Occurrence Of Lymphedema Research Articles

Prospective evaluation of sentinel node navigation surgery in Japanese patients with low-risk endometrial cancer-safety and occurrence of lymphedema.

The present study aimed to clarify the occurrence rate of lymphedema and prognosis in patients with endometrial cancer according to sentinel lymph node biopsy alone with intraoperative histopathological examination. The study included 45 consecutive patients with endometrial cancer treated at Tohoku University Hospital between October 2014 and August 2017. All patients had endometrial carcinoma with endometrioid histology Grade 1 or Grade 2 confirmed by biopsy and stage I on magnetic resonance imaging and/or computed tomography at their preoperative evaluation. Sentinel lymph node detection was performed by radioisotope and dye. Patients who were diagnosed intraoperatively as negative for sentinel lymph node metastasis did not undergo further systematic pelvic lymphadenectomy. The occurrence rate of lymphedema and prognosis was evaluated. Bilateral sentinel lymph nodes were detected in 44 of 45 patients (97%). Forty-three patients underwent sentinel lymph node biopsy alone, and only two patients underwent systematic lymphadenectomy. Sentinel lymph node metastases were detected in one patient intraoperatively and two patients postoperatively as ITCs. No patients experienced recurrence. New symptomatic lower-extremity lymphedema was identified in one of 43 patients (2.3%) who underwent sentinel lymph node biopsy alone. Sentinel lymph node biopsy alone with intraoperative histopathological diagnosis appears to be a safe and effective strategy to detect lymph node metastasis and to reduce the number of patients with lower-extremity lymphedema among patients with endometrial cancer.

Associated risk factors of lower limb lymphedema after treatment of cervical and endometrial cancer.

The scope of the study was to identify the associated risk factors of lower limb lymphedema development in cervical and endometrial cancer patients. We retrospectively analysed 326 patients: 186 cases (57.06%) with cervical cancer and 140 cases (42.94%) with endometrial cancer were treated in Surgery, Radiotherapy, Oncology and Gynaecology Clinics of ‘St. Apostle Andrew’ Emergency Clinical Hospital Galati over 9 years. Adjuvant radiotherapy was performed in 83.57% of endometrial cancer cases. Adjuvant chemotherapy was performed in 45.16% of cervical cancer cases. Over 10 lymph nodes were removed in 74.73% of cervical cancer patients. Incidence of lymphedema was 15.05% in cervical cancer patients and 10% in endometrial cancer patients, P=0.06. Analysed risk factors for lower limb lymphedema occurrence were: Age, disease stage, radiotherapy, number of invaded lymph nodes (for cervical cancer patients), number of removed lymph nodes (for cervical cancer patients) and obesity. Multivariate analysis for associated risk factors of lower limb lymphedema development in cervical cancer showed that number of removed lymph nodes, OR=2.109 (0.907-4.903), P<0.0001, number of lymph nodes with metastasis, OR=1.903 (0.253-4.332), P=0.004 and obesity, OR=1.713 (0.226-2.967), P=0.006 were found as statistically significant risk factors for lower limb lymphedema onset. For endometrial cancer patients, obesity, OR=1.518 (0.721-2.75), P=0.0003, was the only associated risk factor with statistical significance for the lower limb lymphedema development. Lower limb lymphedema represents one of the adverse reactions of multimodal treatment in gynaecological cancers which affects patient's quality of life. Lower limb lymphedema occurrence is related with number of risk factors, the most important being removed lymph nodes, obesity and radiotherapy.

