Erdoğan İyigün Zeynep, Ozmen Tolga, İlgün Serkan, Nakipoğlu Cansu, Özkurt Enver, Çelebi Filiz, Ünal Çağlar, Öztürk Alper, Alço Gül, Ordu Çetin, Soybir Gürsel
Department of Physical Therapy and Rehabilitation, Bahçeşehir University Faculty of Medicine, İstanbul, Turkey.
Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, USA.
Eur J Breast Health. 2025 Jan 1;21(1):40-45. doi: 10.4274/ejbh.galenos.2024.2024-9-5.
The aim of this study was to evaluate the relationship between subclinical lymphedema identified prior to surgical intervention and clinical lymphedema observed in the late period, the incidence of lymphedema in our cohort, and the associated risk factors.
This prospective study was conducted with early-stage breast cancer patients who had been enrolled in a previous study. For diagnosing lymphedema, physical examination, L-Dex® score, and circumferential measurement was used. The L-Dex score was used as a screening test for preoperative, subclinical lymphedema since there were no clinical findings. Patients with subclinical lymphedema were provided with education and followed up more frequently with regular monitoring.
The mean age of the 217 participants was 56.7±12.7 years (range 29-90), and the mean body mass index was 27.7±3.3 kg/m (range 19.3-36.9). Among the 217 patients, lymphedema was detected in 31 (14.7%) at a median follow-up period of 89 months (range 73-108 months). Multivariable analysis of factors associated with late-stage lymphedema revealed positive lymph node count and capsular invasion as significant factors ( = 0.001 for both). Forty (18.4%) had preoperative subclinical lymphedema. At the end of the follow-up period, lymphedema persisted in 11 patients (27.5%) and resolved in 29 patients (72.5%). In multivariable analysis, the positive lymph node count was identified as an independent variable in these patients.
Identifying high-risk patients, regular monitoring, and early intervention can significantly reduce the risk of clinical lymphedema through timely treatment.
本研究旨在评估手术干预前发现的亚临床淋巴水肿与后期观察到的临床淋巴水肿之间的关系、我们队列中淋巴水肿的发生率以及相关危险因素。
本前瞻性研究针对先前一项研究中纳入的早期乳腺癌患者进行。采用体格检查、L-Dex®评分和周径测量来诊断淋巴水肿。由于没有临床症状，L-Dex评分被用作术前亚临床淋巴水肿的筛查测试。对亚临床淋巴水肿患者进行教育，并通过定期监测更频繁地进行随访。
217名参与者的平均年龄为56.7±12.7岁（范围29 - 90岁），平均体重指数为27.7±3.3 kg/m（范围19.3 - 36.9）。在217名患者中，中位随访期89个月（范围73 - 108个月）时，有31名（14.7%）检测到淋巴水肿。对与晚期淋巴水肿相关因素的多变量分析显示，阳性淋巴结计数和包膜侵犯是显著因素（两者均P = 0.001）。40名（18.4%）患者有术前亚临床淋巴水肿。随访期末，11名患者（27.5%）淋巴水肿持续存在，29名患者（72.5%）淋巴水肿消退。在多变量分析中，阳性淋巴结计数被确定为这些患者的一个独立变量。
识别高危患者、定期监测和早期干预可通过及时治疗显著降低临床淋巴水肿的风险。
