Hot off the Press December 2023



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

Longitudinal Pattern of Lymphedema and Fibrosis in Patients with Oral Cavity or Oropharyngeal Cancer: A Prospective Study - click for abstract

Longitudinal Pattern of Lymphedema and Fibrosis in Patients with Oral Cavity or Oropharyngeal Cancer: A Prospective Study

Jie Deng, Mary S. Dietrich, Joseph M. Aulino, Robert J. Sinard, Kyle Mannion, Barbara A. Murphy. Int J Radiat Oncol Biol Phys. 2023 Nov 6.

PURPOSE: The study aimed to describe the prevalence, severity, and trajectory of internal lymphedema, external lymphedema, and fibrosis in patients with oral cavity or oropharyngeal (OCOP) cancer.

METHODS AND MATERIALS: 120 patients with newly diagnosed OCOP cancer were enrolled in a prospective longitudinal study. Recruitment was conducted at a comprehensive medical center. Participants were assessed at pre-treatment, end-of-treatment, 3-, 6-, 9-, and 12-month post-cancer treatment. Validated clinician-reported measures and CT imaging were used to assess the study outcomes.

RESULTS: 76 patients who completed the 9- or 12-month assessments were included in this report. 1) External lymphedema and fibrosis trajectories: The total severity score peaked between end-of-treatment and 3 months post-treatment; reduced gradually over time but did not return to baseline by 12 months post-treatment (p < .001). The longitudinal patterns of severity scores for patients treated with surgery only or with multimodality therapy were similar. 2) Internal swelling trajectories: All patients demonstrated a significant increase in sites with swelling immediately post-treatment. For patients treated with surgery only, swelling was minimal and returned to baseline by 9- to 12 months post-treatment. Patients receiving multi-modal treatment demonstrated a gradual decrease in number of sites with swelling during the 12-month post-treatment period yet remained significantly above baseline (p < .05). 3) CT imaging: Different patterns of changes in prevertebral soft tissue and epiglottic thickness were observed in the surgery-only and multimodality treatment groups during the 12-month post-treatment period. There were minimal changes in thickness in either region in the surgery-only group. Patients with multi-modal treatment had significant increases in thickness in both regions 3 months post-treatment which remained thicker at 12 months than it was at baseline (p <.001). CONCLUSION: Lymphedema and fibrosis are common complications of OCOP cancer therapy. Routine assessment, monitoring, and timely treatment of lymphedema and fibrosis are critical.

Development of predictive models for lymphedema by using blood tests and therapy data

Xuan-Tung Trinh, Pham Ngoc Chien, Nguyen-Van Long, Le Thi Van Anh, Nguyen Ngan Giang, Sun-Young Nam, Yujin Myung. Sci Rep. 2023 Nov 13.

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The Critical Role of Phlebolymphedema in Cellulitis Associated with Lymphedema: its Incidence and Economic Impact in a Large Real-World Population

Alexandra Tedesco, Thomas O’Donnell, Derek Weycker, Payam Salehi

J Vasc Surg Venous Lymphat Disord. 2023 Nov 15

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Prevalence and Risk Factors

Preventing lower limb lymphedema after pelvic lymphadenectomy with progressive resistance exercise training: A randomized controlled trial - click for abstract

Preventing lower limb lymphedema after pelvic lymphadenectomy with progressive resistance exercise training: A randomized controlled trial

Assessment

Optimal Cut-Off Value for Detecting Breast Cancer-Related Lymphedema Using Ultrasonography - click for abstract

Optimal Cut-Off Value for Detecting Breast Cancer-Related Lymphedema Using Ultrasonography

Seung Mi Yeo, Tae Kyung Kim, So Hyun Park, Chang-Hyung Lee. Lymphat Res Biol. 2023 Nov 16.

Background: We previously devised an ultrasonographic evaluation to calculate subcutaneous tissue cross-sectional area (△CSA). The reliability and accuracy of this method were demonstrated in healthy individuals and in patients with lymphedema. The purpose of this study was to estimate the optimal cut-off value of the ratio of the △CSA of the involved side (lesion side) to the contralateral side for detecting breast cancer-related lymphedema (BCRL) using ultrasonography.
Methods and Results: Ultrasonographic measurements were performed 290 times in 150 patients. BCRLD was defined as a confirmed difference of >2 cm in arm circumference. BCRL confirmed by a clinician (BCRLC) was defined as the patient group that included not only BCRLD but also patients with subcutaneous thickening and abnormal findings on lymphoscintigraphy, even if the difference in arm circumference was <2 cm. The △CSAs of both upper arms and forearms were calculated by measuring the thickness of the subcutaneous tissue at four locations using ultrasonography (superior, medial, inferior, lateral) at 10 cm above the elbow and 10 cm below the elbow. With a 1.35 △CSA ratio as the cut-off value for detecting BCRLD, the sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) were 0.88, 0.87, and 0.95, respectively. With a 1.20 △CSA ratio as the cut-off value for detecting BCRLC, the sensitivity, specificity, and AUC were 0.92, 0.89, and 0.97, respectively.
Conclusions: Our findings suggest that a 1.20 △CSA ratio as determined using ultrasonography, corresponding to a tape measurement of 1.05 cm, can be considered as a diagnostic criterion for lymphedema.

Evaluation of the Superficial Collecting Lymph Vessels’ Vasa Vasorum in Lymphoedematous Limbs Using Video Capillaroscopy - click for abstract

Evaluation of the Superficial Collecting Lymph Vessels’ Vasa Vasorum in Lymphoedematous Limbs Using Video Capillaroscopy

Chihiro Matsui a b, Reiko Tsukuura b, Hayahito Sakai b, Joseph M. Escandón c, Arbab Mohammad d, Takumi Yamamoto b. European Journal of Vascular and Endovascular Surgery. Available online 23 November 2023

Objective

The pre-collecting and collecting lymph vessels have smooth muscle cells, and sufficient perfusion is vital to maintain their function. Although the vasa vasorum of the collecting lymph vessels (VVCL) have been histologically investigated, little is known about their physiology. This study aimed to investigate the relationship between morphology and blood flow of the VVCL in lymphoedematous limbs.

