Hot of the Press March 2025

Article to ponder

This study found that chemotherapy significantly increases the risk of developing breast cancer-related lymphedema (BCRL), with taxane-based regimens posing the highest risk. Using a nationwide cohort from South Korea, researchers observed a 1.95 times higher BCRL risk in chemotherapy patients compared to those who did not receive it. The risk was particularly elevated in patients receiving taxanes, antimetabolites, or anthracyclines and was more pronounced in those with advanced cancer, lower income, or rural residence. These findings highlight the need for vigilant monitoring and tailored interventions to mitigate chemotherapy-related complications in breast cancer survivors.

Association between chemotherapy and the risk of developing breast cancer-related lymphedema: a nationwide retrospective cohort study

Sung Hoon Jeong, Seong Min Chun, Hyunji Lee, Miji Kim, Mira Choi, Ja-Ho Leigh. Support Care Cancer. 2025 Feb 3.

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Key Takeaway: Chemotherapy increases the risk of breast cancer-related lymphedema (BCRL), especially with taxane-based treatments. The risk is higher in patients with advanced cancer, lower income, or rural residence. Vigilant monitoring and tailored interventions are essential for high-risk groups.

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

The prognostic effect and mechanism of erysipelas in cancer-associated lymphedema

Peilin Li, Zimin Zhao, Yuguang Sun, Song Xia, Wenbin Shen. Sci Rep. 2025 Feb 14.

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Etiology of Leg Edema: A Tertiary Care Hospital Experience

SK Roy, AR Bhuiyan, RM Talukder, M Rahman… – Med. Sci, 2024

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Prevalence and Risk Factors

RELEVANT-C study: patient-reported prevalence of lower extremity lymphedema after sentinel lymph node mapping vs lymphadenectomy after surgery for early-stage cervical cancer

Kathryn M. Miller, Chrissy Liu, Qin Zhou, Alexia Iasonos, Ray Baser, Bhavani Ramesh, Yukio Sonoda, Jennifer J. Mueller, Vance Broach, Nadeem R. Abu-Rustum, Mario M. Leitao. Int J Gynecol Cancer. 2024 Dec 20.

OBJECTIVE: To compare the prevalence of patient-reported lower extremity lymphedema and evaluate patient-reported quality of life after sentinel lymph node mapping vs comprehensive lymphadenectomy with or without sentinel lymph node mapping for the surgical management of early-stage cervical cancer.
METHODS: In July 2022, we mailed a survey that included a validated 13-item lower extremity lymphedema screening questionnaire to patients who underwent lymph node evaluation at the time of primary surgery for the 2018 International Federation of Gynecology and Obstetrics stage IA1 to IIB cervical cancer between January 1, 2006, and January 31, 2019. We excluded patients diagnosed with lower extremity lymphedema prior to surgery and those who answered ≤6 survey items, and we carried out 2 group comparisons: sentinel lymph node mapping vs lymphadenectomy with or without sentinel lymph node mapping, and patients with lower extremity lymphedema vs patients without.
RESULTS: Of 459 potential participants, 90 (20%) responded to the survey, all of which were evaluable (37 sentinel lymph nodes; 53 lymphadenectomies ± sentinel lymph nodes). Self-reported lower extremity lymphedema prevalence was 10.8% (4/37) in the sentinel lymph node mapping group and 43.4% (23/53) in the lymphadenectomy with or without sentinel lymph node mapping group (OR 6.32, 95% CI 2.14 to 23.5, p = .002). Histologic subtype and number of lymph nodes removed were associated with increased prevalence of lower extremity lymphedema. After adjusting for the histology subtype, lymphadenectomy retained independent association with an increased prevalence of lower extremity lymphedema over sentinel lymph node mapping (OR 4.96, 95% CI 1.61 to 18.8, p = .009). Patients with self-reported lower extremity lymphedema had significantly worse quality of life compared to those without self-reported lower extremity lymphedema.
CONCLUSIONS: We found sentinel lymph node mapping to be independently associated with a significantly decreased prevalence of patient-reported lower extremity lymphedema and with improved quality of life in patients undergoing surgical management of early-stage cervical cancer.:10.1016/j.ijgc.2024.100063

Prevalence of lymphedema symptoms across cancer diagnoses and association with depression, pain interference and health-related quality of life

Gitte Sone Larsen, Christoffer Johansen, Annika Von Heymann, Bolette Skjødt Rafn. Acta Oncol. 2025 Jan 21.-95

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Insights into diet, psychological distress, and personality traits among patients with lower-extremity lymphedema and overweight/obesity in comparison to patients with lifestyle-induced overweight/obesity and patients with normal body weight

Małgorzata Jeziorek, Gabriela Kania, Ivana Stanimirova, Klaudia Konikowska, Andrzej Szuba, Angelika Chachaj. Obes Res Clin Pract. 2025 Jan 25.

