Shah Chirag, Vicini Frank A, Arthur Douglas
Department of Radiation Oncology, Cleveland Clinic, Taussig Cancer Institute, Cleveland, Ohio.
Michigan Healthcare Professionals, Farmington Hills, Michigan.
Breast J. 2016 Nov;22(6):645-650. doi: 10.1111/tbj.12647. Epub 2016 Aug 4.
With improved breast cancer survivorship, lymphedema of the arm is a growing concern for many patients following treatment. Diagnosis and management of breast cancer related lymphedema (BCRL) is often delayed due to low sensitivity diagnostic techniques and a failure to incorporate BCRL assessments into standard clinical practice. Bioimpedance spectroscopy (BIS) is an increasingly utilized diagnostic technique that allows for the subclinical detection of BCRL, prior to clinically evident disease. We provide a summary of the data supporting the early detection and treatment of BCRL, a comparison of BCRL diagnostic modalities and data supporting the utilization of BIS. Finally, clinical practice guidelines will be provided to allow for the incorporation of BIS into the standard management of breast cancer patients prior to and following locoregional and systemic therapy. These clinical practice guidelines offer clinicians a method to introduce bioimpedance into routine breast cancer care. With increasing focus on BCRL, such protocols will allow for prospective evaluation of patients and early diagnosis and treatment.
随着乳腺癌患者生存率的提高,手臂淋巴水肿成为许多患者治疗后日益关注的问题。由于诊断技术敏感性低以及未能将乳腺癌相关淋巴水肿(BCRL)评估纳入标准临床实践,BCRL的诊断和管理常常被延误。生物电阻抗光谱法(BIS)是一种越来越多地被使用的诊断技术,它能够在临床明显疾病出现之前对BCRL进行亚临床检测。我们总结了支持BCRL早期检测和治疗的数据,比较了BCRL的诊断方式以及支持使用BIS的数据。最后,将提供临床实践指南,以便在局部区域和全身治疗之前及之后将BIS纳入乳腺癌患者的标准管理中。这些临床实践指南为临床医生提供了一种将生物电阻抗引入常规乳腺癌护理的方法。随着对BCRL的关注度不断提高,此类方案将允许对患者进行前瞻性评估以及早期诊断和治疗。