Materiały źródłowe

• #1 Integrated Treatment of Breast Cancer-related Lymphedema: A Descriptive Review of the State of the Art | Anticancer Research

  https://ar.iiarjournals.org/content/41/7/3233

  Improved survival rates in breast cancer patients contribute to an increased number of survivors complaining of upper limb Breast Cancer-Related Lymphedema (BCRL), which is a secondary lymphedema after surgery and radiation therapy. […] Up to 30% of breast cancer survivors may suffer from BCRL and its physical and psychological consequences such as: pain, pitting edema, upper limb heaviness and discomfort, decreased range of motion of the affected joints, recurrent skin infections and ulcers, elephantiasis, cutaneous angiosarcoma, depression, anxiety, body image-related disorder. Quality of life (QoL) is dramatically worsened by BCRL. […] Early detection and treatment on BCRL may reduce chronic BCRL rates by 50%. […] However, BCRL is considered a chronic disease, and its management aims at disease control, prevention of complications and limb function preservation.

• #2 The Third Circulation: Radionuclide Lymphoscintigraphy in the Evaluation of Lymphedema | Journal of Nuclear Medicine

  https://jnm.snmjournals.org/content/44/1/43

  Lymphedema is a chronic debilitating disease that is frequently misdiagnosed, treated too late, or not treated at all. […] There are, however, effective therapies for lymphedema that can be implemented, particularly after the disorder is properly diagnosed and characterized with lymphoscintigraphy. […] Effective use of lymphoscintigraphy to plan therapy for lymphedema requires an understanding of its pathophysiology and the influence of technical factors such as selection of the radiopharmaceutical, imaging times after injection, and patient activity after injection on the images. […] In a recent study of 19 women undergoing therapy for postmastectomy lymphedema, Szuba et al. found that the degree of impairment of lymphatic function before the treatment correlated with the outcome of manual lymphatic therapy.

• #3 A Scoring System to Predict Arm Lymphedema Risk for Individual Chinese Breast Cancer Patients

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4813652/

  Lymphedema (LE) is recognized as a common complication after axillary lymph node dissection (ALND). […] The purpose of this study was to construct a scoring system for predicting the probability of LE after ALND for Chinese breast cancer patients. […] The probability of LE was predicted according to the total risk scores. The system had good discrimination, with an AUC at 0.877. […] Our scoring system could be a simple and easy tool for physicians to estimate the risk of LE. […] Based on the multivariate analysis, a scoring system was developed to predict individual probability of LE after ALND in breast cancer. […] The discrimination of our scoring system in distinguishing patients with different outcomes was good, with an AUC of 0.877 (95% CI, 0.830-0.924). […] Despite the limitations mentioned above our scoring system could be a simple and easy tool for both the physician and patients to estimate the risk of LE.

• #4 Prediction of lymphedema occurrence in patients with breast cancer using the optimized combination of ensemble learning algorithm and feature selection

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9310496/

  Breast cancer-related lymphedema is one of the most important complications that adversely affect patients’ quality of life. Lymphedema can be managed if its risk factors are known and can be modified. This study aimed to select an appropriate model to predict the risk of lymphedema and determine the factors affecting lymphedema. […] Once the sensitivity and accuracy of the algorithms were evaluated and compared, the Support Vector Machine algorithm showed the highest sensitivity and was found to be the superior model for predicting lymphedema. Meanwhile, the combined method had an accuracy coefficient of 91%. […] Applying a combination of ensemble learning approach with the selected classification algorithms, feature selection, and optimization by Genetic algorithm, Lymphedema can be predicted with appropriate accuracy.

• #5 Prediction of lymphedema occurrence in patients with breast cancer using the optimized combination of ensemble learning algorithm and feature selection | BMC Medical Informatics and Decision Making | Full Text

  https://bmcmedinformdecismak.biomedcentral.com/articles/10.1186/s12911-022-01937-z

  Breast cancer-related lymphedema is one of the most important complications that adversely affect patients’ quality of life. Lymphedema can be managed if its risk factors are known and can be modified. This study aimed to select an appropriate model to predict the risk of lymphedema and determine the factors affecting lymphedema. […] Once the sensitivity and accuracy of the algorithms were evaluated and compared, the Support Vector Machine algorithm showed the highest sensitivity and was found to be the superior model for predicting lymphedema. Meanwhile, the combined method had an accuracy coefficient of 91%. […] Applying a combination of ensemble learning approach with the selected classification algorithms, feature selection, and optimization by Genetic algorithm, Lymphedema can be predicted with appropriate accuracy. Developing applications by effective variables to determine the risk of lymphedema can help lymphedema clinics choose the proper preventive and therapeutic method.

