functional status both at baseline and 18 month. Limb volume reduction was observed in both groups; mean reduction was greater in group A (57 %) than in group B (18 %). Infection episodes in group A were significantly reduced compared to those in group B patients. All group A patients reported painless and feeling of heaviness-free extremities with overall functional improvement, while the corresponding changes in group B patients were no more than marginal. Moreover, the LNT procedure was estimated as cost effective compared to conservative treatment alone. LNT represents an effective therapeutic approach for stage II lymphoedema patients; it significantly reduces limb volume, decreases recurrent infections and improves the overall function.

Yoga protocol for treatment of breast cancer-related lymphedema.

Introduction:Vaqas and Ryan (2003) advocated yoga and breathing exercises for lymphedema. Narahari et al. (2007) developed an integrative medicine protocol for lower-limb lymphedema using yoga. Studies have hypothesized that yoga plays a similar role as that of central manual lymph drainage of Foldi's technique. This study explains how we have used yoga and breathing as a self-care intervention for breast cancer-related lymphedema (BCRL).Methods:The study outcome was to create a yoga protocol for BCRL. Selection of yoga was based on the actions of muscles on joints, anatomical areas associated with different groups of lymph nodes, stretching of skin, and method of breathing in each yoga. The protocol was piloted in eight BCRL patients, observed its difficulties by interacting with patients. A literature search was conducted in PubMed and Cochrane library to identify the yoga protocols for BCRL.Results:Twenty yoga and 5 breathing exercises were adopted. They have slow, methodical joint movements which helped patients to tolerate pain. Breathing was long and diaphragmatic. Flexion of joints was coordinated with exhalation and extension with inhalation. Alternate yoga was introduced to facilitate patients to perform complex movements. Yoga's joint movements, initial positions, and mode of breathing were compared to two other protocols. The volume reduced from 2.4 to 1.2 L in eight patients after continuous practice of yoga and compression at home for 3 months. There was improvement in the range of movement and intensity of pain.Discussion:Yoga exercises were selected on the basis of their role in chest expansion, maximizing range of movements: flexion of large muscles, maximum stretch of skin, and thus part-by-part lymph drainage from center and periphery. This protocol addressed functional, volume, and movement issues of BCRL and was found to be superior to other BCRL yoga protocols. However, this protocol needs to be tested in centers routinely managing BCRL.

Sympathetic Block as a New Treatment for Lymphedema

Background: Breast cancer-related lymphedema (BCRL) not only has physical implications, but also affects the quality of life in breast cancer survivors. Despite numerous studies of various therapies, the optimal treatment for BCRL is unknown. Objective: In this study, we investigated the efficacy of sympathetic blockade (thoracic sympathetic ganglion block, [TSGB]) in treating BCRL. Study Design: Retrospective study. Setting: Tertiary referral center/teaching hospital. Methods: TSGB was performed in 35 patients under fluoroscopic guidance. First, arm circumference and Lymphedema and Breast Cancer Questionnaire [LBCQ] score were assessed before TSGB and 2 weeks and 2 months after the procedure. Efficacy was defined as a ≥ 50% reduction in the LBCQ score and a ≥ 50% decrease in the circumference difference between the unaffected and affected arms 2 months after TSGB. Second, TSGB efficacy according to the lymphedema stage and the period between BCRL onset and TSGB (&lt; 6 months vs. &gt; 6 months) was evaluated. Results: The arm circumference and LBCQ score significantly decreased at 2 months (P &lt; 0.001), and 65.7% of patients showed good efficacy. Patients with high stage lymphedema showed improved efficacy after TSGB compared to those with low stage disease (P = 0.045). The TSGB efficacy did not differ according to the period between BCRL onset and TSGB. Limitations: This study was not a randomized prospective controlled study and did not compare the therapeutic outcomes to those in a conservative treatment group. Conclusions: TSGB in BCRL patients appears to be effective in decreasing the affected arm circumference. TSGB may be an alternative option in BCRL patients who do not respond to conservative therapy. Key words: Breast cancer, lymphedema, thoracic sympathetic ganglion block, quality of life

A comparison of the effectiveness of complex decongestive physiotherapy and stellate ganglion block with triamcinolone administration in breast cancer-related lymphedema patients.

