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Longitudinal, Long-Term Comparison of Single- versus Multipoint Upper Limb Circumference Periodical Measurements as a Tool to Predict Persistent Lymphedema in Women Treated Surgically for Breast Cancer: An Optimized Strategy to Early Diagnose Lymphedema and Avoid Permanent Sequelae in Breast Cancer Survivors

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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Abstract

Purpose

We aim to evaluate whether upper limb (UL) circumference (ULC) and UL swelling sensation (ULSS) performed shortly after surgery or later on during follow-up can predict long-term/persistent forms of lymphedema in women who underwent surgery for breast cancer.

Patients and Methods

Eighty-five women completed at least 24 months of follow-up. At each follow-up visit (1, 3, 6, 12, and 24 months after surgery), patients were tested for lymphedema using ULC and ULSS. Two different approaches to ULC were compared: (1) a “positive” lymphedema diagnosis if a difference ≥ 2 cm between the affected and contralateral UL was detected in at least two contiguous measurement points (MPs) and (2) a “positive” result if just one MP ≥ 2 cm. Patients were also questioned about their perception of weight, swelling, and/or tension (ULSS). The gold standard for long-term lymphedema was a water displacement difference between the UL ≥ 200 mL 24 months after surgery (ULWD).

Results

Twenty-four months after surgery, 19 (22.4%) women were diagnosed with long-term lymphedema. Using 24-month data, comparison of log-likelihoods denoted a clear superiority of the ULC approach 1 compared with 2 for the diagnosis of long-term lymphedema (p < 0.001). Using approach 1, the best prediction of a woman developing long-term lymphedema if she had a positive ULC in the follow-up was obtained at 6 months after surgery (posterior probability of 60%).

Conclusions

Our study reveals that performing ULC 6 months after surgery, regarding as “positive” only women with a difference ≥ 2 cm at two contiguous MPs, is the best strategy to identify women at increased risk of later developing permanent forms of lymphedema.

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Acknowledgments

This study was funded in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior—Brasil (CAPES)—Funding Code 001. Cintia Furlan received a 2-year studentship grant from Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – Brasil (Capes).

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Division of Gynecologic and Breast Oncology, Women’s Hospital (CAISM), State University of Campinas (Unicamp), Campinas , SP, Brazil

    Cintia Furlan PT, PhD, Sophie F. M. Derchain MD, PhD, João Renato Bennini Jr. MD, PhD & Luís Otavio Sarian MD, PhD

  2. Division of Gynecologic and Breast Oncology, Women’s Hospital (CAISM), Unicamp, Campinas, SP, Brazil

    Cintia Furlan PT, PhD, Sophie F. M. Derchain MD, PhD, João Renato Bennini Jr. MD, PhD & Luís Otavio Sarian MD, PhD

  3. Department of Physical Therapy, Einstein Integrated Colleges (FIEL), Limeira, Brazil

    Carolina Nascimben Matheus PT, PhD

  4. Imaging Sector, Women’s Hospital (CAISM), Unicamp, Campinas, SP, Brazil

    Rodrigo Menezes Jales MD, PhD

Authors
  1. Cintia Furlan PT, PhD
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  2. Carolina Nascimben Matheus PT, PhD
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  3. Rodrigo Menezes Jales MD, PhD
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  6. Luís Otavio Sarian MD, PhD
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Correspondence to Luís Otavio Sarian MD, PhD.

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Furlan, C., Matheus, C.N., Jales, R.M. et al. Longitudinal, Long-Term Comparison of Single- versus Multipoint Upper Limb Circumference Periodical Measurements as a Tool to Predict Persistent Lymphedema in Women Treated Surgically for Breast Cancer: An Optimized Strategy to Early Diagnose Lymphedema and Avoid Permanent Sequelae in Breast Cancer Survivors. Ann Surg Oncol 28, 8665–8676 (2021). https://doi.org/10.1245/s10434-021-10290-w

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