Fishman Jordan E, Moroni Elizabeth A, Cruz Carolyn De La
The Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
The Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
J Plast Reconstr Aesthet Surg. 2022 Sep;75(9):3122-3128. doi: 10.1016/j.bjps.2022.02.041. Epub 2022 Feb 27.
Neither anatomic nor functional descriptions exist of trunk/breast lymphedema following breast cancer treatment. Indocyanine green (ICG)-lymphangiography has been shown to characterize lymph channel dysfunction seen in lymphedema. We propose using ICG-lymphangiography to evaluate trunk and breast lymphedema following breast cancer surgery to characterize the regions affected via a novel, validated staging system.
Patients undergoing revisional breast surgery with suspicion of upper extremity lymphedema between December 2014 and March 2020 were offered lymphangiography. The breast and lateral/anterior trunks were visualized and blindly evaluated using Koshima's patterns of dermal backflow. Patients were then staged. A linear-weighted Cohen's kappa statistic was calculated comparing each rated area and stage assignment.
Fifty-two sides (29 patients) were included. Eight sides underwent no treatment and were considered controls. No lymphedema was identified within this cohort. One patient (two sides) had no transit of ICG. Seventy-six percent of the non-controls had dermal backflow. This was seen in 67% of anterior trunks, 50% of lateral trunks, 50% of inframammary folds (IMFs), 43% of inferior breasts, and 5% of superior breasts. Cohen's kappa for area agreement was 0.4117 ± 0.0535. Stage 0 was seen in 31 (±7)% of sides; stage 1: 21 (±1)%; stage 2: 22 (±5)%; stage 3: 18 (±4)%; stage 4: 5 (±1)%; and stage 5: 4 (±0). Cohen's kappa for staging was 0.8109 ± 0.0868.
Following breast cancer surgery, lymphedema occurs throughout the trunk and breast. Severe dysfunction appears to be located around the inferior-lateral aspect of the breast and chest wall. Furthermore, the Pittsburgh Trunk Lymphedema Staging System is a validated measure of trunk and breast lymphedema.
目前尚无关于乳腺癌治疗后躯干/乳房淋巴水肿的解剖学或功能描述。吲哚菁绿（ICG）淋巴管造影已被证明可用于表征淋巴水肿中所见的淋巴通道功能障碍。我们建议使用ICG淋巴管造影来评估乳腺癌手术后的躯干和乳房淋巴水肿，通过一种新的、经过验证的分期系统来表征受影响的区域。
2014年12月至2020年3月期间，对怀疑有上肢淋巴水肿而接受乳房修复手术的患者进行淋巴管造影。对乳房和外侧/前躯干进行可视化，并使用小嶋真皮回流模式进行盲法评估。然后对患者进行分期。计算线性加权科恩kappa统计量，比较每个评分区域和分期分配情况。
纳入52侧（29例患者）。8侧未接受治疗，被视为对照。该队列中未发现淋巴水肿。1例患者（两侧）ICG无通过。76%的非对照者出现真皮回流。在67%的前躯干、50%的外侧躯干、50%的乳房下皱襞（IMF）、43%的乳房下部和5%的乳房上部可见。区域一致性的科恩kappa为0.4117±0.0535。0期见于31（±7）%的侧；1期：21（±1）%；2期：22（±5）%；3期：18（±4）%；4期：5（±1）%；5期：4（±0）。分期的科恩kappa为0.8109±0.0868。
乳腺癌手术后，躯干和乳房均会出现淋巴水肿。严重功能障碍似乎位于乳房和胸壁的下外侧。此外，匹兹堡躯干淋巴水肿分期系统是一种经过验证的躯干和乳房淋巴水肿测量方法。
