Hot off the Press September 2021
We have collated some great articles and material published over the last month. Click on the links below to read the abstract or download the full paper.
Anatomy / Physiology /Pathophysiology
Pathological Changes in the Lymphatic System of Patients with Secondary Lower Limb Lymphedema Based on Single Photon-Emission Computed Tomography/Computed Tomography/Lymphoscintigraphy Images- click for abstract
Pathological Changes in the Lymphatic System of Patients with Secondary Lower Limb Lymphedema Based on Single Photon-Emission Computed Tomography/Computed Tomography/Lymphoscintigraphy Images
Diagnosis of Lymphatic Dysfunction by Evaluation of Lymphatic Degeneration with Lymphatic Ultrasound- click for abstract
Diagnosis of Lymphatic Dysfunction by Evaluation of Lymphatic Degeneration with Lymphatic Ultrasound
Hisako Hara, MD, PhD, and Makoto Mihara, M.LYMPHATIC RESEARCH AND BIOLOGY. Volume 19, Number 4, 2021
Background: The standard examination for diagnosing lymphedema is lymphoscintigraphy, which has a disadvantage in versatility and radiation exposure. We have reported the usefulness of echography in observing the
lymphatic degeneration. The purpose of this study was to investigate the usefulness of lymphatic ultrasound in
diagnosing lymphedema.
Methods and Results: The study included 14 patients (28 lower limbs) who underwent lymphaticovenous
anastomosis for lower limb lymphedema. Preoperative echography with a common 18-MHz linear probe was
used to detect lymphatic vessels. We evaluated abnormal expansion or sclerosis of lymphatic vessels in the
medial legs, which indicated the presence of lymphedema. We proposed the method ‘‘D-CUPS’’ on how to
detect and observe the lymphatic vessels. We then performed indocyanine green (ICG) lymphography to
diagnose lymphedema. The results of examination were compared. Stage 1 lymphedema was diagnosed in
9 limbs, Stage 2a in 7, Stage 2b in 8, and Stage 3 in 4. Lymphatic vessel detection was possible in all
28 medial thighs and in 27 medial lower legs. The sensitivity and specificity for diagnosis of lymphedema
based on echography of the medial leg were 95.0% and 100.0%, respectively. The accuracy rate was 94.6%.
We could detect lymphatic vessels with echography in 39 of 54 areas that failed detection using lymphoscintigraphy or ICG lymphography (72.2%).
Conclusion: The location and degeneration of lymphatic vessels in lymphedematous limbs can be evaluated
with a commonly used ultrasound device. Although exclusion of comorbidities is still necessary, lymphatic
ultrasound has potential for use in diagnosis of lymphedema or lymphatic dysfunction.
Genetic Determinants of the Effects of Training on Muscle and Adipose Tissue Homeostasis in Obesity Associated with Lymphedema- click for abstract
Genetic Determinants of the Effects of Training on Muscle and Adipose Tissue Homeostasis in Obesity Associated with Lymphedema
Andrea Vettori, PhD,1 Stefano Paolacci, PhD,2 Paolo Enrico Maltese, PhD,2 Karen L. Herbst, MD,3–6
Marina Cestari, MD,7,8 Sandro Michelini, MD,9 Serena Michelini, MD. LYMPHATIC RESEARCH AND BIOLOGY Volume 19, Number 4, 2021
It is widely accepted that metabolic changes associated with training are influenced by a person’s genetic background. In this review, we explore the polymorphisms underlying interindividual variability in response to training of weight loss and muscle mass increase in obese individuals, with or without lymphedema, and in normal-weight subjects. We searched PubMed for articles in English published up to May 2019 using the following keywords: (((physical training[Title/Abstract] OR sport activity[Title/Abstract]) AND predisposition[Title/Abstract]) AND polymorphism [Title/Abstract]). We identified 38 single-nucleotide polymorphisms that may modulate the genetic adaptive response to training. The identification of genetic marker(s) that improve the beneficial effects of training may in perspective make it possible to assess training programs, which in combination with dietary intervention can optimize body weight reduction in obese subjects, with or without lymphedema. This is particularly important for patients with lymphedema because obesity can worsen the clinical status, and therefore, a personalized approach that could reduce obesity would be fundamental in the clinical management of lymphedema.