Using the axillary reverse mapping technique to screen breast cancer patients with a high risk of lymphedema

BackgroundPreventing breast cancer-related lymphedema (BCRL) by preserving upper lymphatic drainage is still controversial. Our study aimed to use the axillary reverse mapping (ARM) technique in patients who underwent axillary surgery to analyse the correlation between postoperative residual ARM nodes and the occurrence of lymphedema, select candidates at high risk of developing lymphedema, and analyse the oncologic safety of ARM nodes.MethodsPatients undergoing sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND) from October 2015 to February 2016 at the Peking University People’s Hospital Breast Center were prospectively recruited for the study. ARM was performed in all patients before surgery. ARM nodes were separated from SLNB and ALND specimens. Data were collected on the identification of ARM nodes before surgery, number of residual ARM nodes after surgery, nodal status, crossover rate, and correlation between residual ARM nodes and the occurrence of lymphedema.ResultsThe analysis included 78 patients. Of the 53 patients who underwent SLNB, crossover between ARM nodes and breast sentinel lymph nodes (SLNs) was seen in 22 specimens. The incidence of ARM node metastasis was 1.89% (1/53) and 25% (9/36) in the SLNB and ALND groups, respectively. The number of positive axillary lymph nodes was associated with the involvement of ARM nodes (P = 0.036). The incidence of residual ARM nodes was significantly higher in the SLNB group than in the ALND group (67.6% vs. 37.9%, P = 0.016). The incidence of lymphedema was significantly higher in the ALND group than in the SLNB group (33.3% vs. 5.4%, P = 0.003).ConclusionsFor SLNB, the ARM technique can help to resect SLNs more accurately. However, we do not recommend using the ARM technique to preserve ARM nodes in patients undergoing ALND due to oncologic safety issues. Nevertheless, we can predict patients undergoing axillary surgery who are more likely to have a high risk of lymphedema by assessing residual ARM nodes.Trial registrationThis study was registered on ClinicalTrials.gov in February 2016.The clinical trial registration number is NCT02691624.

Abstract 65: Immediate Lymphatic Reconstruction After Axillary Lymphadenectomy Makes A Difference: A Two Year Comparative Analysis

Purpose: Axillary lymph node dissection (ALND) in the treatment of breast cancer increases the risk of iatrogenic lymphedema. Current rates after ALND range from 11-30%. We hypothesize that our lymphedema prevention surgical (LPS) paradigm, ALND with axillary reverse mapping (ARM) and lymphatico-venous bypass (LVB), lowers the risk of lymphedema. Here, we present findings from a case control study from patients undergoing this procedure. Methods: A review of our prospectively maintained lymphedema surgical registry was performed. Ninety-six consecutive patients with complete ALND underwent LPS at our institution from 9/2016-10/2019. A control group was selected consisting of 92 patients who underwent ALND without LPS in a concurrent time interval from 9/2016-11/2017 to prevent surgical technique or learning curve bias. Patients were followed for both signs and symptoms of lymphedema throughout the post treatment interval and underwent serial assessments for lymphedema via standardized arm circumference measurements by a certified lymphedema therapist. Lymphedema was defined as more than a 10% difference in volume between upper limbs in conjunction with characteristic symptoms and signs. Demographic, procedural and oncologic data was compared between groups. Results: Lymphedema occurrence rates were significantly different between control and treatment groups during the followup period (16.3% non-LPS vs. 5.3% LPS, p=0.006). Of the 15 non-LPS patients who developed lymphedema, 14 received PMRT and 5 had neoadjuvant chemotherapy. Five LPS patients acquired lymphedema, two had PMRT and all five underwent neoadjuvant chemotherapy. Clinical staging differed with a higher proportion of advanced nodal stage in LPS patient group. The mean lymph nodes removed per case was slightly higher in the LPS group (14.4 vs. 11.2). Rates of post mastectomy radiation therapy (PMRT) were similar (77% to 89%, respectively), but neoadjuvant chemotherapy rates were lower in non-LPS patients (43% vs 74%). The follow-up time was 15.3 months for the LPS group and 31.3 months for the non-LPS group. Following reverse mapping in LPS, an average of 2.1 blue transected lymphatics were identified per case. An average of 0.1 blue lymphatic vessels was left in continuity per case and 1.6 vessel anastomoses performed per case with intussusception being performed more frequently than end to end technique (55% vs 44%). Conclusion: In one of the largest controlled studies in this topic to date, our findings support that optimizing lymphatic preservation and restoring antegrade lymphatic flow with LPS significantly decreases short term lymphedema rates in patients undergoing axillary lymphadenectomy for breast cancer.

