CME lecture 1
Lymphedema measurements in
Breast cancer
By Ayman Darrag
Outlines:
Risk assessment.
Pre-op measurements Mastectomy protocol .
Unilateral vs bilateral mastectomy
Risk association
In a cohort of 2,171 prospectively screened
women, BCRL onset peaked between 12 and
30 months postoperatively; however, timing of
onset varied with treatment.
Early-onset BCRL (< 12 months
postoperatively) was associated with ALND
without regional lymph node radiation,
Late-onset BCRL (> 12 months) was associated
with RLNR and ALND.
Onset at 18-24 months in the ALND + RLNR
group, and at 36-48 months in the SLNB +
RLNR. (McDuff et al., 2019)
Risk assessment
1-3%
●
5%
●
SLNB
● SLNB+RT
36 - 60
●
7-13% ● ALND
16-23% ● ALND+RT
36-48 months
●
Earlier than 1 year
●
18-24 Months
Pre-op measurement mastectomy protocol
1.Body weight and height ,BMI
2.Arm girth measurements (both arms)
3.Pre-operative and post operative(at any point from 0-3
months)
Strict measurements at 7 cm intervals (6 points)(Bevilacqua et al., 2012),
(Brijker et al., 2000)
Assess stemmer sign
Practical session
V=πr2h
Unilateral mastectomy vs bilateral mastectomy
• Unilateral breast surgery : Relative volume change
• RVC= (A2.U1) / (U2.A1) — 1
●A(1) and A(2) are pre-operative (1) and post-operative (2)arm volumes
on surgical side; U(1) and U(2) are contralateral volumes at same time
points.(Ancukiewicz... Taghian et al 2010)
Bilateral mastectomy
● Bilateral breast surgery: Weight-adjusted volume change
WARVC= (A2.W1)/(W2.A1)-1
• A(1) and A(2) are pre-operative (1) and post-operative (2) arm volumes on
surgical side; W(1) and W(2) are patient weights at the corresponding time
points.
Lymphedema is diagnosed when 10% increase is detected .
Thank you