Division of Breast Surgery, Department of General Surgery, Changi General Hospital, Singapore.
SingHealth-Duke NUS Breast Centre.
Ann Acad Med Singap. 2024 Feb 28;53(2):80-89. doi: 10.47102/annals-acadmedsg.2023264.
We presented the key findings from Singapore's Changi General Hospital Breast Centre's lymphedema surveillance strategy that used patients' reported symptoms, standard arm circumference measurements and clinical assessment in the diagnosis of breast cancer-related lymphedema (BCRL). Our secondary aim was to highlight and discuss important elements of a surveillance strategy that can be implemented to track this outcome measure of breast cancer treatment for future research.
We conducted a cross-sectional study of 511 breast cancer patients to assess the prevalence of BCRL and its associated risk factors. We defined BCRL prevalence rates based on patients' self-reporting, objective arm circumference measure-ments and clinical diagnosis based on International Society of Lymphology (ISL) staging.
The median follow-up of patients was 88.8 months. The cumulative prevalence rate in the cohort was 30.9%. The cohort of BCRL patients were older (58.4 versus [vs] 54.9 years), had higher mean Body Mass Index (27.7 vs 25.2), higher proportion of mastectomy (77% vs 64.3%), axillary clearance, less likely breast reconstruction, higher-grade tumour, more lymph nodes excised, more advanced nodal disease, and had undergone adjuvant chemotherapy. However, clinically apparent BCRL was only 6.5% (33 out of 511 patients). The proportion of clinically significant BCRL in patients undergoing sentinel lymph node biopsy (SLNB) or axillary sampling was 1.7% compared to 9.9% in patients who had undergone axillary clearance. Majority of the BCRL were subclinical or mild in severity.
Our study showed that our rates of BCRL were comparable to international rates and highlighted similar patient profiles who were at risk of developing the disease. Having a comprehensive lymphedema surveillance strategy is paramount in paving the way for future studies.
我们介绍了新加坡樟宜综合医院乳腺中心淋巴水肿监测策略的关键发现，该策略使用患者报告的症状、标准臂围测量和临床评估来诊断乳腺癌相关淋巴水肿（BCRL）。我们的次要目的是强调和讨论可用于跟踪乳腺癌治疗这一结果衡量指标的监测策略的重要元素，为未来的研究铺平道路。
我们对 511 名乳腺癌患者进行了横断面研究，以评估 BCRL 的患病率及其相关危险因素。我们根据患者的自我报告、客观臂围测量和基于国际淋巴学会（ISL）分期的临床诊断来定义 BCRL 的患病率。
患者的中位随访时间为 88.8 个月。队列的累积患病率为 30.9%。BCRL 患者年龄更大（58.4 岁 vs 54.9 岁），平均体重指数更高（27.7 对 25.2），乳房切除术比例更高（77% 对 64.3%），腋窝清扫术更多，乳房重建可能性较小，肿瘤分级更高，切除的淋巴结更多，淋巴结疾病更晚期，且接受了辅助化疗。然而，临床上明显的 BCRL 仅占 6.5%（511 名患者中有 33 名）。在接受前哨淋巴结活检（SLNB）或腋窝取样的患者中，临床显著 BCRL 的比例为 1.7%，而在接受腋窝清扫术的患者中，该比例为 9.9%。大多数 BCRL 为亚临床或轻度。
我们的研究表明，我们的 BCRL 发生率与国际发生率相当，并突出了具有发病风险的相似患者特征。全面的淋巴水肿监测策略对于未来的研究至关重要。