Diagnostic Significance of Fibrin Degradation Products and D-Dimer in Patients With Breast Cancer-Related Lymphedema.

ObjectiveTo find out whether levels of fibrin degradation products (FDP) and D-dimer are increased in breast cancer-related lymphedema (BCRL) as in many vascular diseases. FDP and D-dimer have been used in blood tests to help differentiate deep vein thrombosis in the diagnosis of lymphedema. Levels of FDP and D-dimer are often elevated in patients with BCRL.MethodsPatients with BCRL (group I), non-lymphedema after breast cancer treatment (group II), and deep venous thrombosis (group III) from January 2012 to December 2016 were enrolled. Levels of FDP and D-dimer were measured in all groups and compared among groups.ResultsMean values of FDP and D-dimer of group I were 5.614±12.387 and 1.179±2.408 μg/μL, respectively. These were significantly higher than their upper normal limits set in our institution. Levels of FDP or D-dimer were not significantly different between group I and group II. However, values of FDP and D-dimer in group III were significantly higher than those in group I.ConclusionValues of FDP and D-dimer were much higher in patients with thrombotic disease than those in patients with lymphedema. Thus, FDP and D-dimer can be used to differentiate between DVT and lymphedema. However, elevated levels of FDP or D-dimer cannot indicate the occurrence of lymphedema.

Abstract P4-10-16: Neoadjuvant chemotherapy infusion in the arm ipsilateral to breast cancer increases the risk of lymphedema

Abstract Background: Neoadjuvant chemotherapy (NAC) has been administered to clinically axillary positive breast cancer (BC) patients. Current guidelines still recommend axillary lymphadenectomy (AL) in patients with persistent positive axillary lymph node disease. We aimed to evaluate the association of NAC and/or adjuvant chemotherapy (CT) infusion in the ipsilateral upper limb (IA) with AL and the occurrence of lymphedema (LE) secondary to BC treatment. Methods: A prospective cohort study of 683 women subjected to AL and treated with NAC and/or adjuvant CT for BC. The patients were evaluated before treatment, immediate and every 6 months after surgery. Cumulative incidence and population attributable risks of LE were calculated. Results: 8-year cumulative incidence of LE was 33.1%. NAC and CT infusion and infusion of &amp;gt;2 cycles into the IA respectively increased by 1.68, 1.67 and 1.78 times the risk of LE respectively (all P&amp;lt;0.01). LE could be avoided in 9.4% of cases if the CT infusion had not been administered in the IA. Conclusions: 33.1% of women developed LE. The risk of LE was increased among women who received CT in the IA. Avoidance of NAC or adjuvant CT in the IA could prevent 9% of the LE cases observed in this population. Citation Format: Bergmann A, Bello MA, Thuker LC, Andrade MF, Bevilacqua JI. Neoadjuvant chemotherapy infusion in the arm ipsilateral to breast cancer increases the risk of lymphedema [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-10-16.

Abstract ES11-2: Current status of diagnosis, monitoring, and non-surgical management of lymphedema

Abstract Lymphedema (LE) is a common but underreported complication of breast cancer treatment since most studies lack baseline and follow-up measurements or follow-up that is long enough to adequately record true incidence. Contemporary prospective randomized trials continue to document the occurrence of lymphedema after any axillary treatment and note that combination therapy with axillary surgery and radiation nearly doubles LE risk. Over the last 5 years clinicians have witnessed a paradigm shift in the diagnostic practices of LE with concerted efforts focusing on early detection as opposed to reactionary interventions. Controversy however has existed over how to define and diagnose LE and as such the literature surrounding diagnosis is heterogeneous with respect to incidence and recommendations. Existing guidelines emphasize the need for routine monitoring for LE and the critical importance of baseline, bilateral, and longitudinal limb assessments but do not embrace one measurement technique. A growing body of prospective observational data is systematically challenging the value of precautionary behaviors. Further, prospective randomized data demonstrates exercise does not promote the development of LE. Complex decongestive therapy remains the cornerstone of non-surgical LE treatment. With the NCI predicting over 4 million breast cancer survivors in the US by 2024, lymphedema is potentially a significant public health burden. Citation Format: McLaughlin S. Current status of diagnosis, monitoring, and non-surgical management of lymphedema [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr ES11-2.

