Ibrahim Mohamed, Habashy Hany, Monib Sherif
General Surgery Department, Fayoum University Hospital, Faiyum, Egypt.
St Albans Hospital Breast Unit, West Hertfordshire Hospitals NHS Trust, Waverley Rd, St Albans, AL3 5PN UK.
Indian J Surg Oncol. 2023 Sep;14(3):637-643. doi: 10.1007/s13193-023-01725-9. Epub 2023 Mar 7.
While upper limb lymphoedema following breast and axillary surgery is well established in the literature, breast lymphoedema is rarely documented. Our primary objective was to identify risk factors of breast lymphoedema, and our secondary aim was to assess the possibility of using a breast ultrasound scan to assess breast lymphoedema. This study was a case series analysis, including patients who had wide local excision for primary breast cancer treatment between January 2013 and January 2018. Patients' demographics, including age, weight, body mass index (BMI), breast volume, tumour characteristics, and histological findings, were noted. All patients had a clinical assessment and ultrasound scan 6 months and 12 months after surgery, comparing ipsilateral to the contralateral breast skin, subcutaneous thickness, as well as parenchymal changes. We have included two hundred eighty-six breast cancer; the mean age was 54.7 years SD 17.3, the mean weight was 76.5 kg SD 12.6, the mean BMI was 31.5 SD 5.2, and the mean breast volume was 1223 ml SD 179. This study identified breast lymphoedema in patients with clinically detected skin oedema in the absence of radiotherapy skin changes; skin and subcutaneous 5 mm added thickness more than the contralateral side, and based on that, 22 patients (7.7%) were found to have breast lymphoedema. We have also found that patients with high BMI, larger breast volume, upper outer quadrant tumours, and patients who had axillary lymph node clearance had an increased incidence of breast lymphoedema. The incidence of breast lymphoedema in this cohort was 7.7%. We suggest that breast lymphoedema should be considered if skin and subcutaneous thickness are 5 mm more than the contralateral side in the absence of severe radiotherapy skin changes. Also, we have found that high body mass index (BMI), larger breast volume, upper outer quadrant tumours, and patients who had axillary lymph node clearance are associated with an increased incidence of breast lymphoedema.
虽然乳房和腋窝手术后上肢淋巴水肿在文献中有充分记载，但乳腺淋巴水肿却鲜有记录。我们的主要目的是确定乳腺淋巴水肿的危险因素，次要目的是评估使用乳腺超声扫描评估乳腺淋巴水肿的可能性。本研究为病例系列分析，纳入了2013年1月至2018年1月期间因原发性乳腺癌接受广泛局部切除的患者。记录了患者的人口统计学数据，包括年龄、体重、体重指数（BMI）、乳房体积、肿瘤特征和组织学结果。所有患者在术后6个月和12个月进行了临床评估和超声扫描，比较患侧与对侧乳房的皮肤、皮下厚度以及实质变化。我们纳入了286例乳腺癌患者；平均年龄为54.7岁，标准差为17.3，平均体重为76.5千克，标准差为12.6，平均BMI为31.5，标准差为5.2，平均乳房体积为1223毫升，标准差为179。本研究在临床检测到皮肤水肿且无放疗皮肤改变的患者中发现了乳腺淋巴水肿；皮肤和皮下厚度比另一侧增加5毫米以上，据此，发现22例患者（7.7%）患有乳腺淋巴水肿。我们还发现，BMI高、乳房体积大、外上象限肿瘤以及接受腋窝淋巴结清扫的患者乳腺淋巴水肿的发生率增加。该队列中乳腺淋巴水肿的发生率为7.7%。我们建议，如果在没有严重放疗皮肤改变的情况下，皮肤和皮下厚度比另一侧厚5毫米以上，应考虑乳腺淋巴水肿。此外，我们发现高体重指数（BMI）、乳房体积大、外上象限肿瘤以及接受腋窝淋巴结清扫的患者与乳腺淋巴水肿发生率增加有关。
