Hot of the Press May 2025

Article to ponder

This retrospective cohort study investigated whether commonly prescribed chronic medications contribute to the risk of developing breast cancer-related lymphedema (BCRL) among 162 post-surgical breast cancer survivors. While no significant association was found between BCRL and the use of NSAIDs, steroids, antihypertensives, or hypoglycemics, the study identified overweight (BMI ≥ 25), hypertension, radiotherapy, and breast prosthesis implantation as independent risk factors for BCRL. These findings highlight the importance of targeted risk assessment and preventative strategies in managing BCRL among high-risk patients.

Commonly Prescribed Chronic Pharmacological Medications as Risk Factors for Breast Cancer-Related Lymphedema: An Observational Retrospective Cohort Study

Margherita B. Borg, Marco Battaglia, Laura Mittino, Alberto Loro, Laura Lanzotti, Lorenza Scotti, Giuseppina Gambaro, Marco Invernizzi, Alessio Baricich. Healthcare (Basel). 2025 Mar 21

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Key Takeaway: Breast prosthesis, radiotherapy, hypertension, and overweight were independently linked to higher BCRL risk, while common chronic medications showed no significant association.

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

Deep learning-based classification of lymphedema and other lower limb edema diseases using clinical images

Thanat Lewsirirat, Taravichet Titijaroonroj, Sirin Apichonbancha, Ason Uthatham, Veera Suwanruangsri, Nirut Suwan, Surakiat Bokerd, Tossapol Prapassaro, Wanchai Chinchalongporn, Nutcha Yodrabum. Sci Rep. 2025 Apr 11.

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Lymphoedema Development Following a Cancer Diagnosis: An Anonymised Data Linkage Study in Wales, United Kingdom

Ioan Humphreys, Alan Watkins, Ashley Akbari, Rowena Griffiths, Marie E. Gabe-Walters, Melanie J. Thomas, Cheryl E. Pike, Angela Williams, Tom Dobbs, John Gibson, Iain S. Whitaker, Hayley A. Hutchings. Int Wound J. 2025 Apr 16. 

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Prevalence and Risk Factors

Study on the relationship between lymphedema stage and related symptoms in patients with breast cancer after surgery

Yun Li, Yan Ma, Shengqun Hou, Xia Zhang, Yaqiong Chen, Youman Ma, Lichen Tang, Xiaoju Zhang, Zhenqi Lu, Jiajia Qiu. Gland Surg. 2025 Mar 26.

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Prospective 2 Year Review of Lymphedema Rates in Breast Cancer Patients Following Mastectomy, Axillary Clearance, and Immediate Free Flap Breast Reconstruction

M Anderson, D Hamilton, A Munnoch. Lymphology. 2024.

The reported incidence of lymphedema varies greatly among women treated for breast cancer, making counselling for surgery challenging. This study assessed the incidence of lymphedema in patients undergoing mastectomy and free flap reconstruction using robust, quantifiable, and replicable diagnostic criteria. Data on limb circumference, limb volume, and reported symptoms was collected prospectively pre-operatively, post operatively, and at 2 years. All patients undergoing skin sparing mastectomy with axillary node clearance and immediate free tissue breast reconstruction between 2009 and 20. were included. We followed 113 patients to 2-year follow-up. The prevalence of patients meeting two identifying criteria was highest in the immediate post-operative period at 11%, falling to 4% at 2 years. The proportion of patients meeting three criteria remained static from the post-operative period to two years at 7%, though the incidence declined over that period. All the patients with three identifying criteria post-operatively and at two years had received either chemotherapy or chemotherapy and radiotherapy. Clear diagnostic criteria are important for the accurate assessment and study of post operative lymphedema. It is possible that free tissue transfer could reduce the incidence of or delays the onset of lymphedema in patients undergoing mastectomy and axillary clearance.

Assessment

Evaluating observer reliability and diagnostic accuracy of CT-LEFAT criteria for post-treatment head and neck lymphedema: A prospective blinded comparative analysis

Natalie A. West, Serageldin K. Attia, Zaphanlene Kaffey, Cem Dede, Samuel L. Mulder, Dina M. El-Habashy, Roger Neuberger, Mohamed A. Naser, Steven J. Frank, Shitong Mao, Holly McMillan, Brad G. Smith, David Rosenthal, Stephen Y. Lai, Katherine A. Hutcheson, Amy C. Moreno, Clifton D. Fuller, MD Anderson Head and Neck Cancer Symptom Working Group. Oral Oncol. 2025 Apr 1.

BACKGROUND: Radiation-associated lymphedema and fibrosis (LEF) is a significant toxicity following radiation therapy (RT) for head and neck cancer (HNC) patients. Recently, the CT Lymphedema and Fibrosis Assessment Tool (CT-LEFAT) was developed to standardize LEF diagnosis through fat stranding visualized on CT. This study aims to evaluate the inter-observer reliability and diagnostic accuracy of the CT-LEFAT criteria.