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The incidence of and risk factors for axillary web syndrome with limited shoulder movement after surgery for breast cancer, and the effect of early physical therapy intervention

YH Chou, SF Liao, DR Chen, ST Chen, WT Wang – Discover Oncology, 2025

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External Validation of a 5-Factor Risk Model for Breast Cancer–Related Lymphedema

C Lin, J Su, AJ Wu, N Lin, MS Hossack, W Shi, W Xu… – JAMA Network Open, 2025

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Assessment

Combining indocyanine green lymphography and ultrasonography findings to identify lymphatic vessels in advanced-stage lymphedema: The milestone and swirl sign approach

Hidehiko Yoshimatsu, Min-Jeong Cho, Keita Inoue, Ryo Karakawa, Yuma Fuse, Akitatsu Hayashi, Tomoyuki Yano. J Plast Reconstr Aesthet Surg. 2025 Jan 20.-141.

BACKGROUND: Historically, lymphovenous bypass (LVB) is reserved for patients with early-stage lymphedema owing to the difficulty in identifying functional lymphatic vessels using indocyanine green (ICG) lymphography in patients with advanced lymphedema. Although ultrasound is useful in these patients, ultrasound mapping of the entire limb can be technically demanding and time-consuming. This study presents the use of ICG lymphography and ultrasound to identify functional lymphatics in patients with advanced-stage lymphedema.
METHODS: The “milestone sign” is defined as a high-intensity area that diminishes with the application of pressure during ICG lymphography. The “swirl sign” is defined as the appearance of a round, low-echo area rotating along a vessel on ultrasonography. Incisions were made when both signs were present in regions where no linear pattern could be seen. We performed retrospective review of patients who were treated using the milestone-swirl approach. Patient characteristics and perioperative data were analyzed.
RESULTS: Among the 19 patients, 47.4% had late ISL stage 2 lymphedema, followed by 26.3% with early ISL stage 2% and 26.3% with ISL stage 3 lymphedema. We identified functional lymphatic vessels in all 19 patients using the milestone-swirl sign approach. The average diameter of the lymphatic vessel was 0.78 mm and 89.4% patients demonstrated signs of ectasia.
CONCLUSION: Our study shows that the milestone-swirl approach is an effective tool in identifying functional lymphatic vessels in patients with advanced-stage lymphedema. By employing this approach, we believe that we can expand the indications for LVB beyond patients with early-stage lymphedema.:10.1016/j.bjps.2025.01.016

Evaluation of Disease Severity, Respiratory Muscle Strength, Respiratory Functions, Functionality, and Quality of Life in Patients With Upper Limb Lymphedema

Gamze Aydin, Emine Atici, Ezgi Yarasir, Songul Baglan Yentur, Muhammet Sahin Elbasti. Clin Breast Cancer. 2025 Jan 2.

OBJECTIVE: Lymphedema is a chronic, progressive disease that results from the accumulation of protein-rich fluid in the interstitial tissue spaces. The aim of this study is to assess disease severity, respiratory muscle strength, respiratory functions, pectoralis minor muscle shortening, functionality, and quality of life(QoL) in patients with upper limb lymphedema (ULL), and to compare these findings with healthy controls.
METHODS: The disease severity was assessed using the Stillwell classification system; respiratory muscle strength was measured through maximum inspiratory and expiratory intraoral pressures (MIP, MEP, respectively); respiratory functions were evaluated with a spirometer; muscle length of pectoralis minor (PM) was measured with a tape measure; functionality was assessed using the Disabilities of the Arm, Shoulder and Hand (DASH); and QoL was evaluated with the Lymphedema Quality of Life Questionnaire – Arm (LYMQOL-Arm). The participants were divided into 2 groups, patients with ULL in Group 1; the healthy individuals were included in Group 2.
RESULTS: The group 1 had lower values for MIP, MEP, FEV1, FVC, FEF25, FEF75, PEF, muscle length of PM, and DASH scores compared to group 2(p:0.018, p:0.010, P < .001, P < .001, p:0.001, p:0.043, P < .001, P < .001, P < .001, respectively). A negative correlation was found between disease severity and MIP, MEP, FEV1, FVC, and muscle length of PM (r:-0.598, r:-0.451, r:-0.458, r:-0.347, r:-0.498 (fair to good) respectively, P < .05). A positive correlation was observed between disease severity and LYMQOL-Arm (r:0.496 (good), P < .05).
CONCLUSION: Patients with ULL were found to be impaired in respiratory muscle strength, respiratory function tests, functionality and muscle length of PM compared to healthy individuals.:10.1016/j.clbc.2025.01.008