Risk Factors for Lymphedema in Breast Cancer Survivors Following Axillary Lymph Node Dissection.

The aim of the current study was to assess the risk factors for developing lymphedema following breast cancer treatment. The subjects of this study were 238 consecutive patients who underwent axillary lymph node dissection for breast cancer at Shikoku Cancer Center. The study variables were the occurrence of lymphedema, the body mass index, the follow-up period, the drain removal time, the level of lymph node dissection, the presence or absence of co-resident household members, radiation therapy, neoadjuvant chemotherapy, and adjuvant chemotherapy. We observed lymphedema in 23.9% of patients after axillary lymph node dissection for breast cancer. Neoadjuvant chemotherapy and adjuvant chemotherapy using docetaxel and cyclophosphamide increased the risk of developing lymphedema (P <0.05). Those patients treated with neoadjuvant chemotherapy and adjuvant chemotherapy using docetaxel and cyclophosphamide should be observed closely after axillary lymph node dissection, and appropriate intervention should be considered from an early stage.

Efek Latihan Fisik Berkelanjutan Pada Pasien Pasca Mastektomi Radikal Modifikasi Terhadap Kejadian Limfedema dan Keterbatasan Gerak Sendi Bahu

Aim: Determine the effects of continual physical exercise on lymphedema and limitations of Range of Motion (ROM) of shoulder joint events in post-Modified Radical Mastectomy (MRM) patients. Methods: The Pretest-Posttest Control Group Design study with inclusion criteria are women aged d”60 years and BMI d”30 kg/m2 with a diagnosis of breast cancer post MRM. The control group received physical exercise during hospitalization and the treatment group received continual physical training until 16 weeks. This study using chi-square and Kolmogorov-Smirnov test for statistical analyzing.Results: Study was carried out on 24 subjects. There were no lymphedema and limitations of shoulder ROM in the group who receive continual physical exercise, but it is not statistically significant difference between groups (p > 0,05).Conclusion: This study shows that continual physical exercise could prevent the occurrence of lymphedema and limited ROM of shoulder joint in post MRM patients.

Risk factors for postoperative lymphedema in breast cancer patients

Objective To investigate the risk factors of lymphedema in patients with breast cancer after operation. Methods From January 2012 to May 2016, the clinical data of 350 patients with breast cancer who underwent surgical treatment in First People′s Hospital of Foshan were collected. According to the occurrence of postoperative lymphedema, the patients were divided into lymphedema group (87 cases) and non lymphedema group (263 cases). The possible risk factors were evaluated from general demographic indicators, pathological data of breast cancer, perioperative related data and preventive action implementation. Results General demographic data: there was no correlation between the incidence of lymphedema and age, preoperative body mass index (BMI), postoperative BMI, educational level, marital status, residence, family income, menopause, hypertension history (P>0.05). Pathological data of breast cancer: the occurrence of lymphe-dema was related with tumor quadrant (χ2=20.039, P 0.05). Comparison of preventive behaviors: avoiding injuries such as cuts and bites (χ2=15.754, P 0.05). Lymphedema as the dependent variable, multivariate logistic regression analysis results showed that tumor located in the upper outer quadrant (OR=3.943, P<0.001), surgical incision for longitudinal incision (OR=3.767, P<0.001) or oblique incision (OR=2.492, P<0.001), Ⅱ (OR=1.707, P=0.003) or Ⅲ (OR=4.211, P<0.001) axillary lymph node dissection, breast/chest wall radiotherapy (OR=2.869, P<0.001) or lymph node radiotherapy (OR=4.829, P<0.001), grabing heavy objects or not (OR=3.264, P<0.001), avoiding injuries such as cuts and bites (OR=2.602, P<0.001) were independent risk in-fluence factors of postoperative lymphedema. Conclusion A variety of factors affect the occurrence of posto-perative lymphedema in breast cancer patients. Tumors located in the upper outer quadrant, longitudinal or oblique incision, high level of axillary lymph node dissection, radiotherapy, having injuries such as cuts and bites, grabing heavy objects are independent risk influence factors of postoperative lymphedema in breast cancer patients. More attention should be paid to the high risk of lymphedema, and the preventive measures should be taken actively. Key words: Breast neoplasms; Lymphedema; Risk factors