MATERIALS AND METHODS: This study retrospectively evaluated 26 HNC patients treated with RT that received a minimum of two contrast-enhanced CT scans. Qualitative review was conducted by five physician raters to assess the fat stranding observed on CT according to the CT-LEFAT criteria. Fleiss’ kappa analysis was used to assess the inter- and intra-rater reliability, and Receiver Operating Characteristic (ROC) Area Under the Curve (AUC) analysis was used to evaluate diagnostic accuracy.

RESULTS: The inter-rater reliability across the six CT-LEFAT regions generally indicated a slight to fair agreement across all raters (0.04 ≤ kappa ≤ 0.36). Intra-observer agreement was generally fair to moderate (overall kappa = 0.44). The ROC AUC analysis varied based on aggregation method used (0.60 ≤ average AUC ≤ 0.70).

CONCLUSION: This specific use- case evaluating CT-LEFAT criteria displays limited performance. This suggests that additional materials, such as further training, refinement of imaging methods, or other processes may be required before achieving clinically-ready diagnostic performance of LEF diagnosis.:10.1016/j.oraloncology.2025.107265

Improving Precision of Bioimpedance Spectroscopic Analysis for Lymphedema and Lipedema Assessment

Leigh C. Ward, Katrina Gaitatzis, Belinda Thompson, Vincent Singh Paramanandam, Louise A. Koelmeyer. Lymphat Res Biol. 2025 Apr 14.

Background: Bioimpedance spectroscopy (BIS) is commonly used for the detection and monitoring of lymphedema and potentially lipedema. BIS measures limb electrical resistance, which decreases with fluid accumulation in these conditions. R0, the index of extracellular fluid and lymph accumulation, is typically estimated using Cole modeling, but technical and biological factors can affect accuracy.
Methods: Participants with clinically affirmed bilateral leg lymphedema, lipedema, self-ascribed swelling, and healthy controls were included in this study. Impedance measurements were taken using a stand-on BIS device, and R0 was estimated using both the Cole modeling method and a regression approach. Quality of data fitting was assessed visually and statistically.
Results: Control participants were younger and lighter compared with the clinical groups. The regression method was able to analyze 100% of participant data, whereas the Cole method was successful in only 80%-88% of cases in the lymphedema and lipedema groups. Additionally, the regression approach provided better curve fitting accuracy for all participants.
Conclusion: The regression method offers a robust alternative for estimating R0 values in BIS data, especially in lower limb assessments where data analysis is challenging. The small difference between methods in absolute R0 values (2.5%) has minimal practical implications, suggesting interchangeability in data analysis. The Cole method showed poorer performance, particularly in participants with lymphedema, possibly due to differences in water proportions and limb size. Overall, the regression method can be effectively used in clinical practice for estimating R0 values in BIS data, offering a more accurate and reliable approach than traditional Cole plotting methods.:10.1089.0086

Effects of Forearm Bandaging Technique, Muscle Contraction, and Additional Compression Pad Use on Sub-Bandage Pressure

Elif Sakizli Erdal, Miray Haspolat, Burak Erturk, Ilke Keser. Lymphat Res Biol. 2025 Apr 10.

Background: This study aimed to evaluate the effects of forearm bandaging techniques, muscle contraction, and additional compression pad use on sub-bandage pressure.
Methods and Results: Thirty-one individuals (26 females, 5 males) with no chronic or lymphatic-related conditions participated in the study. Sub-bandage pressure was measured using the Kikuhime device, with a standardized protocol applied to the wrist extensor muscle belly. Participants were evaluated under rest and wrist extension conditions using two bandaging techniques: spiral and figure-of-eight. Variations included single and double layers, 1/2 and 1/3 overlaps, and the presence or absence of additional compression pads. Certified physiotherapists trained performed all bandaging applications using short-stretch compression materials. The figure-of-eight wrapping technique consistently produced significantly higher sub-bandage pressures compared to the spiral technique in all conditions. Double bandaging generated 1.4 times more pressure than single-layer applications, while 1/3 overlap resulted in greater pressure than 1/2 overlap. The addition of compression pads increased resting pressure by approximately 5 mmHg, and wrist extension further augmented pressure by 4-8 mmHg. The highest pressures were observed with the figure-of-eight technique, double bandaging, and 1/3 overlap combined (p < 0.05).
Conclusions: These findings highlight the critical role of forearm bandaging technique, layering, and additional materials in determining sub-bandage pressure.:10.1089.0026

The Role of Bioelectrical Impedance Analysis in Predicting Secondary Surgical Interventions for Lymphedema

Wataru Otsuka, Shuhei Yoshida, Nanami Taketomi, Yasushi Orihashi, Isao Koshima. J Clin Med. 2025 Mar 21.

