Wagner Benjamin D, Rubin Jonathan, Boe Lillian A, Diwan Richard, Bloomfield Emily, Giles Caitlin, Rochlin Danielle H, Yoshimatsu Hidehiko, Mehrara Babak J, Coriddi Michelle R
Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Biostatistics Service, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Ann Surg Oncol. 2025 Sep 19. doi: 10.1245/s10434-025-18334-1.
Breast cancer-related lymphedema (BCRL) is commonly diagnosed using limb volume criteria; however, diagnostic thresholds vary and lack empirical validation. This variability may lead to underdiagnosis, particularly in patients using compression garments that can reduce limb size.
This study evaluated how different diagnostic criteria and compression therapy influence the reported incidence of BCRL.
A single-institution analysis was conducted on 165 female patients with breast cancer originally enrolled in a randomized controlled trial comparing axillary lymph node dissection with and without immediate lymphatic reconstruction from 2020 to 2025. Limb volumes were measured preoperatively and at 12, 18, and 24 months postoperatively. BCRL incidence was assessed using 5%, 10%, and 15% thresholds for relative volume change (RVC) and interlimb volume difference. The Upper Limb Lymphedema-27 (ULL-27) questionnaire evaluated symptoms. Compression use was evaluated to determine the effect on BCRL incidence.
BCRL incidence varied by threshold, from 55.8% at 5% RVC to 12.1% at 15% RVC. ULL-27 scores indicated comparable symptom burdens between patients meeting volume-based diagnostic criteria and those wearing compression garments but not meeting volume criteria. Both groups had significantly worse physical domain scores than patients without volume changes or compression use (P < 0.001). Including compression users who did not meet volume criteria increased the incidence of BCRL across all thresholds (e.g., 23.6% to 41.8% at 10% RVC).
BCRL incidence varied markedly by volume-based diagnostic thresholds, and inclusion of compression users significantly increased reported rates. Relying solely on volume thresholds may miss symptomatic patients. Integrating compression use and patient-reported outcomes can better identify clinically meaningful BCRL.
乳腺癌相关淋巴水肿（BCRL）通常采用肢体体积标准进行诊断；然而，诊断阈值各不相同且缺乏实证验证。这种变异性可能导致诊断不足，尤其是在使用可减小肢体尺寸的加压服装的患者中。
本研究评估了不同的诊断标准和加压治疗如何影响报告的BCRL发病率。
对2020年至2025年期间最初纳入一项比较腋窝淋巴结清扫术加与不加即刻淋巴重建的随机对照试验的165例女性乳腺癌患者进行单机构分析。在术前以及术后12、18和24个月测量肢体体积。使用相对体积变化（RVC）和肢体间体积差异的5%、10%和15%阈值评估BCRL发病率。上肢淋巴水肿-27（ULL-27）问卷评估症状。评估加压服装的使用情况以确定其对BCRL发病率的影响。
BCRL发病率因阈值而异，从RVC为5%时的55.8%到RVC为15%时的12.1%。ULL-27评分表明，符合基于体积的诊断标准的患者与穿着加压服装但不符合体积标准的患者之间症状负担相当。两组患者的身体领域评分均显著低于无体积变化或未使用加压服装的患者（P < 0.001）。将不符合体积标准的加压服装使用者纳入计算后，所有阈值下BCRL的发病率均有所增加（例如，RVC为10%时从23.6%增至41.8%）。
BCRL发病率因基于体积的诊断阈值而有显著差异，纳入加压服装使用者会显著提高报告的发病率。仅依靠体积阈值可能会遗漏有症状的患者。综合考虑加压服装的使用情况和患者报告的结果能够更好地识别具有临床意义的BCRL。