Abstract: Comparing Outcomes Between Vascularized Lymph Node Transfer and Lymphovenous Anastomosis in the Treatment of Primary Lymphedema

INTRODUCTION: Primary lymphedema is a devastating and debilitating disease. Much of the current treatment options demonstrate evidence in the treatment of secondary lymphedema. This study was to investigate the outcomes between vascularized lymph node transfers (VLNT) and lymphovenous anastomosis (LVA) in the treatment of primary lymphedema. METHODS: A total of 17 patients with a mean age of 31 (ranged 2- 57) years were recruited to the study with a total of 19 lower limbs with primary lymphedema. All patients reported a non-hereditary, occurrence of lymphedema without surgical and medical history. All patients were treated with either VLNT or LVA. Patients with a grade 1 or early grade 2 lymphedema were treated with LVA whereas late grade 2 to grade 4 patients received VLNT treatment. Quality of life and serial circumferential limb measurements including number of episodes of cellulitis were compared both pre and postoperatively. RESULTS: Fifteen limbs underwent VLNTs and had an average of 3.8 cm circumferential reduction above knee, 3.6 cm below knee and 4 cm above ankle with an average reduction of 3.7 cm. Four limbs received LVA treatment and had an average of 1.3 cm circumferential reduction AK, 3.0 cm BK and 1.5 cm AA, giving an average reduction of 1.9 cm. Follow-up was for an average of 19.7 ± 8.5 months. Patients in the VLNT group had an average cellulitis episode drop from 5.2 preoperatively to 0.1 postoperatively. Patients in the LVA group reported an average reduction in cellulitic episodes from 5 preoperatively to 0.8 postoperatively. In the VLNT group, an average significant improvement in overall quality of life was noted by 2.5 points. In the LVA group, an average improvement in the overall quality of life score was seen by 2 points. CONCLUSION: In conclusion, primary lymphedema can be effectively treated adequately with improvements in both functional and quality of life outcomes with appropriate lymphedema microsurgeries. VLNT when used in severe cases of lymphedema, can provide greater relief with more impactful outcomes in both functional restoration and quality of life outcomes.

Lymphedema in women undergoing breast cancer surgery

Objective: to estimate the prevalence and to identify possible factors associated with the occurrence of lymphedema in women undergoing treatment for breast cancer. Methods: a prevalence study with 125 women. An interview and a consultation of the medical record were carried out using a questionnaire. Univariate and multivariate analysis were performed through logistic regression. Results: a prevalence rate of 34.4% was found. Obesity, sentinel lymph node biopsy, radiotherapy, and the presence of some treatment complications were statistically significant for the occurrence of lymphedema. Conclusion: the prevalence of lymphedema in this study was high. The variables positively related to lymphedema, considered as associated factors, were: obesity, sentinel lymph node biopsy, radiotherapy and some treatment related complications (adhesion,retraction, paraesthesia, seroma, fibrosis, infection and dehiscence).