Prevalence and Risk Factors
Prevalence and predictors of peripheral neuropathy after breast cancer treatment
Breast cancer-related lymphoedema: Risk factors and prediction model - click for abstract
Breast cancer-related lymphoedema: Risk factors and prediction model
A historical literature review on the role of posterior axillary boost field in the axillary lymph node coverage and development of lymphedema following regional nodal irradiation in breast cancer - click for abstract
A historical literature review on the role of posterior axillary boost field in the axillary lymph node coverage and development of lymphedema following regional nodal irradiation in breast cancer
Lymphedema and Post-Operative Complications after Sentinel Lymph Node Biopsy versus Lymphadenectomy in Endometrial Carcinomas—A Systematic Review and Meta-Analysis - click for abstract
Lymphedema and Post-Operative Complications after Sentinel Lymph Node Biopsy versus Lymphadenectomy in Endometrial Carcinomas—A Systematic Review and Meta-Analysis
Rianne J.A. Helgers 1, Bjorn Winkens 2, Brigitte F.M. Slangen 3 and Henrica M.J. Werner 3,*.J. Clin. Med. 2021, 10, 120
Background: Lymph node dissection (LND) is recommended as staging procedure in presumed low stage endometrial cancer. LND is associated with risk of lower-extremity lymphedema and post-operative complications. The sentinel lymph node (SLN) procedure has been shown to have high diagnostic accuracy, but its effects on complication risk has been little studied. This systematic review compares the risk of lower-extremity lymphedema and post-operative complications in SLN versus LND in patients with endometrial carcinoma.
Methods: A systematic search was conducted in PubMed and Cochrane Library.
Results: Seven retrospective and prospective studies (total n = 3046 patients) were included. Only three studies reported the odds ratio of lower-extremity lymphedema after SLN compared to LND, which was 0.05 (95% CI 0.01–0.37; p = 0.067), 0.07 (95% CI 0.00–1.21; p = 0.007) and 0.54 (95% CI 0.37–0.80; p = 0.002) in these studies. The pooled odds ratio of any post-operative complications after SLN versus LND was 0.52 (95% CI 0.36-0.73; I2 = 48%; p < 0.001). For severe post-operative complications the pooled odds ratio was 0.52 (95% CI 0.28–0.96; I2 = 0%; p = 0.04). Conclusions: There are strong indications that SLN results in a lower incidence of lower extremity lymphedema and less often severe post-operative complications compared to LND. In spite of the paucity and heterogeneity of studies, direction of results was similar in all studies, supporting the aforementioned conclusion. These results support the increasing uptake of SLN procedures in endometrial cancer.
Risk Factors for Lymphedema After Breast Conservation Therapy and Oncoplastic Reduction - click for abstract
Risk Factors for Lymphedema After Breast Conservation Therapy and Oncoplastic Reduction
Arvind U. Gowda, MD, James Nie, BS, Elbert Mets, BS, Michael Alperovich, MD, and Tomer Avraham, MD. Annals of Plastic Surgery, Volume 87, Number 3, September 2021.
Background: Lymphedema is a known complication after the surgical management of breast cancer, yet the incidence is poorly defined after breast conserving therapy and oncoplastic reduction. The primary aim of this study was to define lymphedema incidence in this population. Furthermore, we sought to correlate demographic factors, surgical approach, and complementary treatment modalities with incidence.
Methods: Data were collected retrospectively on patients who underwent breast conserving therapy at our institution from 2012 to 2015 with greater than 1 year of follow-up. Patients were excluded if they underwent breast surgery before treatment, completion mastectomy, delayed breast reconstruction, or delayed
breast reduction.
