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Systematic review of breast cancer related lymphoedema: making a balanced decision to perform an axillary clearance.

Göker M, Devoogdt N, Van de Putte G, Schobbens JC, Vlasselaer J, Van den Broecke R, de Jonge ET - Facts Views Vis Obgyn (2013)

Bottom Line: Most studies measured BCRL based on differences in arm circumference (n = 18) or by self-reported symptoms (n = 18).We argue self-report as the most appropriate method to -establish a diagnosis of BCRL.Therefore a 28% risk of finding non-sentinel lymph node metastases in a completion ALND will be regarded as the cut-off in a medical decision to proceed with ALND.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics & Gynaecology, Ziekenhuis Oost-Limburg Campus St Jan, Schiepse Bos 6, 3600 Genk, -Belgium.

ABSTRACT

Aim: Breast cancer-related lymphoedema (BCRL) is a disabling complication developing after breast cancer treatment in a proportion of patients. Its impact on quality of life becomes more substantial as survival after breast cancer diagnosis increases. The incidence of BCRL following breast cancer treatment varies due to a lack of -uniform definition and measurement criteria. This review aims to determine the prevalence of BCRL following axillary lymph node dissection (ALND) as a benchmark to be used in a risk-benefit medical decision whether to proceed with ALND or not. The risk of leaving unresected non-sentinel metastatic lymph nodes with a presumed inherent risk of local recurrence will be balanced against the risk of BCRL following a potentially unnecessary ALND.

Methods: Pubmed and Embase databases were searched for all publications on BCRL in order to estimate its -incidence and to decide on the most appropriate measurement method to use in clinical practice.

Results: 51 articles were identified on BCRL incidence and measurement technique. Most studies measured BCRL based on differences in arm circumference (n = 18) or by self-reported symptoms (n = 18). The weighted average of BCRL incidence following ALND measured by self-report and circumference method was 28% and 16%, respectively.

Conclusion: The importance of ALND and irradiation as part of the treatment of operable breast carcinoma is well established, but its morbidity is less well documented. We argue self-report as the most appropriate method to -establish a diagnosis of BCRL. Therefore a 28% risk of finding non-sentinel lymph node metastases in a completion ALND will be regarded as the cut-off in a medical decision to proceed with ALND.

No MeSH data available.


Related in: MedlinePlus

Incidence of BCRL assessed by arm circumference measurements and by self-report for the different studies with more than 12 months of follow-up and the weighted mean incidence.
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Figure 2: Incidence of BCRL assessed by arm circumference measurements and by self-report for the different studies with more than 12 months of follow-up and the weighted mean incidence.

Mentions: The overall weighted average incidence of BCRL was 16% (5% up to 33%) for the arm circumference method and 28% (11% up to 39%) for the self-report method (Table I, Fig. 2). Tables II and III summarize a total of 36 reports on BCRL incidence based on arm circumference and self-report respectively, following treatment for breast cancer including ALND. The studies are a mixture of retro- and prospective studies. Most studies were published after the year 2000 and included almost nineteen thousand patients.


Systematic review of breast cancer related lymphoedema: making a balanced decision to perform an axillary clearance.

Göker M, Devoogdt N, Van de Putte G, Schobbens JC, Vlasselaer J, Van den Broecke R, de Jonge ET - Facts Views Vis Obgyn (2013)

Incidence of BCRL assessed by arm circumference measurements and by self-report for the different studies with more than 12 months of follow-up and the weighted mean incidence.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3987359&req=5

Figure 2: Incidence of BCRL assessed by arm circumference measurements and by self-report for the different studies with more than 12 months of follow-up and the weighted mean incidence.
Mentions: The overall weighted average incidence of BCRL was 16% (5% up to 33%) for the arm circumference method and 28% (11% up to 39%) for the self-report method (Table I, Fig. 2). Tables II and III summarize a total of 36 reports on BCRL incidence based on arm circumference and self-report respectively, following treatment for breast cancer including ALND. The studies are a mixture of retro- and prospective studies. Most studies were published after the year 2000 and included almost nineteen thousand patients.

Bottom Line: Most studies measured BCRL based on differences in arm circumference (n = 18) or by self-reported symptoms (n = 18).We argue self-report as the most appropriate method to -establish a diagnosis of BCRL.Therefore a 28% risk of finding non-sentinel lymph node metastases in a completion ALND will be regarded as the cut-off in a medical decision to proceed with ALND.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics & Gynaecology, Ziekenhuis Oost-Limburg Campus St Jan, Schiepse Bos 6, 3600 Genk, -Belgium.

ABSTRACT

Aim: Breast cancer-related lymphoedema (BCRL) is a disabling complication developing after breast cancer treatment in a proportion of patients. Its impact on quality of life becomes more substantial as survival after breast cancer diagnosis increases. The incidence of BCRL following breast cancer treatment varies due to a lack of -uniform definition and measurement criteria. This review aims to determine the prevalence of BCRL following axillary lymph node dissection (ALND) as a benchmark to be used in a risk-benefit medical decision whether to proceed with ALND or not. The risk of leaving unresected non-sentinel metastatic lymph nodes with a presumed inherent risk of local recurrence will be balanced against the risk of BCRL following a potentially unnecessary ALND.

Methods: Pubmed and Embase databases were searched for all publications on BCRL in order to estimate its -incidence and to decide on the most appropriate measurement method to use in clinical practice.

Results: 51 articles were identified on BCRL incidence and measurement technique. Most studies measured BCRL based on differences in arm circumference (n = 18) or by self-reported symptoms (n = 18). The weighted average of BCRL incidence following ALND measured by self-report and circumference method was 28% and 16%, respectively.

Conclusion: The importance of ALND and irradiation as part of the treatment of operable breast carcinoma is well established, but its morbidity is less well documented. We argue self-report as the most appropriate method to -establish a diagnosis of BCRL. Therefore a 28% risk of finding non-sentinel lymph node metastases in a completion ALND will be regarded as the cut-off in a medical decision to proceed with ALND.

No MeSH data available.


Related in: MedlinePlus