Qualitative research on risk factors of lymphedema for patients with breast cancer

Objective To deeply understand the risk factors of lymphedema for patients with breast cancer after surgery. Methods The phenomenological method was applied in this study. Semi-structured interview was used to collected data from 9 female breast cancer patients with lymphedema after surgery in our hospital from June to September 2016 for generic analysis. Results The risk factors of lymphedema could be categorized into four themes: (1)choice of treatment is the primary cause: axillary lymph node dissection; radiotherapy; chemotherapy; (2)not paying enough attention to lymphedema: lacking the knowledge of lymphedema; imbalance of physical activities for the affected limb; lacking awareness of exercise and protection of the affected limb. Conclusions Axillary lymph node dissection after radical surgery for patients with breast cancer is the primary cause of lymphedema, and paying not enough attention is an important factor, especially lacking the consciousness of prevention, so the nurses should emphasize education about prevention of lymphedema after surgery for patients, to improve the consciousness of them to reduce the occurrence of lymphedema and its influence on their quality of life. Key words: Breast neoplasms; Lymphedema; Risk factors; qualitative research

Risk Factors Affecting Breast Cancer-related Lymphedema: Serial Body Weight Change During Neoadjuvant Anthracycline Plus Cyclophosphamide Followed by Taxane

IntroductionThe aim of our study was to analyze the risk of lymphedema (LE) according to the clinicopathologic factors and to investigate the serial change in body weight during neoadjuvant anthracycline plus cyclophosphamide followed by taxane and its correlation with the incidence of LE. Patients and MethodsWe performed a retrospective 2-center study of 406 patients who had undergone neoadjuvant chemotherapy (NAC) followed by surgery from 2007 to 2014. The regimen included 4 cycles of anthracycline plus cyclophosphamide, followed by 4 cycles of taxane. We investigated the presence and degree of LE using a telephone questionnaire assessment. Weight changes were calculated at each cycle of NAC, and the baseline and preoperative body weights were used to calculate the rate of change to account for the change in weight before and after NAC. ResultsOf the 406 patients, 270 answered the questionnaires, of whom 97 (35.9%) experienced LE. The increase in body weight was significant during the 4 cycles of taxane, but the change in weight was not significant during the 4 cycles of anthracycline plus cyclophosphamide. The change in body weight was most significant just after the fourth cycle of taxane (P < .001). The body mass index (BMI) was an independent factor of LE occurrence on multivariate analysis. However, the change in body weight was not a significant factor for the incidence of LE. ConclusionBecause a BMI ≥ 25 kg/m2 was an independent factor of LE occurrence on multivariate analysis, patients with a preoperative BMI ≥ 25 kg/m2 should be closely monitored for LE given their increased risk, and monitoring and education should be initiated before surgery and continued throughout the course of NAC.

Breast reconstruction and risk of lymphedema after mastectomy: A prospective cohort study with 10 years of follow-up

The aim of this study is to assess the incidence and risk factors for lymphedema in women submitted to mastectomy, with or without breast reconstruction. A cohort study was performed on women submitted to mastectomy with axillary lymphadenectomy in a single center. The follow-up included clinical evaluation and arm column measurements before surgery, at 30 days, 6 months, 5 years, and 10 years after surgery. For women subjected to late reconstruction, the time of occurrence of lymphedema (before or after reconstruction) was observed. We followed up on 622 patients submitted to mastectomy and axillary lymphadenectomy for an average period of 57 months after surgery. In total, 94 women were submitted to breast reconstruction, 47 (8%) of them immediate and 47 (8%) late reconstructions. Incidence of lymphedema in the whole group was 33% (n=204). Among the patients submitted to reconstruction, 28% of them developed lymphedema, on average, 93 months (CI 95%, 88-98) after surgical treatment. In women not subjected to reconstruction, 179 (34%) developed lymphedema, on average, after 106 months (CI 95%, 96-116) (p=0.03). Breast reconstruction reduced lymphedema risk in 36% (HR=0.64, CI 96%, 0.42-0.98, p=0.04). After adjustment for pathological staging and radiotherapy, this was not statistically significant (HR=0.79, CI 95%, 0.52-1.21, p=0.28). Breast reconstruction does not increase the risk of lymphedema in long-term follow-up.