• #6 Prediction of lymphedema occurrence in patients with breast cancer using the optimized combination of ensemble learning algorithm and feature selection

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9310496/

  The most influential risk factors of lymphedema included the number of involved lymph nodes to the number of removed lymph nodes ratio (68%), feeling of heaviness (67%), involved limb range of motion (65%), number of removed lymph nodes (64%), receiving radiotherapy (63%), non-alignment of dominant and involved limb (62%), fibrotic tissue (62%), type of surgery (62%), tingling sensation (62%), number of affected lymph nodes (61%), BMI (61%), number of chemotherapy sessions (60%), age (58%), limb injury (53%), chemotherapy regimen (53%), occupation (50%), stage of breast cancer (48%), metastasis (44%), stage of lymphedema (43%), tumor size (40%), receiving chemotherapy (38%) and hormone therapy (34%). […] The proposed ensemble learning with selected algorithms with the optimized feature selection with an accuracy of 91% as the most appropriate model could determine the probability of the risk factors of lymphedema in the Iranian female population.

• #7 Prediction of lymphedema occurrence in patients with breast cancer using the optimized combination of ensemble learning algorithm and feature selection | BMC Medical Informatics and Decision Making | Full Text

  https://bmcmedinformdecismak.biomedcentral.com/articles/10.1186/s12911-022-01937-z

  The most influential risk factors of lymphedema included the number of involved lymph nodes to the number of removed lymph nodes ratio (68%), feeling of heaviness (67%), involved limb range of motion (65%), number of removed lymph nodes (64%), receiving radiotherapy (63%), non-alignment of dominant and involved limb (62%), fibrotic tissue (62%), type of surgery (62%)), tingling sensation (62%), number of affected lymph nodes (61%), BMI (61%), number of chemotherapy sessions (60%), age (58%), limb injury (53%), chemotherapy regimen (53%), occupation (50%), stage of breast cancer (48%), metastasis (44%), stage of lymphedema (43%), tumor size (40%), receiving chemotherapy (38%) and hormone therapy (34%). […] Our study predicted the probability of developing lymphedema with an appropriate accuracy via the combined method of ensemble learning algorithms and optimized feature selection with the Genetic algorithm. […] The proposed ensemble learning with selected algorithms with the optimized feature selection with an accuracy of 91% as the most appropriate model could determine the probability of the risk factors of lymphedema in the Iranian female population.

• #8 Increases in arm volume predict lymphoedema and quality of life deficits after axillary surgery: a prospective cohort study | British Journal of Cancer

  https://www.nature.com/articles/s41416-020-0844-4

  Lymphoedema develops after axillary clearance (ANC) in 25% of patients. […] Predictors of lymphoedema were determined using logistic regression. […] BMI30 was an independent factor for both development and progression of lymphoedema. […] RAVI at 1 month, BMI30 and number of involved nodes contributed to a novel scoring model to predict lymphoedema by 36 months. […] RAVI measurement was the best diagnostic tool for lymphoedema. […] BMI30 predicted lymphoedema diagnosis and progression. […] The incidence of lymphoedema defined by RAVI10% by 24 months was 22.4%, compared with 45.2% using BIS l-Dex10 criterion. […] Arm swelling category by 6 months predicted lymphoedema by 24 months. […] The factors predicting lymphoedema diagnosis after ANC surgery from 1 to 36 months were assessed.

• #9 Increases in arm volume predict lymphoedema and quality of life deficits after axillary surgery: a prospective cohort study | British Journal of Cancer

  https://www.nature.com/articles/s41416-020-0844-4

  A scoring model, ranging from 0 to 5, was produced based on the regression coefficients of the multivariable logistic regression. […] At sleeve application 187 patients had a RAVI20% but despite compression-sleeves application for 22 months, progression to RAVI20% occurred in 29 cases. […] Increasing cancer survival will increase patients at risk of the consequences of their treatments. […] The lack of standardised diagnostic criteria for lymphoedema make estimation of the true incidence of lymphoedema difficult. […] Relative arm volume change is the optimal method for early diagnosis of lymphoedema. […] Compared to either RAVI10% or sleeve application, BIS wrongly diagnosed (false positive) 12% patients with lymphoedema. […] Self-reported symptoms often lead to lymphoedema treatment.