This study aims to investigate the comparison of effectiveness between stellate ganglion block (SGB) and complex decongestive physiotherapy (CDT) in breast cancer-related lymphedema (BCRL) patients. The study is a retrospective matched cohort study. A total of 60 subjects who had secondary lymphedema after breast cancer treatments were included in this study. Thirty subjects who had SGB were matched with other 30 subjects treated with CDT, which is the standard therapy for BCRL. The groups were matched for age, duration of lymphedema, type of surgery, and history of lymph node dissection. SGB subjects received SGB three times, once every 2 weeks and CDT subjects were treated for 2 weeks. The circumferences of the forearm and upper arm were used as the outcome variable. These parameters were measured with baseline value before each treatment and repeated the evaluation after the treatments. We investigated the difference of circumferences within each treatment and compared the clinical effect between treatments. Sixty subjects (mean age 58.2 ± 8.7) were treated with CDT and SGB each. There was no significant difference in demographic data including cancer treatment. The mean circumferences of the forearm and upper arm after CDT significantly reduced; forearm from 24.91 to 23.87 cm and upper arm from 30.52 to 29.58 cm (p < 0.001). And the clinical effect of SGB was also significant; forearm from 24.90 to 23.64 cm and upper arm from 30.96 to 29.16 cm (p < 0.001). The differences of the forearm between CDT and SGB was not significant, but the circumference of the upper arm was more reduced after SGB treatment (1.81 ± 1.21 cm) than CDT (0.94 cm ± 0.78 cm) (p < 0.01). SGB is an effective treatment which can reduce the circumference of arm in breast cancer-related lymphedema patients and could be an alternative treatment for lymphedema.

Analysis of factors related to arm weakness in patients with breast cancer-related lymphedema.

The aim of this study was to evaluate the ratio of significant weakness in the affected arm of breast cancer-related lymphedema patients to their unaffected side. Another purpose was to identify factors related to arm weakness and physical function in patients with breast cancer-related lymphedema. Consecutive patients (n = 80) attended a single evaluation session following their outpatient lymphedema clinic visit. Possible independent factors (i.e., lymphedema, pain, psychological, educational, and behavioral) were evaluated. Handgrip strength was used to assess upper extremity muscle strength and the disabilities of arm, shoulder, and hand (DASH) questionnaire was used to assess upper extremity physical function. Multivariate logistic regression was performed using factors that had significant differences between the handgrip weakness and non-weakness groups. Out of the 80 patients with breast cancer-related lymphedema, 29 patients (36.3 %) had significant weakness in the affected arm. Weakness of the arm with lymphedema was not related to lymphedema itself, but was related to the fear of using the affected limb (odds ratio = 1.76, 95 % confidence interval = 1.30-2.37). Fears of using the affected limb and depression significantly contributed to the variance in DASH scores. Appropriate physical and psychological interventions, including providing accurate information and reassurance of physical activity safety, are necessary to prevent arm weakness and physical dysfunction in patients with breast cancer-related lymphedema.

Dynamic Indocyanine Green (ICG) Lymphography for Breast Cancer-Related Arm Lymphedema

Lymph transportation capacity is a critical function maintaining fluid circulation. After breast cancer treatments, lymph obstruction at the axilla leads to abnormal lymph circulation, resulting in lymph pump dysfunction. As well as lymph circulation, lymph pump function is important for lymphedema evaluation. We assessed and analyzed lymph transportation capacity of 15 breast cancer-related arm lymphedema patients using dynamic indocyanine green (ICG) lymphography. ICG velocity and transit time could evaluate lymph pump function; ICG velocity decreases and transit time increases as the lymphedema severity stage progresses. Measurement of ICG velocity required 3 minutes after the dye injection, whereas that of transit time took more than 1 hour in severe cases. ICG velocity can be easily obtained and is recommended for evaluation of lymph pump function. Dynamic ICG lymphography, which evaluates both lymph pump function and circulation, plays an important role in comprehensive assessment of lymphedema pathophysiology.