Division of Breast Surgery, Department of Surgery, University of Kansas Cancer Center, Kansas City, KS, USA.
Department of Radiation Oncology, University of Kansas Cancer Center, Kansas City, KS, USA.
Ann Surg Oncol. 2018 Oct;25(10):2948-2952. doi: 10.1245/s10434-018-6601-8. Epub 2018 Jul 9.
Breast cancer-related lymphedema (BCRL) is a chronic progressive disease that results from breast cancer treatment and nodal surgery. NCCN guidelines support baseline measurements with prospective assessment for early diagnosis and treatment. We sought to determine if baseline measurement with bioimpedance spectroscopy (BIS) and serial postoperative evaluations provide early detection amenable to conservative interventions that reduce BCRL.
Breast cancer patients with unilateral disease high-risk for BCRL from a single institution were evaluated from November 2014 to December 2017. High risk was defined as axillary lymph node dissection with radiation and/or taxane chemotherapy. Patients received preoperative baseline BIS measurements followed by postoperative measurements with at least two follow-ups. Patients with BIS results that were 2 standard deviations above baseline (10 + points) started home conservative interventions for 4-6 weeks. Postintervention measurements were taken to assess improvement.
A total of 146 patients high-risk for BCRL were included. Forty-nine patients (34%) developed early BCRL and started self-directed treatment. Forty patients (82%) had elevated BIS measurements return to normal baseline range. Nine (6%) patients had persistent BCRL requiring referral for advanced therapy. Patients with persistent BCRL had significant nodal burden on surgical pathology; eight (89%) had N2/N3 disease. Six (76%) with BCRL refractory to conservative measures died of their breast cancer.
Our results demonstrated that early conservative intervention for breast cancer patients high risk for BCRL who were prospectively monitored by utilizing BIS significantly lowers rates of BCRL. These findings support early prospective screening and intervention for BCRL. Early detection with patient-directed interventions improves patient outcomes and decreases the risk of persistent BCRL.
乳腺癌相关淋巴水肿（BCRL）是一种由乳腺癌治疗和淋巴结手术引起的慢性进行性疾病。NCCN 指南支持基线测量，并进行前瞻性评估，以实现早期诊断和治疗。我们旨在确定基线时使用生物阻抗谱（BIS）测量和术后连续评估是否能够早期发现疾病，从而采取保守干预措施减少 BCRL 的发生。
从 2014 年 11 月至 2017 年 12 月，我们对来自单一机构的单侧疾病且有发生 BCRL 高风险的乳腺癌患者进行了评估。高风险定义为腋窝淋巴结清扫术联合放疗和/或紫杉烷类化疗。患者接受术前基线 BIS 测量，随后进行至少两次随访的术后测量。BIS 结果比基线高出 2 个标准差（10+ 点）的患者开始接受为期 4-6 周的家庭保守干预治疗。治疗后进行测量以评估疗效。
共纳入 146 例有发生 BCRL 高风险的患者。49 例（34%）患者出现早期 BCRL 并开始自我治疗。40 例（82%）患者的 BIS 测量值升高恢复至正常基线范围。9 例（6%）患者出现持续性 BCRL，需要转介接受高级治疗。持续性 BCRL 患者的手术病理存在显著的淋巴结受累；8 例（89%）患者有 N2/N3 疾病。6 例（76%）经保守治疗无效的 BCRL 患者死于乳腺癌。
我们的结果表明，前瞻性监测并利用 BIS 对有发生 BCRL 高风险的乳腺癌患者进行早期保守干预，显著降低了 BCRL 的发生率。这些发现支持对 BCRL 进行早期前瞻性筛查和干预。通过患者导向的干预措施进行早期检测，可以改善患者的结局并降低持续性 BCRL 的风险。
