Ultrasonographic features of skin and subcutis correlated with severity of breast cancer-related lymphedema
Ji Youn Park, Jae Yong Jeon , Seungwoo Cha
Asan Medical Center, Seoul, Korea
Corresponding Author: Seungwoo Cha ,Tel: 010-2888-3957, Fax: 02-3010-1174, Email: miracleofs@naver.com
Received: April 7, 2024;  Accepted: May 31, 2024.  Published online: May 31, 2024.
Breast cancer-related lymphedema (BCRL) severity assessments typically require various clinical tools; however, there remains a lack of methodological standardization. Ultrasonography is promising for diagnosing and determining the severity of lymphedema. This study investigated the clinical utility of ultrasonography in patients with BCRL.
In this retrospective cross-sectional study of patients with unilateral BCRL, analyzed data encompassed patient demographics, lymphedema location and International Society of Lymphology (ISL) stage, surgical history, treatment regimens, and arm circumference. Ultrasonographic assessments of skin, subcutis, and muscle thickness were performed at predetermined sites. We calculated the percentage of excess thickness. Multivariate logistic regression analysis identified associations between ultrasonographic measurements and advanced lymphedema (ISL 2 or 3). The LYM-QOL arm questionnaire evaluated patient-reported outcomes related to lymphedema and their correlation with ultrasonographic findings.
Of 118 patients, 71 and 47 were ISL 0–1 and ISL 2, respectively. Those with advanced lymphedema were older, had more advanced nodal stages, underwent more axillary lymph node dissections, and had higher rates of dominant-arm lymphedema. Multivariate logistic regression revealed significant associations between increased skin thickness (adjusted OR 4.634, 95% CI 1.233-17.419), subcutis thickness (adjusted OR 7.741, 95% CI 1.649-36.347), and subcutis echogenicity (adjusted OR 4.860, 95% CI 1.517-15.566) with advanced lymphedema. Furthermore, increased skin thickness (P = 0.016) and subcutis echogenicity (P = 0.023) correlated with patient-reported discomfort concerning appearance.
This study highlighted a significant association between ultrasonographic measurements and advanced lymphedema in BCRL patients. Ultrasonography is emerging as a valuable tool for lymphedema diagnosis and severity assessment.
Keywords: lymphedema; ultrasonography; breast neoplasm; lymphatic system
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