Klarić-Kukuz Ivana, Mršić Danijela Budimir, Matana Antonela, Barun Blaž, Aljinović Jure, Marinović-Guić Maja, Poljičanin Ana
Department of Health Studies, University of Split, 21000 Split, Croatia.
Department of Diagnostic and Interventional Radiology, University Hospital of Split, 21000 Split, Croatia.
Biomedicines. 2025 Jun 6;13(6):1396. doi: 10.3390/biomedicines13061396.
: Accurate diagnosis of breast cancer-related lymphedema remains a clinical challenge. This study evaluated the diagnostic utility of ultrasound in detecting early lymphedema compared to conventional criteria, including the International Society of Lymphology staging and limb volume measurements. : In this retrospective cross-sectional study, 68 female participants with unilateral breast cancer, who had completed cancer treatment at least six months before study enrolment, underwent both ultrasonographic assessment and standard limb circumference measurements. Ultrasound was performed bilaterally at five standardized anatomical sites. Sonographic parameters included assessment of cutaneous and subcutaneous thickness and echogenicity. Clinical staging and symptom profiles were assessed using ISL criteria and a structured questionnaire. Volume status was determined by relative volume change (RVC). : Among 68 participants, 36 were classified as ISL stage 0 and 32 as ISL stage II, 30 had RVC < 5%, while 38 had RVC ≥ 5%. Advanced stages were associated with older age. Multivariate analysis identified increased skin thickness at the medial upper arm cutis as significantly correlated with RVC ≥ 5% (OR 1.49, 95% CI: 1.01-2.21, = 0.047). A similar trend was observed at the medial forearm (OR 1.3 (95% CI: (0.99, 1.71))). : This study highlights ultrasound's potential for early breast cancer-related lymphedema detection, especially in patients with minimal volume changes where conventional methods fall short. Increased cutaneous thickness in the medial upper arm emerged as a sensitive marker of early disease, while subcutaneous thickness and echogenicity may reflect in advanced stages. This distinction underscores the clinical value of cutaneous thickness as a potential clinical key marker for early lymphedema detection, emphasizing the need for standardized protocols and defined thresholds to guide timely interventions.
准确诊断乳腺癌相关淋巴水肿仍然是一项临床挑战。本研究评估了超声在检测早期淋巴水肿方面相对于传统标准（包括国际淋巴学会分期和肢体体积测量）的诊断效用。
在这项回顾性横断面研究中，68名单侧乳腺癌女性参与者在入组研究前至少已完成癌症治疗六个月，她们接受了超声评估和标准肢体周长测量。在五个标准化解剖部位进行双侧超声检查。超声参数包括评估皮肤和皮下厚度以及回声性。使用国际淋巴学会标准和结构化问卷评估临床分期和症状特征。通过相对体积变化（RVC）确定体积状态。
在68名参与者中，36人被归类为国际淋巴学会0期，32人被归类为国际淋巴学会II期，30人的RVC < 5%，而38人的RVC≥5%。晚期与年龄较大相关。多变量分析确定上臂内侧皮肤厚度增加与RVC≥5%显著相关（OR 1.49，95% CI：1.01 - 2.21，P = 0.047）。在前臂内侧也观察到类似趋势（OR 1.3（95% CI：（0.99，1.71）））。
本研究强调了超声在早期乳腺癌相关淋巴水肿检测方面的潜力，特别是在体积变化极小、传统方法难以检测的患者中。上臂内侧皮肤厚度增加成为早期疾病的敏感标志物，而皮下厚度和回声性可能反映疾病晚期。这种差异凸显了皮肤厚度作为早期淋巴水肿检测潜在临床关键标志物的临床价值，强调需要标准化方案和明确阈值以指导及时干预。