Clinimetric properties of clinical objective measurement methods for screening, diagnosis, and/or evaluation of lower limb lymphoedema: a systematic review with narrative synthesis of results

Tessa De Vrieze, Nele Devoogdt, Ceren Gursen, An-Kathleen Heroes, Charlotte Van Calster, Nick Gebruers, Sarah Moonen, Ad Hendrickx, Janine Hidding. Disabil Rehabil. 2025 Feb 13.-16.

PURPOSE: To offer a summary of the clinimetrics of measurement methods used for screening, diagnosis, and evaluation of lower limb lymphoedema (LLL).
MATERIALS AND METHODS: Data sources: According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline, a systematic literature search was conducted in PubMed, Web of Science, and EMBASE. Searches were performed on 1 December 2022 and reconducted on 18 July 2024. Study selection: Studies in patients with (or at risk for) LLL, whether or not compared to healthy controls. Data extraction: Quantitative data on clinimetric properties.
RESULTS: Twenty-three papers were included and divided in papers reporting on clinimetrics of methods assessing swelling, skin properties, local tissue water, and intra- and extracellular fluid. Water displacement, opto-electronic volumetry, and circumference measures seem to be reliable measurement methods to be applied in clinical practice. Circumference measures (with 8 cm interval) is a time-efficient method with few practical limitations.
CONCLUSIONS: Based on the little literature available in patients with LLL, we recommend to select different methods assessing more than one lymphedoema characteristic to get a clear overview on the patient’s lymphoedema status. At this moment, literature is still unclear on the use of specific measurement methods in LLL. More research regarding validity, responsiveness, and feasibility is needed.:10.1080/09638288.2025.2459891

Lymphedema, Fatigue, and Quality of Life in Breast Cancer Survivors with Axillary Lymph Node Dissection

S ACIKGOZ ORHAN, E OZSAKER – Lymphatic Research and Biology, 2025

Introduction: Health-related quality of life (QOL) has gained importance due to the increasing incidence of breast cancer and the survival rate of breast cancer patients. We aimed to investigate the relationship between lymphedema, fatigue, and QOL in breast cancer survivors with axillary lymph node dissection.
Methods: A total of 122 female breast cancer survivors with axillary lymph node dissection who applied to the oncology center of a teaching and research hospital between April 1, 2022, and July 1, 2022, were included in the cross-sectional study. An individual identification form, the EQ-5D General Quality of Life Scale, and the Cancer Fatigue Scale were used to collect data. Mann–Whitney U test, Kruskal–Wallis H test, Bonferroni post hoc test, and Spearman’s correlation were used to assess differences between the survivor groups.
Results: The study found that 40.2% of breast cancer survivors experienced lymphedema. The mean scores on the EQ-5D index, Visual Analogue Scale (VAS), and Cancer Fatigue Scale were 0.27 ± 0.25, 71.12 ± 14.21, and 35.86 ± 6.98, respectively. The Cancer Fatigue Scale total score and the EQ-5D VAS showed a strong positive correlation (r = 0.630; p < 0.05). Conversely, the total Cancer Fatigue Scale and the EQ-5D VAS scores showed a significant negative correlation (r = −0.626; p < 0.05).
Conclusions: The study found that almost half of the breast cancer survivors experienced lymphedema. They also had excellent general health, moderate fatigue, and a good overall QOL.