Abstract P2-12-02: Axillary reverse mapping: A feasibility study

Abstract Background The mainstay of the therapy in breast cancer has been mastectomy or wide local excision along with axillary lymph node dissection (ALND). There are a lot of adverse effects associated with ALND, lymphedema being the most devastating. Sentinel lymph node biopsy (SLNB) can identify women who may or may not need axillary dissection and translate into a smaller number of patients undergoing axillary dissection. However, patients having positive lymph node on SLNB will still have to undergo ALND. To reduce the occurrence of lymphedema and its associated complications the technique of Axillary Reverse Mapping (ARM) has been developed. It is based on the hypothesis that the lymphatic pathway of the arm is not involved by the metastasis of the breast primary and after accurately identifying and preserving the arm lymphatics, there would be risk of neither lymphedema, nor leaving behind metastatic cells in the lymph nodes. This prospective study was carried out to evaluate the feasibility of ARM in patients undergoing ALND. Methods This prospective study was carried out in the Department of General Surgery, PGIMER, from July 2010 to Dec 2011. There were seventy five Biopsy/FNAC confirmed breast cancer female patients between 18 to 75 years. All patients were undergoing ALND as part of their treatment. Patients with any prior surgical treatment for primary invasive breast cancer, bilateral breast cancer and metastatic breast disease were excluded. Patients with heart diseases, active or uncontrolled infection, dementia, altered mental status or any psychiatric condition, pregnant or lactating women and with known allergies to blue dye were also excluded. All patients were treated as per the standard treatment for stage. All ALNDs were performed by a single surgeon. ARM was performed in all the patients by giving 5 ml of Isosulfan Blue Dye (Sterlized 1% solution) in the upper inner arm of the involved site approximately 60 minutes before exposure. Results The results were analyzed clinically during surgery and post-operatively by histo-pathological examination of lymphnodes. Intra-operatively, the identification of lymphnodes and lymphathics were noted in 17(22.7%) and 33 patients(44%) respectively. In none of the patient any attempt was made to preserve the blue nodes and all the lymph nodes were resected and sent for histopathological examination. In only 2 of 17 patients (11.76%) the lymph node was positive for malignant tumour cells. The tumour burden in both these patients was very high (more than 10 nodes involved). No association was found in the identification rates of ARM nodes and lymphatics to age, BMI, size of tumour, site of tumour, pathological status of axilla and timing of dye. Conclusion The identification rate of ARM lymphatics and nodes is low when only blue dye is used. The method appears it to be oncologically safe in patients with low tumour burden. However there is need for further studies will before this procedure can be universally applied without compromising the oncologic safety. Once the technique is proven to be oncologically safe even in a selected group of patients, a large randomized trial will be needed to give a satisfactory answer whether the problem of lymphedema be eliminated or minimized in the patients in whom arm lymphatics are successfully preserved. Citation Format: Khare S, Singh G, Das A, Bal A. Axillary reverse mapping: A feasibility study. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P2-12-02.

A Prospective Study to Assess the Feasibility of Axillary Reverse Mapping and Evaluate Its Effect on Preventing Lymphedema in Breast Cancer Patients