• #10 Utilization of bioelectrical impedance analysis for detection of lymphedema in breast Cancer survivors: a prospective cross sectional study | BMC Cancer | Full Text

  https://bmccancer.biomedcentral.com/articles/10.1186/s12885-019-5840-9

  Our data provides evidence to support that the use of SFBIA ratio can serve as an alternative method to monitor and/or diagnose BCRL. […] The SFBIA ratio obtained using BIA can be an alternative method for monitoring and/or diagnosing BCRL. The BIA had a sensitivity of 63.64% and a specificity of 95.15% in predicting BCRL. In addition, number of dissected lymph nodes, operation site, surgery type, obesity, and the SFBIA ratio are significantly associated with the occurrence of lymphedema.

• #11 Prediction of Treatment Outcome with Bioimpedance Measurements in Breast Cancer Related Lymphedema Patients

  https://www.e-arm.org/journal/view.php?doi=10.5535/arm.2011.35.5.687

  Objective: To investigate the usefulness of bioimpedance measurement for predicting the treatment outcome in breast cancer related lymphedema (BCRL) patients. […] Conclusion: These results show that ECF volume measurements and SFBIA before treatment are useful tools for predicting the outcome of patients with lymphedema. We concluded that ECF volume measure can be used as a screening tool for predicting treatment outcome of BCRL patients. […] The primary object of this study was to investigate whether bioimpedance measurements could help in predicting the treatment outcome in BCRL patients. […] In our present study, we suggest that measurement of bioimpedance can help in predicting treatment outcome by estimating fluid volume of the affected arm in lymphedema patients. However, correlation coefficients of bioimpedance values and clinical data indicate that bioimpedance measure is not very accurate for predicting treatment outcome. This means that while bioimpedance measurements are useful tools for assessing severity and predicting treatment outcome, it is better to interpret the results of bioimpedance measure comparising with evaluation tools, such as arm circumference and volume measure, water displacement method, and lymph scintigraphy.

• #12 Prediction of Treatment Outcome with Bioimpedance Measurements in Breast Cancer Related Lymphedema Patients

  https://www.e-arm.org/journal/view.php?number=55

  Objective: To investigate the usefulness of bioimpedance measurement for predicting the treatment outcome in breast cancer related lymphedema (BCRL) patients. […] Conclusion: These results show that ECF volume measurements and SFBIA before treatment are useful tools for predicting the outcome of patients with lymphedema. We concluded that ECF volume measure can be used as a screening tool for predicting treatment outcome of BCRL patients. […] The primary object of this study was to investigate whether bioimpedance measurements could help in predicting the treatment outcome in BCRL patients. […] We hypothesized that calculating the extent of fluid in upper extremities with lymphedema would predict the treatment outcome of BCRL patients, and we observed a larger arm circumference reduction in patients with more fluid in an upper extremity.

• #13 The Third Circulation: Radionuclide Lymphoscintigraphy in the Evaluation of Lymphedema | Journal of Nuclear Medicine

  https://jnm.snmjournals.org/content/44/1/43

  When postoperative lymphoscintigraphy in patients undergoing axillary dissection during breast cancer surgery demonstrates disruption of lymphatic drainage, the risk that arm lymphedema will develop increases. […] These studies suggest that postoperative lymphoscintigraphy can identify patients with a high risk of development of extremity lymphedema. Early identification of these patients will allow specific implementation of preventive strategies to minimize the risk of lymphedema. […] Lymphatic imaging can play a pivotal role in defining the etiology of extremity swelling and in predicting the success of common therapies.

• #14 Lymphatic and Angiogenic Candidate Genes Predict the Development of Secondary Lymphedema following Breast Cancer Surgery | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0060164

  While the phenotypic characterization of risk for LE following breast cancer treatment warrants additional investigation, recent evidence suggests that some of the variation in the occurrence and time to onset of LE may be related to genomic determinants. These two studies evaluated candidate genes that are known to play a role in lymphatic development or were identified in studies of primary LE which are Mendelian inherited disorders. Taken together, these findings suggest that additional studies are warranted to determine the phenotypic and genotypic factors associated with increased risk for LE following breast cancer treatment. Therefore, the purposes of this study were to evaluate for differences in phenotypic and genotypic characteristics in women who did and did not develop LE following breast cancer treatment.

