The LyBra score: A risk assessment tool to address targeted prevention against breast cancer – Related lymphedema

Abstract

Introduction

Nowadays, physicians have tools to prevent breast cancer-related lymphedema (BCRL) but there is no consensus on when to apply them. The authors analysed patient- and treatment-related risk factors to create the LyBra score, to identify patients that may benefit the most from BCRL preventive interventions.

Materials and methods

Patients were selected from cases of breast cancer treated from January 2019 to July 2022. Inclusion criteria were age above 18, breast cancer diagnosis and surgical treatment with lymph-node biopsy or axillary dissection. Recurrent cancers, inflammatory cancer, previous axillary surgery, bilateral cases and patients with primary lymphedema were excluded. Selected cases were assessed with the LyBra Score. Numerosity and distribution of expected BCRL were compared to the BCRL registered during the minimum follow-up of 2 years.

Results

During an average 41 months follow-up (range, 24–62), 131 cases (14 %) of BCRL were registered in the total 933 patients included in the study. According to LyBra score, expected BCRL cases were 149 (16 %), slightly higher but with no statistical significance. The major incidence of BCRL (40 cases in 47 patients) was registered in the high-risk group that included 5 % of the study population. A ROC curve was used to determine the diagnostic performance of the LyBra score and the AUC was 0.78 corresponding to a good discriminating ability.

Conclusion

By sorting patients into risk groups, the LyBra score offers a solution to the actual dilemma of timing and indication of the modern preventive-BCRL microsurgeries.