Methods

Medical records of lower extremity lymphoedema patients who underwent video capillaroscopy observation during supermicrosurgical lymphaticovenous anastomosis (LVA) surgery were reviewed. The collecting lymph vessels, dissected for LVA, were examined under video capillaroscopy (GOKO Bscan-ZD, GOKO Imaging Devices Co., Japan) with a magnification of 175x and 620x. Blood flow velocity of the VVCL was calculated by measuring the red blood cell movement using software (GOKO-VIP ver. 1.0.0.4, GOKO Imaging Devices Co., Japan). Based on the video capillaroscopy findings, the VVCL were grouped according to their morphology; the VVCL morphology types and blood flow velocity were then compared according to lymphosclerosis severity grade.

Results

Sixty-seven lymph vessels in 20 lower extremity lymphoedema patients were evaluated, including s0 in 19 (28.4%), s1 in 34 (50.7%), s2 in 10 (14.9%), and s3 in four (6.0%) lymph vessels. The VVCLs were grouped into four types: type 1 (n = 4), type 2 (n = 37), type 3 (n = 19), and type 4 (n = 7). Blood flow velocity of the VVCL ranged 0 – 189.3 μm/sec (average 26.40 μm/sec). There were statistically significant differences in VVCL morphology (p < .001) and blood flow velocity (p < .001) according to lymphosclerotic severity.

Conclusion

Vasa vasorum of the collecting lymph vessels could be grouped into four types with different characteristics. Morphological and physiological changes of the VVCL were related to sclerotic changes of the collecting lymph vessels.

Imaging Modalities for Evaluating Lymphedema - click for abstract

Imaging Modalities for Evaluating Lymphedema

Bendeguz Istvan Nagy1, Balazs Mohos 2,3,4 and Chieh-Han John Tzou. Medicina 2023,59,2016

Lymphedema is a progressive condition. Its therapy aims to reduce edema, prevent its progression, and provide psychosocial aid. Nonsurgical treatment in advanced stages is mostly insufficient. Therefore—in many cases—surgical procedures, such as to restore lymph flow or excise lymphedema tissues, are the only ways to improve patients’ quality of life. Imaging modalities: Lymphoscintigraphy (LS), near-infrared fluorescent (NIRF) imaging—also termed indocyanine green (ICG) lymphography (ICG-L)—ultrasonography (US), magnetic resonance lymphangiography (MRL), computed tomography (CT), photoacoustic imaging (PAI), and optical coherence tomography (OCT) are standardized techniques, which can be utilized in lymphedema diagnosis, staging, treatment, and follow-up. Conclusions: The combined use of these imaging modalities and self-assessment questionnaires deliver objective parameters for choosing the most suitable surgical therapy and achieving the best possible postoperative outcome.

Relationship Between Kinesiophobia and Quality of Life Among Patients with Breast Cancer-Related Lymphedema: Chain-Mediating Effect of Self-Care and Functional Exercise Compliance

Qi Wang, Na Du. November 17, 2023. Asia-Pacific Journal of Oncology Nursing

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Management Strategies

Breast cancer survivors’ experiences of barriers and facilitators to lymphedema self-management behaviors: a theory-based qualitative study - click for abstract

Breast cancer survivors’ experiences of barriers and facilitators to lymphedema self-management behaviors: a theory-based qualitative study

Aomei Shen, Peipei Wu, Wanmin Qiang, Fei Zhu, Zijuan Zhang, Ying Wang, Qian Lu. J Cancer Surviv. 2023 Nov 16.

PURPOSE: Lifelong self-management plays a critical role in the prevention and management of lymphedema among breast cancer survivors. However, adherence to lymphedema self-management behaviors has remained suboptimal. Hence, we adopted a theory-informed method to elucidate the facilitators and barriers of lymphedema self-management for breast cancer survivors.
METHODS: In-depth semi-structured interviews were conducted between August and October 2022 in the lymphedema nursing clinic of a tertiary cancer hospital. The maximum variation sampling technique was used to ensure a diverse sample. The ITHBC (Integrated Theory of Health Behavior Change) framework was used to inform the interview outline and data analysis. Interview transcripts were coded line-by-line and mapped to domains in accordance with the ITHBC, using both deductive and inductive content analysis.
RESULTS: A total of 16 participants were interviewed (aged 35 to 67). Twenty-three themes (12 facilitators and 11 barriers) were mapped onto the three domains (knowledge and belief, social facilitation, and self-regulation skill and ability) of ITHBC as facilitators and barriers to lymphedema self-management. Three additional themes including limited treatment resources for lymphedema, inconvenience of lymphedema management, boredom and tedium of lymphedema self-management were categorized under the domain of other barriers.
CONCLUSIONS: Incorporating these findings into the ITHBC framework allows for a more systematic selection of theory-based strategies that may improve the design of effective lymphedema self-management interventions for breast cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS: Elucidating impact factors, especially facilitators and barriers, for lymphedema self-management adherence is essential for developing effective intervention programs to enhance breast cancer survivors’ lymphedema self-management behaviors

A Systematic Review of Kinesiology Taping in Patients With Lymphedema

Jaehee Yang , RN, CLT, MSc, Eun Jin Lim , MPH, PhD. Phys. Ther. Korea 2023; 30(4): 288-305

J Vasc Surg Venous Lymphat Disord. 2023 Nov 15

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