• #15 Lymphatic and Angiogenic Candidate Genes Predict the Development of Secondary Lymphedema following Breast Cancer Surgery | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0060164

  The only genetic associations that remained significant in the multivariate logistic regression analyses were for FOXC2 haplotype A03, LCP2 rs315721, NRP2 rs849530, NRP2 haplotype F01, SYK rs158689, VCAM1 rs3176861, and VEGFC haplotype B03. In the regression analysis for the FOXC2 haplotype A3, which was composed of two SNPs (i.e., rs34221221, rs1035550), the overall model explained 18.6% of the variance in the odds of developing LE. Each additional dose of the FOXC2 haplotype A03 was associated with 37.0% decrease in the odds of developing LE. […] In the regression analysis for LCP2 rs315721, the overall model explained 18.9% of the variance in the odds of developing LE. Carrying one or two doses of the rare allele (i.e., AA versus AG + GG) was associated with a 50.0% decrease in the odds of developing LE. In the regression analysis for NRP2 rs849530, the overall model explained 19.0% of the variance in the odds of developing LE. Carrying two doses of the rare allele (i.e., TT+TG versus GG) was associated with 62.0% decrease in the odds of developing LE.

• #16 Lymphatic and Angiogenic Candidate Genes Predict the Development of Secondary Lymphedema following Breast Cancer Surgery | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0060164

  In the regression analysis for SYK rs158689, the overall model explained 20.1% of the variance in the odds of developing LE. Carrying two doses of the rare allele (i.e., AA + AT versus TT) was associated with 3.43-fold increase in the odds of developing LE. In the regression analysis for VCAM1 rs3176861, the overall model explained 18.4% of the variance in the odds of developing LE. Carrying one or two doses of the rare allele (i.e., CC versus CT + TT) was associated with a 45.0% decrease in the odds of developing LE. […] In the regression analysis for the VEGFC haplotype B03, which was composed of two SNPs (i.e., rs3775202, rs3775195), the overall model explained 18.3% of the variance in the odds of developing LE. Each additional dose of the VEGFC haplotype B03 was associated with 36.0% decrease in the odds of developing LE.

• #17 Lymphatic and Angiogenic Candidate Genes Predict the Development of Secondary Lymphedema following Breast Cancer Surgery | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0060164

  This study is the first to evaluate phenotypic and genotypic predictors of LE in a large cohort of women who had LE diagnosed using BIS rather than self-report. Based on an extensive evaluation of demographic, disease, and treatment characteristics, the factors associated with an increased risk of LE in the bivariate analyses were higher BMI, poorer functional status, having lung disease, a higher stage of disease, increased number of lymph nodes removed, increased number of positive lymph nodes, not having a SLND, having had an ALND, and receipt of CTX or RT. All of these risk factors are consistent with previous reports. […] In the past few years, the complex array of molecular events that regulate the development and maintenance of lymphatic system, as well as contribute to its malfunction have begun to be elucidated in animals and humans. While not all of the candidate genes were associated with the development of LE, the significant associations that were identified provide new information on genomic risk factors and potential therapeutic targets. Of note, each of the SNPs explained between 1.0% (VCAM1 rs3176861) to 3.1% (SYK rs158689) of the variance in the development of LE. […] Findings from this study suggest a role for a number of lymphatic and angiogenic candidate genes in the development of secondary LE following breast cancer treatment.

• #18 Lymphedema: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/1087313-overview

  The outcome for persons with lymphedema depends on its chronicity, the complications that result, and the underlying disease state that caused the lymphedema. (Primary lymphedema usually does not progress, with the condition stabilizing after several years of activity.) […] Patients with chronic lymphedema for 10 years have a 10% risk of developing lymphangiosarcoma, the most dreaded complication of this disease. Patients with this tumor commonly present with a reddish purple discoloration or nodule that tends to form satellite lesions. It may be confused with Kaposi sarcoma or traumatic ecchymosis. This tumor is highly aggressive, requires radical amputation of the involved extremity, and has a very poor prognosis. […] The 5-year survival rate for lymphangiosarcoma is less than 10%, with the average survival following diagnosis being 19 months. This malignant degeneration is most commonly observed in patients with postmastectomy lymphedema (Stewart-Treves syndrome), in whom the incidence is estimated to be 0.5%.

