Indirect partial volumetry in breast cancer-related lymphoedema: Distribution of oedema and clinical-diagnostic implications

Introduction and objectives

Currently, the assessment of lymphoedema related to breast cancer (BCRL) is performed through the global perimeter volumetry. We implemented an additional system with partial measures (hand, forearm, and upper arm) that allows us to approximate the segmental distribution of oedema. We used this measurement tool to determine the oedema distribution and its evolution, as well as its possible impact on clinical assessment.

Methods

We carried out a retrospective observational study of the patients referred to our service with suspected BCRL.

Inclusion criteria

Unilateral breast cancer, availability of global and partial digital medical record, and follow-up for a minimum of 24 months.

Of the 210 selected patients, 190 were considered affected (≥10% excess volume). We analysed at three time points (initial, final, and peak involvement) the oedema distribution and segmental predominance and its relationship with the evolutionary course and the severity of the process. We subsequently examined, at the initial timepoint, the concordance of the global assessment with the partial assessment for the clinical classification of the 210 patients in the initial sample.

Results

The BCRL oedema was characteristically irregular, with the forearm being the most affected segment and the hand the least affected (RM ANOVA: p < 0.001). The irregularity was related to its severity (χ²: p < 0.001) and the evolutionary course (Student t-test: p < 0.005 for the hand). Overall, disagreement of 46.67% was observed between the clinical classification of the global and partial assessment.

Conclusions

This work supports the need to add partial volumetry to the commonly used global assessment.