Iyigun Zeynep Erdogan, Duymaz Tomris, Ilgun Ahmet Serkan, Alco Gul, Ordu Cetin, Sarsenov Dauren, Aydin Ayse Esra, Celebi Filiz Elbuken, Izci Filiz, Eralp Yeşim, Ozmen Vahit
1 Department of Physical Theraphy and Rehabilitation, Istanbul Bilim University School of Medicine , Istanbul, Turkey .
2 Department of General Surgery, Gaziosmanpaşa Taksim Training and Research Hospital , Istanbul, Turkey .
Lymphat Res Biol. 2018 Feb;16(1):28-35. doi: 10.1089/lrb.2016.0045. Epub 2017 Mar 27.
Prolongation of survival in patients with breast cancer due to early diagnosis and modern methods of treatment has turned the attention on lymphedema, which is the most important morbidity secondary to the treatment of the disease. Determination of lymphedema and related risk factors in patients before a surgical intervention may provide protection for patients and early treatment. The aim of this study was to determine the presence of lymphedema before surgery by bioimpedance analysis in patients with breast cancer and to establish risk factors associated with lymphedema.
A total of 277 patients who were diagnosed as having breast cancer, were planned to undergo a surgical intervention, and had no clinical lymphedema were included in the study. The presence of lymphedema was evaluated with clinical examination, measurement of arm circumference, and bioimpedance analysis.
Lymphedema was found in 59 (21.3%) patients with no detected differences in arm circumferences. A significant relationship was found between the presence of lymphedema and body mass index (BMI), number of positive lymph nodes, and capsule invasion of the tumor (p = 0.001, p = 0.003, p = 0.002, respectively). Multiple regression analysis revealed that BMI and the number of positive lymph nodes were independent variables (p = 0.024, p = 0.002). ROC curve analysis resulted in an increased risk of preoperative lymphedema when the number of positive lymph nodes was ≥8. Correlation analysis revealed a positive correlation between the number of positive lymph nodes and L-dex score (p = 0.001, r = 0.219).
Preoperative bioimpedance analysis demonstrated that ∼1/5 of the patients had subclinical lymphedema. Preoperative subclinical lymphedema is associated with obesity and the number of positive lymph nodes, and thus, treatment of the axilla in patients who are preoperatively detected to have subclinical lymphedema should be revised.
由于早期诊断和现代治疗方法，乳腺癌患者的生存期得以延长，这使得人们将注意力转向淋巴水肿，它是该疾病治疗后最重要的并发症。在手术干预前确定患者的淋巴水肿及相关危险因素可为患者提供保护并实现早期治疗。本研究的目的是通过生物电阻抗分析确定乳腺癌患者术前淋巴水肿的存在情况，并确定与淋巴水肿相关的危险因素。
本研究纳入了277例被诊断为乳腺癌、计划接受手术干预且无临床淋巴水肿的患者。通过临床检查、手臂周长测量和生物电阻抗分析评估淋巴水肿的存在情况。
59例（21.3%）患者存在淋巴水肿，手臂周长无差异。发现淋巴水肿的存在与体重指数（BMI）、阳性淋巴结数量和肿瘤包膜侵犯之间存在显著关系（分别为p = 0.001、p = 0.003、p = 0.002）。多元回归分析显示BMI和阳性淋巴结数量是独立变量（p = 0.024、p = 0.002）。ROC曲线分析结果显示，当阳性淋巴结数量≥8时，术前淋巴水肿风险增加。相关性分析显示阳性淋巴结数量与L-dex评分呈正相关（p = 0.001，r = 0.219）。
术前生物电阻抗分析表明约五分之一的患者存在亚临床淋巴水肿。术前亚临床淋巴水肿与肥胖和阳性淋巴结数量有关，因此，对于术前检测出有亚临床淋巴水肿的患者，腋窝治疗方案应予以修订。