• #19 Lymphedema: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/1087313-overview

  Other neoplasms identified in areas of chronic lymphedema are squamous cell carcinoma, Kaposi sarcoma, […] B-cell lymphoma, […] and malignant fibrous histiocytoma. […] Complications of lymphedema also include recurrent bouts of cellulitis and/or lymphangitis, bacterial and fungal infections, lymphangio-adenitis, deep venous thrombosis, severe functional impairment, cosmetic embarrassment, and necessary amputation. Some patients may develop protein-losing enteropathy and visceral involvement. Chylous ascites and chylothorax can develop but are rare. Amyloidosis has been described as a complication of primary lymphedema. […] Complications following surgery are common and include partial wound separation, seroma, hematoma, skin necrosis, and exacerbation of foot or hand edema.

• #20 Prediction of Treatment Outcome with Bioimpedance Measurements in Breast Cancer Related Lymphedema Patients

  https://www.e-arm.org/journal/view.php?number=55

  In our present study, we suggest that measurement of bioimpedance can help in predicting treatment outcome by estimating fluid volume of the affected arm in lymphedema patients. However, correlation coefficients of bioimpedance values and clinical data indicate that bioimpedance measure is not very accurate for predicting treatment outcome. This means that while bioimpedance measurements are useful tools for assessing severity and predicting treatment outcome, it is better to interpret the results of bioimpedance measure comparising with evaluation tools, such as arm circumference and volume measure, water displacement method, and lymph scintigraphy. […] In the present study, bioimpedance values measured by BIS and SFBIA were significantly correlated with arm circumferences changes, and it appears that BIS is more accurate than SFBIA. Thus, estimating ECF volume with bioimpedance measurement may be a useful modality for assessing severity and predicting treatment outcome in lymphedema patients. Further studies concerning the accuracy and usefulness of bioimpedance measure will be needed.

• #21 Increases in arm volume predict lymphoedema and quality of life deficits after axillary surgery: a prospective cohort study | British Journal of Cancer

  https://www.nature.com/articles/s41416-020-0844-4

  Screening for subclinical lymphoedema to enable intervention to reduce the risk of developing clinical lymphoedema is recommended internationally. […] Our approach was to combine factors to produce a novel scoring index to allow identification of patients at risk of the condition who may benefit from lymphoedema surveillance.

• #22 Integrated Treatment of Breast Cancer-related Lymphedema: A Descriptive Review of the State of the Art | Anticancer Research

  https://ar.iiarjournals.org/content/41/7/3233

  A recent meta-analysis compared the efficacy of surgery for prevention and treatment of BCRL by investigating the tissue volume and distribution, the limb composition, and by evaluating the BCRL status through the use of imaging exams after performing LVA and VLNT. […] Despite reporting low-certainty evidence in the effectiveness of LVA and VLNT respectively in preventing BCRL and treating stage II LYE, the meta-analyses showed that surgery provides encouraging results. […] A previous systematic review regarding VLNT surgery investigated 18 studies and showed that 91% had improvement in limb circumference, 86% had improvement in limb volume, and 60% had improvement of flow at lymphoscintigraphy/lymphangiography. […] In conclusion, BCRL is still to be considered a challenging issue for breast cancer survivors, and there is not a gold-standard treatment. […] Furthermore, the lack of clinically globally accepted criteria in evaluating BCRL makes it challenging to evaluate BCRL treatments effectiveness.

• #23 Lymphatic and Angiogenic Candidate Genes Predict the Development of Secondary Lymphedema following Breast Cancer Surgery | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0060164

  Lymphedema (LE) following treatment for breast cancer is the most common form of LE in the industrialized world. LE is caused by a reduction in lymph transport capacity associated with the cancer and its treatment (e.g., surgery, radiation therapy (RT), chemotherapy (CTX)) and results in the accumulation of protein-rich fluid in the interstitial space. LE results in disfigurement, discomfort, and functional impairments. In addition, LE may precipitate cellulitis and lymphangitis. […] The exact prevalence of LE in breast cancer survivors is unknown with estimates ranging from 3% to 87%. This wide variation is due to differences in measurement methods, inconsistencies in diagnostic criteria, as well as variations in sample characteristics, timing of measurements, and duration of follow-up. However, as noted by Armer, if the incidence of LE is conservatively set at 20%, more than 500,000 breast cancer survivors in the United States are affected by this condition.

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