Results: Five hundred and eighty-four patients met study criteria with a 11% lymphedema rate. Patients developing lymphedema had higher preoperative body mass index (P = 0.02), larger breast mass resection volume (P < 0.01), higher rate of axillary dissection (P < 0.01), increased rate of adjuvant whole-breast radiation (P = 0.03), supraclavicular radiation (P < 0.01), axillary radiation (P < 0.01), and neoadjuvant medical therapy (P < 0.01). Multivariate analysis showed breast specimen mass, axillary radiation, and neoadjuvant medical therapy, which were associated with lymphedema (P < 0.05). There was no difference in lymphedema incidence between partial mastectomy and oncoplastic reduction cohorts with independent multivariate analyses for each showing axillary radiation and neoadjuvant medical therapy were significantly associated with lymphedema (P < 0.05), although breast specimen mass was not. Conclusions: Elevated preoperative body mass index, radiation, axillary dissection, and neoadjuvant medical therapy are associated with an increased risk of lymphedema after breast conserving surgery. Oncoplastic reconstruction is not a risk factor for lymphedema.
Risk factors of recurrent erysipelas in adult Chinese patients: a prospective cohort study - click for abstract
Risk factors of recurrent erysipelas in adult Chinese patients: a prospective cohort study
Ang Li1*, Ni Wang2, Lingzhi Ge3, Hongyan Xin4 and Wenfei Li. BMC Infectious Diseases (2021) 21:26
Background: Erysipelas is a common skin infection that is prone to recur. Recurrent erysipelas has a severe effect
on the quality of life of patients. The present study aimed to investigate the risk factors of recurrent erysipelas in
adult Chinese patients.
Methods: A total of 428 Chinese patients with erysipelas who met the inclusion criteria were studied. The patients
were divided into the nonrecurrent erysipelas group and the recurrent erysipelas group. Clinical data were collected on the first episode and relapse of erysipelas. The patients were followed up every 3 months. Statistical analysis was performed to analyze and determine the risk factors of erysipelas relapse.
Results: Univariate analysis was performed to analyze the data, including surgery, types of antibiotics administered in the first episode, obesity, diabetes mellitus, venous insufficiency, lymphedema, and malignancy. The differences between the groups were statistically significant (p < 0.05). The Cox proportional hazards regression model analysis showed that the final risk factors included surgery, obesity, diabetes mellitus, venous insufficiency, and lymphedema. Conclusions: Surgery, obesity, diabetes mellitus, venous insufficiency, and lymphedema are considered as risk factors for recurrent erysipelas.
Assessment
Impact of lymphadenectomy and lymphoedema on health-related quality of life one year after surgery for endometrial cancer. A prospective longitudinal multicentre study - click for abstract
Impact of lymphadenectomy and lymphoedema on health-related quality of life one year after surgery for endometrial cancer. A prospective longitudinal multicentre study
Sensory signs and symptoms in women with self-reported breast cancer-related lymphedema: a case-control study close up - click for abstract
Sensory signs and symptoms in women with self-reported breast cancer-related lymphedema: a case-control study close up
Management Strategies
Hemodynamic Responses in Lower Limb Lymphedema Patients Undergoing Physical Therapy
Manual Lymphedema Drainage for Reducing Risk for and Managing Breast Cancer-Related Lymphedema After Breast Surgery: A Systematic Review - click for abstract
Manual Lymphedema Drainage for Reducing Risk for and Managing Breast Cancer-Related Lymphedema After Breast Surgery: A Systematic Review
Effectiveness of Combined Complex Decongestive Therapy and Resistance Exercises in the Treatment of Lymphedema Associated with Breast Cancer and the Effect of Pain on Treatment Response - click for abstract
Effectiveness of Combined Complex Decongestive Therapy and Resistance Exercises in the Treatment of Lymphedema Associated with Breast Cancer and the Effect of Pain on Treatment Response
Mustafa Corum, MD,1 Ceyhun Basoglu, MD,2 Merve Damla Korkmaz, MD,3 Mustafa Aziz Yildirim, MD,1 and Kadriye Ones, MD, LYMPHATIC RESEARCH AND BIOLOGY Volume 19, Number 4, 2021.