BackgroundThe axillary reverse mapping (ARM) procedure can distinguish lymphatics draining the arm from those draining the breast. It has been proposed to preserve lymphatic drainage of the upper limbs and reduce the incidence of upper limb lymphedema during breast cancer surgery. The aim of our study was to assess the feasibility of ARM in modified radical mastectomy and to evaluate its effect on prevention of lymphedema. Patients and MethodsFrom January 2012 to March 2014, a prospective study was performed in 265 breast cancer patients who underwent modified radical mastectomy. Patients were divided into 2 groups, 127 patients (47.93%, control group) received a traditional axillary lymph node dissection (ALND), and 138 patients (52.07%, experimental group) received ARM preservation of the nodes and lymphatics during ALND. Radioactive tracer and methylene blue were used for ARM of the nodes and lymphatics. All of the identified ARM nodes were diagnosed using fine needle aspiration cytology for assessment of metastatic status. All resected axillary lymph nodes were conducted in a pathology examination to evaluate tumor metastasis. Data were collected on variations in identification of the ARM nodes and lymphatics, the metastasis of ARM nodes, and the occurrence of lymphedema. ResultsIn the experimental group, the ARM procedure was successfully conducted in 129 cases (93.48%). ARM nodes metastasis occurred in 11 patients (8.53%). The median follow-up time was 20 months, at the last evaluation there were 42 patients who developed upper limb lymphedema in the control group (33.07%), and in the experimental group the incidence of lymphedema was 5.93% (7/118; P < .001). None of the patients had nodal relapses during the follow-up time. ConclusionARM appears to be a feasible technique with which to identify upper arm nodes and lymphatics during the modified radical mastectomy procedure. The incidence of lymphedema can be decreased in patients with use of the ARM procedure.

Bioelectrical impedance for detecting and monitoring lymphedema in patients with breast cancer. Preliminary results of the florence nightingale breast study group.

The aim of this study was to evaluate the efficacy of bioimpedance spectroscopy for the follow-up of patients with lymphedema in Turkey and its benefits in the diagnosis of stage 0, 1, and 2 lymphedema in patients who are under treatment for breast cancer. Thirty-seven female patients with breast cancer who underwent surgical procedures in our Breast Health Centre were followed up for lymphedema using bioimpedance, and clinical measurements were taken for a minimum period of 1 year at 3-month intervals. Patients who had been monitored regularly between November, 2011, and September, 2013, were enrolled to the study. In total, 8 patients developed lymphedema with an overall rate of 21.6%. Among the 8 patients who developed lymphedema, 4 had Stage 2, 1 had Stage 1, and 3 had Stage 0 lymphedema. Stage 0 lymphedema could not be detected with clinical measurements. During the patients' 1-year follow-up period using measurements of bioimpedance, a statistically significant relationship was observed between the occurrence of lymphedema and the disease characteristics. including the number of the extracted and remaining lymph nodes and the region of radiotherapy (p=0.042, p=0.024, p=0.040). Bioimpedance analysis seems to be a practical and reliable method for the early diagnosis of lymphedema. It is believed that regular monitoring of patients in the high-risk group using bioimpedance analyses increases the ability to treat lymphedema.

The Role of Shoulder Exercise Program in Lymphedema Control Following Breast Cancer Surgery

To evaluate whether shoulder exercise program lowers the occurrence of lymphedema following breast cancer surgery.

Systemic analysis on risk factors for breast cancer related lymphedema.

To evaluate risk factors for upper extremity lymphedema due to breast cancer surgery. Clinical studies published on PubMed, Ovid, EMbase, and Cochrane Library from January 1996 to December 2012 were selected. Twenty-five studies were identified, including 12,104 patients. Six risk factors related to the incidence of lymphedema after breast cancer treatment were detected: axillary lymph node dissection (OR=3.73, 95%CI 1.16 to 11.96), postoperative complications (OR=2.64, 95%CI 1.10 to 6.30), hypertension (OR=1.83, 95%CI 1.38 to 2.42), high body mass index (OR=1.80, 95%CI 1.30 to 2.49), chemotherapy (OR=1.38, 95%CI 1.07 to 1.79) and radiotherapy (OR=1.35, 95%CI 1.10 to 1.66). We found significant protective factors for lymphedema: pathologic T classification (OR=0.57, 95%CI 0.36 to 0.91) and stage (OR=0.60, 95%CI 0.39 to 0.93), while some factors, like age, number of positive lymph nodes, number of lymph node dissection, demonstrated no obvious correlation. Axillary lymph node dissection, postoperative complications, hypertension, body mass index, chemotherapy, radiotherapy are risk factors for lymphedema after breast cancer treatment. Attention should be paid to patients with risk factors to prevent the occurrence of lymphedema.