Objective Assessment of the Cardiorespiratory Fitness Among Individuals With Lymphedema and Lipedema: A Systematic Review and Meta-Analysis

Amirparsa Vanaki, Amirhossein Fallah, Negin Rahimidanesh, Arian Ashnaei, Mohammad Mahdi Naghadian Moghaddam, Mohammad Shahrabi Farahani, Masood Soltanipur, Hossein Yarmohammadi. Int J Vasc Med. 2025 Feb 13

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Predictive modeling of breast cancer-related lymphedema using machine learning algorithms

Y Sun, X Xia, X Liu – Gland Surgery, 2024

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Physical function assessment scales used in the rehabilitation of lower extremity lymphedema: A scoping review

Y Fujimoto, Y Yuri, H Tamiya. LYMPHOEDEMA RESEARCH AND PRACTICE, Vol. 12, No. 1. pp13〜20, 2024

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A Systematic Review of Indocyanine Green Lymphography (ICGL) Imaging for the Diagnosis of Primary Lymphoedema

G Brezgyte, M Mills, M van Zanten, K Gordon… – British Journal of Radiology, 2025

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Management Strategies

The Intermittent Pneumatic Compression Influences Edema Fluid Movement and Promotes the Compensatory Drainage Pathways in Patients with Breast Cancer Related Lymphedema

Marzanna T. Zaleska, Natalia E. Krzesniak. Lymphat Res Biol. 2025 Jan 27.

Introduction: Upper limb lymphedema is the most common complication after breast cancer therapy. Suddenly disturbed lymphatic transport in the affected arm causes tissue fluid accumulation in tissue spaces, limb enlargement, and secondary changes in tissue. Early compression therapy is necessary. We aim to evaluate the effectiveness of intermittent pneumatic compression (IPC) in fluid movement along the limb and the possibility of creating compensatory drainage pathways.
Methods and Results: We investigated 25 patients with Breast Cancer Related Lymphedema (BCRL) stages II and III. Indocyanine green observation and measurement of skin water concentration and skin and subcutaneous tissue stiffness were done before and after a single 45-minute session of IPC. After IPC, we observed the movement of edema fluid upper in the arm (92%) and in three main directions not seen before IPC: to the ipsilateral supraclavicular lymph node (30%), to the ipsilateral axilla (22%), and to the axilla, chest, and scapula (26%). We noticed two changes in fluorescent intensity along the entire limb: a decrease in the hand and forearm, an increase in the arm (64%), and a decrease along some parts or the entire limb (36%). Skin and subcutaneous tissue stiffness decreased at all limb levels. The highest, statistically significant reduction of subcutaneous tissue stiffness was noticed in the middle forearm and elbow (36.4% and 33.4%, respectively).
Conclusions: IPC can effectively move edema fluid from the distal to the proximal part of the limb, promote compensatory drainage pathways, and decrease tissue stiffness. This compression type should be applied even in the early stages to prevent limb enlargement and secondary tissue changes.:10.1089.0061

Compression terms: Defining terminology of compression therapy – An international compression club consensus document

Giovanni Mosti, Jean P. Benigni, Serge Bohbot, Nele Devoogdt, Isabel Forner-Cordero, Eduardo da Matta, Didier Rastel, Claas Roes, Sara Thomis. Phlebology. 2025 Feb 4.

BACKGROUND: The terminology in compression therapy is not always consistent. Confusion arises from layers, components, materials, whether elastic or inelastic, stiff or not stiff, compression class, and other terms. The aim of this paper is to define a standard terminology for compression therapy.

METHOD: the International Compression Club (ICC) board members prepared a draft consensus paper, which was circulated among the ICC members and refined by GM according to the comments and suggestions received.

RESULTS: All the terms used in compression therapy, from the definition to the materials, compression kits or systems, their physical properties, compression pressure, compression characteristics, and components and layers, were considered and agreed upon.

CONCLUSIONS: The given definitions allow for consistent classification of compression materials or devices. The International Compression Club hopes that the proposed terminology will be widely accepted and that papers and congress presentations on compression will use precise terminology.:10.1177/02683555241313422

Preventive effects of progressive resistance training of different intensities on breast cancer-related lymphedema

Zirui Zhang, Luyan Guo, Lizhi Zhou, Xijun Hao, Yijing Fan, Hong Li, Huiqian Xu, Jiwei Hu, Aijun Du, Yaqi Wang. Support Care Cancer. 2025 Feb 14.

