Improving the Assessment and Diagnosis of Breast Lymphedema after Treatment for Breast Cancer

SIMPLE SUMMARY: Lymphedema affecting the breast can develop after breast cancer treatment. Currently breast lymphedema isn’t well recognised nor techniques to measure lymphedema affecting the breast as well studied. This paper explores the validity and reliability of measures which can be used to determine the presence of breast lymphedema. Women with and without breast lymphedema were included in this study to enable comparisons to be made. Improving the assessment of breast lymphedema will advance clinical practice and enable the outcome of treatment to be reported. Ultrasound and tissue dielectric constant were found to be able to reliably distinguish between edema and non edematous breast tissue. In addition certain patient characteristics and breast caner treatments were found to associated with the development of breast lymphedema. ABSTRACT: Lymphedema can develop after treatment for breast cancer (BCRL). Lymphedema of the breast is not well studied. Currently, the main techniques used to diagnose and monitor the effectiveness of treatment are subjective clinician assessment and patient reports. Eighty-nine women who had undergone breast cancer treatment were recruited with and without breast lymphedema. Blinded clinical assessment determined the presence or absence of breast lymphedema. Measurement of skin thickness by ultrasound scanning, local tissue water by tissue dielectric constant (TDC) and tissue indentation by tonometry was recorded. Breast cancer treatment and demographic details were documented. Descriptive statistics were undertaken to compare sample characteristics, including the Chi-squared test, Odds Ratio (OR) and Relative Risks (RR) calculated. Increased body mass index (BMI), larger bra size, increased number of positive lymph nodes, axillary surgery, chemotherapy and increased Nottingham Prognostic Index (NPI) were all associated with breast lymphedema (p < 0.05). Ultrasound and TDC measurements were significantly higher in the lymphedema group (p < 0.05). Receiver Operator Characteristic (ROC) curves demonstrated that ultrasound and TDC measurements could distinguish between edematous and non-edematous breasts. Threshold levels were produced, which demonstrated good levels of sensitivity and specificity. These findings have the potential to improve the diagnosis of breast lymphedema.