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THE EUROPEAN JOURNAL OF
lymphology
and related problems
VOLUME 29 • No. 75 • 2017
INDEXED IN EXCERPTA MEDICA
BREAST CANCER RELATED LYMPHEDEMA: LITERATURE REVIEW ON TECHNIQUES FOR VOLUME ASSESSMENT
CAUN.,PhD1,GALLIM.,Prof.1,2,CIMOLINV.,PhD1, CRIVELLINIM.,Prof.1,BALZARINIA.,MD3
1 Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano, Milan, Italy
2 IRCCS “San Raffaele Pisana”, TOSINVEST Sanità, Rome, Italy
3 Palliative Care, Pain Therapy and Rehabilitation DpT, IRCCS Fondazione Istituto Nazionale
dei Tumori Milan, Italy
ABSTRACT
Background: Lymphedema is considered to be one of the most feared effects of the breast cancer treatment. It is a chronic and progressive condition characterized by arm swelling. An accurate measurement of the pathological arm volume is crucial for the lymphedema management (i.e. to gauge the efficacy of the treatment). Several methods of measurement have been validated and used in clinic, but literature highlights the lack of standardized methodology.
Methods: A review of specific literature was undertaken. Most important electronic databases (PubMed and ISI Web of Knowledge ) were questioned for articles published between 1998 and 2013. Specific keywords have been used: Lymphedema, Volume, Water Displacement, Perometry, Circumferential, Bioimpedance and Laser Scanner 3D.
Results: More than 50 articles have been reviewed and divided into five groups based on measurement methods (Water Displacement – Perometry – Circumferential – Bioimpedance and Laser Scanner 3D). Accuracy and reliability of the different methods are compared.
Conclusions: Our analysis leads to identify the laser scanner method as the most proper technique for arm volume measuring in term of accuracy, reliability, costs and time consuming.
Key Words: Lymphedema measurement, water displacement, Laser scanning, lymphedema review, circumferential method, limb scanning, arm swelling.
INTRODUCTION
Lymphedema is a chronic and progressive condition characterized by arm or leg swelling due to an abnormal protein-rich fluid (lymph) collection in the interstitial tissue. When this fluid is chronically present in extracellular tissues, it causes an inflammatory response with fat deposition and overgrowth of connective tissue (1). As a result, the arm becomes swollen and firm. A common aetiology associated with lymphedema is breast cancer and its treatments. For upper arm established risk factors include axillary dissection, radiotherapy of the breast and/or of axilla, pathological nodal status, obesity, and tumour stage (2). The incidence of lymphedema is approximately 5-50% of all breast cancer patients with a risk of 15-20% after axillary dissection and
THE EUROPEAN JOURNAL OF LYMPHOLOGY - Vol. XXIX - Nr. 75 - 2017
3-10% after sentinel lymph node biopsy. This wide variation depends especially on diagnostic criteria for lymphedema, differences in the studied patient group and on influence of different treatments.
Lymphedema is considered one of the most-feared side effects of breast cancer treatment and is cause of physical and psychological detriments: body image changes, anxiety, aesthetic problems, functional alteration in arm and restriction in quality of life (3). As during recent years the percentage of breast cancer survivals is increasing, the attention of medical doctors and researchers to this problem is ever growing. To confirm this, in Fig. 1 the number of article published during years about the lymphedema (article find in Pubmed source using the keyword “lymphedema”) is shown. More attention is mainly turned to the entity of the lymphedema as well as on treatments for its reduction.
Fig. 1 - Numbers of article on the lymphedema from 1935 to 2014* – source Pubmed. (*) articles published until January 2014.
The main problem in the assessment of lymphedema entity as well as the effects of specific treatments is the measure of dimension and volume of the limb with lymphedema. The clinicians mainly use a qualitative evaluation based on circumferential measurements by tape, which is fast and simple even if not consistent and not accurate; other measures, such as volumetric measures or bioimpedence and spectroscopy measures, are
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