Background: The aim of this study was to compare the effects of complex decongestive therapy (CDT)
accompanied by resistance exercises on extremity circumference, lymphedema volume, grip strength, functional status, and quality of life in the treatment of breast cancer-related lymphedema (BCRL) in patients with
and without pain.
Methods and Results: Fifty patients with unilateral BCRL were divided into groups: with pain (Group 1, n = 25)
and without pain (Group 2, n = 25). Thirty minutes of manual lymphatic drainage and multilayered short-stretch
bandaging were applied to all patients five times a week for 4 weeks. In addition, all patients were informed
about skin care and given a supervised resistance exercise program throughout the treatment. During the 1-
month follow-up period, patients were asked to use low-tension elastic garments and to continue their home
exercise program. Differences in upper extremity circumference and volume; grip strength; Quick Disabilities
of the Arm, Shoulder, and Hand; and Functional Assessment of Cancer Therapy-Breast scores were evaluated at
baseline, after treatment (week 4), and at 1-month follow-up. Moreover, the pain intensity of patients in Group 1
was measured using the visual analog scale (VAS). Patients in both Group 1 and Group 2 showed a statistical
improvement in all outcome measures after treatment and at follow-up ( p < 0.05); however, no significant
difference was observed between the groups ( p > 0.05). In Group 1, a statistically significant decrease was
observed in the VAS score both at the end of treatment (-1.7 – 0.9) and at 1-month follow-up (-3.5 – 1.2)
( p < 0.05).
Conclusion: Combined CDT and resistance exercises appear to be effective in BCRL patients both with and
without pain.
Treatment of Breast Cancer−Related Lymphedema Using Negative Pressure Massage: A Pilot Randomized Controlled Trial- click for abstract
Treatment of Breast Cancer−Related Lymphedema Using Negative Pressure Massage: A Pilot Randomized Controlled Trial
Riikka Lampinen, DPT,a Jeannette Q. Lee, PhD,b Janella Leano, DPT,a Christine Miaskowski, PhD,c Judy Mastick, MN,c Lisa Brinker, MA,a Kimberly Topp, PhD,d Betty Smoot, DPTScd. Archives of Physical Medicine and Rehabilitation 2021;102:1465−72.
Objective: To evaluate the efficacy of negative pressure massage treatment (NPMT) compared with manual lymphatic drainage (MLD) in women with chronic breast cancer−related lymphedema (LE). We hypothesized that NPMT would result in greater improvements in LE and upper limb function.
Design: Pilot single-blinded randomized controlled trial.
Setting: Health sciences university.
Participants: Of 64 women screened, 28 met eligibility requirements (ie, >18y of age; completed active treatment for breast cancer; had unilateral arm LE for ≥1y; were not receiving LE care; had stable LE) and were randomized to the NPMT (n=15) and control groups (n=13).
Interventions: The intervention group received NPMT and the control group received MLD; both received twelve 60-minute sessions over 4- 6 weeks.
Main Outcome Measures: Bioimpedance (lymphedema index [L-Dex] units]), limb volume (mL) calculated from limb circumference, and Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH) score.
Results: Outcomes were analyzed for 28 women. Compared to the MLD group, the NPMT group demonstrated greater improvement with a large effect size in L-Dex scores (P=.001; standardized mean difference [SMD]=-1.15; 95% confidence interval, – 1.96 to -0.35) and interlimb volume differences (P=.038; SMD= -0.83; 95% confidence interval, -1.60 to -0.05). Differences in DASH scores were not statistically significant (P=.067).
Conclusions: Compared to MLD, treatment with NPMT resulted in greater improvement in L-Dex scores and interlimb volume differences in women with a duration of unilateral upper limb LE of >1 year. Our findings need to be confirmed in a larger randomized controlled trial.