PURPOSE: Explore the preventive effects of varying intensity progressive resistance exercise on breast cancer-related lymphedema.
METHODS: A total of 114 breast cancer patients who underwent axillary lymph node dissection at Tangshan People’s Hospital from January to April 2024 were included. Participants were randomly assigned to three groups: the control group received conventional care; intervention group 1 received conventional care + low-intensity progressive resistance exercise; and intervention group 2 received routine nursing + moderate and high-intensity progressive resistance exercise. Body composition and grip strength were assessed pre-intervention, post-intervention, and at 3 and 6 months follow-up to compare differences among the groups.
RESULTS: (1) Body composition: At post-intervention, 3 and 6 months follow-up, segmental water differences and extracellular water ratios, along with 1- and 5-kHz SFBIA in both intervention groups, were lower than in the control group. Intervention group 2 had a lower extracellular water ratio than group 1 at post-intervention, and at 3 months follow-up, group 2 showed lower water differences and extracellular water ratios than group 1, with slight variations at 6 months (P < 0.001). (2) Grip strength: At post-intervention, 3 months and 6 months follow-up, grip strength in intervention group 1 and intervention group 2 was higher than that in control group, and the difference was statistically significant (P < 0.001).
CONCLUSION: Resistance exercise enhances muscle strength and prevents lymphedema, with moderate-high-intensity exercise proving more effective than low intensity. Adverse events were minimal, suggesting that increasing resistance exercise intensity, while considering participants’ conditions, may yield better preventive outcomes.:10.1007

Fluid Distribution: Response to Intermittent Pneumatic Compression in People With and Without Primary Lymphedema

JJ Phillips, SJ Gordon – Lymphatic Research and Biology, 2025

Background: Current understanding of changes in fluid distribution in response to the application of compression in primary lymphedema (PLE) is limited. This study measured fluid distribution before and after one application of standardized intermittent pneumatic compression (IPC) in the lower limbs of people with PLE, compared with those without lymphedema. High-frequency ultrasound (HFU) was used to measure dermal fluid, bioimpedance to measure segmental fluid, and percent water content (PWC) to measure fluid at specific anatomical points.
Methods and Results: Fifteen people with PLE aged 11–40 years were matched for age, gender, and ethnicity to a person without lymphedema (NLE). PWC and HFU measures (low echogenic pixels) were taken bilaterally on the posterior leg and dorsum of the foot. Segmental bioimpedance (Extracellular Fluid/Intracellular Fluid, ECF/ICF) was measured in the foot, leg, and lower limb. Differences between groups, using the affected leg of unilateral and the more affected leg of bilateral PLE, were analyzed using the mixed ANOVA. There was significantly less ECF/ICF in the leg of NLE (p = 0.005) and PLE (p = 0.022) following IPC, and in the whole treated lower limb of NLE (p = 0.013), but no change in the treated limb of PLE. In contrast, the untreated limb showed significantly higher ECF/ICF in PLE (p = 0.040), a change not seen in NLE.
Conclusions: The lack of response to compression in the foot, commonly affected in PLE, and the increase in fluid in the untreated PLE limb, indicates the need for further investigation of the effect of compression on fluid distribution in PLE.

Impact of Physical Exercise on Breast Cancer-Related Lymphedema and Non-Invasive Measurement Tools: A Systematic Review

Marta Arias-Crespo, Rubén García-Fernández, Natalia Calvo-Ayuso, Cristian Martín-Vázquez, Maria de Fátima da Silva Vieira Martins, Enedina Quiroga-Sánchez. Cancers (Basel). 2025 Jan 20

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Research trends on lymphedema after mastectomy for breast cancer patients from 2000 to 2023: a scientometric analysis

Ling Chen, Yuxian Zheng, Daitian Zheng, Zhiyang Li, Hongwu Chen, Chujun Chen, Shuxian Yu. Front Oncol. 2025 Feb 4.

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Physiotherapy Protocol to Reduce the Evolution Time of Axillary Web Syndrome in Women Post-Breast Cancer Surgery: A Randomized Clinical Trial.

JBG Rubiño, R Martín-Valero, MJ Viñolo-Gil – 2025

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The Biophysical Impact of an Alternating Compression Profile

S Ehmann – 2024. Thesis

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Current role of pneumatic compression therapy in lymphedema care: a scoping review of persistent debates and new applications

SK Pandey, BB Ozmen, S Morkuzu, Y Xiong, E Kemp… – Lymphology, 2025

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The Promising Application of Acupressure for Management of Cancer-Related Lymphedema: a Scoping Review

A Shen, M Li, H Ning, G Han, G Castelli, W Qiang, Q Lu… -Asia-Pacific Journal of Oncology Nursing, 2025

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