Pirri Carmelo, Ferraretto Chiara, Pirri Nina, Bonaldo Lara, De Caro Raffaele, Masiero Stefano, Stecco Carla
Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padova, Italy.
Physical Medicine and Rehabilitation School, University of Padova, Via Nicolò Giustiniani, 2, 35128 Padua, Italy.
Diagnostics (Basel). 2024 Dec 15;14(24):2824. doi: 10.3390/diagnostics14242824.
Lymphedema represents a frequent cause of disability for patients undergoing oncological treatments and, being a chronic, non-reversible pathology, requires targeted and continuous rehabilitation treatments. To date, the studies available on the use of ultrasound in patients with lymphedema mainly report descriptive data; therefore, with this study, we wanted to describe in a more objective way the typical ultrasound alterations found in these patients, measuring the thickness of the different superficial structures, and defining subcutis echogenicity.
14 patients affected by secondary lymphedema of the upper limbs were enrolled in this cross-sectional observational study (12 had breast cancer and 2 with melanoma as their primary diagnosis). All patients were classified as stage II according to the ISL classification. Patients were examined between March and July 2023 with a clinical and an ultrasound evaluation. Ultrasound evaluation was performed following a protocol and took into consideration thickness of the cutis, subcutis, superficial and deep fascia, and subcutis echogenicity.
The cutis of the affected limbs was thicker in the distal anterior region of the arm and throughout the anterior region of the forearm. The subcutaneous tissue was thicker in the posterior region of the distal arm and throughout the forearm, including the dorsum of the hand and excluding only the proximal posterior region of the forearm. Fascial structures did not demonstrate statistically significant differences in thickness between pathological and healthy limbs, despite undergoing significant changes from a qualitative point of view (loss of the trilaminar skin appearance and the development of anechoic areas due to fluid accumulation around the hyperechoic adipose lobule). A statistically significant difference in the echogenicity of subcutaneous tissue was found at the distal anterior region of the arm and at the entire anterior forearm.
High-resolution ultrasound has been confirmed to be a tool capable of supporting the diagnosis of lymphedema and identifying the most compromised regions of the limb. A tailored rehabilitation plan can be developed based on the non-uniform alterations in subcutaneous tissue, where some areas are affected earlier than others. This compartmentalization should be considered in lymphedema staging and management. Ultrasound may provide early detection of these changes, guiding a more precise therapeutic approach.
淋巴水肿是肿瘤治疗患者致残的常见原因，作为一种慢性、不可逆的病理状况，需要有针对性的持续康复治疗。迄今为止，关于超声在淋巴水肿患者中的应用的现有研究主要报告描述性数据；因此，通过本研究，我们希望以更客观的方式描述这些患者中典型的超声改变，测量不同浅表结构的厚度，并确定皮下组织的回声性。
本横断面观察性研究纳入了14例上肢继发性淋巴水肿患者（12例原发性诊断为乳腺癌，2例为黑色素瘤）。根据国际淋巴学会（ISL）分类，所有患者均被分类为II期。在2023年3月至7月期间，对患者进行了临床和超声评估。超声评估按照方案进行，考虑了表皮、皮下组织、浅筋膜和深筋膜的厚度以及皮下组织的回声性。
患侧肢体的表皮在手臂远端前部区域和整个前臂前部区域较厚。皮下组织在手臂远端后部区域和整个前臂，包括手背，较厚，仅排除前臂近端后部区域。尽管从定性角度来看筋膜结构发生了显著变化（失去了三层皮肤外观，由于高回声脂肪小叶周围液体聚集而出现无回声区），但病理肢体和健康肢体之间的筋膜结构厚度没有统计学上的显著差异。在手臂远端前部区域和整个前臂前部，皮下组织的回声性存在统计学上的显著差异。
高分辨率超声已被证实是一种能够辅助淋巴水肿诊断并识别肢体最受影响区域的工具。可以根据皮下组织的不均匀改变制定个性化的康复计划，其中一些区域比其他区域更早受到影响。在淋巴水肿的分期和管理中应考虑这种分区情况。超声可以早期发现这些变化，指导更精确的治疗方法。