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Management Strategies

Insights from lymphoedema healthcare professionals managing lipalgia syndrome (lipoedema): a service evaluation

Garry Cooper, Jayne Williams, Marie E. Gabe-Walters, Nilofer Husain, Sian Clement-Wake, Melanie J. Thomas. Br J Community Nurs. 2025 Apr 1.Sup4)

BACKGROUND: Lipalgia syndrome, also known as lipoedema, is a chronic condition involving disproportionate adipose tissue accumulation with pain and tenderness.

AIM: This study explores the perceptions, challenges and needs of lymphoedema healthcare professionals supporting and managing patients with lipalgia syndrome/lipoedema in Wales.

METHODS: A service evaluation was conducted between March and June 2024, involving six face-to-face and one online session. Sixty registered and non-registered healthcare practitioners (HCPs) working in lymphoedema services across Wales participated in the evaluation.

RESULTS: Thematic analysis revealed challenges in differential diagnosis, gaps in evidence-based resources and emotional impact on practitioners. Key findings include HCPs feeling inadequate because of perceived limited treatment options and feeling unable to meet perceived patient expectations. However, increased empathy and transparent communication were identified as crucial for enhancing care delivery.

CONCLUSIONS: The study highlights the need for standardised diagnostic tools, evidence-based guidelines and interdisciplinary collaboration to support effective and empathetic care.:10.12968.0013

Wrapping up the evidence: bandaging in breast cancer-related lymphedema-a systematic review and meta-analysis

Celia García-Chico, Susana López-Ortiz, Carmen Lorenzo-Crespo, José Pinto-Fraga, Alejandro Santos-Lozano, Ana Domínguez-García. Breast Cancer. 2025 Mar 31.

BACKGROUND: The standard approach for breast cancer-related lymphedema (BCRL) is Complex Decongestive Therapy. This therapy involves various components, including the use of compression bandages to reduce swelling. Among these, multilayer bandage is the most frequently applied bandage in these patients. Nevertheless, alternative bandaging methods may also be effective. The current systematic review and meta-analysis of randomized-controlled trials (RCTs) aimed to compare the effectiveness of different bandaging techniques in patients with BCRL.
METHODS: A search was conducted in PubMed, Web of Science, and Scopus to identify RCTs that analyzed different bandaging techniques in patients with BCRL. The methodological quality of the RCTs was assessed using the Physiotherapy Evidence Database (PEDro). The meta-analysis was performed using RevMan 5.4 software, with standardized mean differences (SMDs) calculated by comparing change scores and standard deviations between intervention and control groups. This study was registered in PROSPERO (CRD42024597170).
RESULTS: A total of 21 RCTs were included in the systematic review (n = 1122) and five could be meta-analyzed (n = 239). The meta-analysis did not reveal significant differences in the reduction of the affected arm volume among different bandaging techniques, including multilayer, kinesio-taping, cohesive, and alginate bandage [SMD = – 0.04, 95% confidence interval – 0.30 to 0.21; p = 0.750; I2 = 0%].
CONCLUSIONS: The current scientific evidence does not suggest a clear advantage of one bandaging technique over another, including kinesio-taping and multilayer bandages. Further studies with larger sample sizes are warranted to better understand their potential benefits across the different stages and phases of BCRL management.:10.1007

Effects of resistance training on breast cancer-related arm lymphedema: a systematic review and dose-response meta-analysis

Luxin Wang, Yanfei Liu, Weihong Zhang, Yanlei Wang, Zhikai Zhai, Han Cheng, Nannan Yao. Support Care Cancer. 2025 Apr 17.

PURPOSES: This meta-analysis aims to (1) examine how resistance training affects lymphedema and muscle strength; and (2) evaluate the extent of improvement in lymphedema with different exercise dosages in breast cancer patients.
METHODS: Eight English and Chinese electronic databases were searched from their inception up to April 7, 2024. A dose-response meta-analysis was performed with R software. Egger’s regression analysis and funnel plots were utilized to assess the potential for publication bias.
RESULTS: Thirty studies were synthesized in the systematic review. Resistance training was found to reduce lymphedema (SMD = – 0.28; 95% CI = – 0.44 to – 0.15) and significantly enhance upper and lower limb muscle strength. High-intensity training [5 ~ 8 repetition maximum (RM)] with a frequency of four times per week and a duration of 120~180 min per week showed a larger effect on lymphedema compared to moderate- to low-intensity training (8 ~ 20 RM) with three or fewer sessions per week and a duration of up to 120 min. Additionally, exercise programs lasting 12 weeks were more effective than those lasting less than 12 weeks.
CONCLUSIONS: High-intensity resistance training is more effective than low-intensity training in reducing lymphedema and enhancing muscle strength. Breast cancer patients with lower tolerance to exercise intensity can achieve maximal benefits in improving lymphedema by appropriately increasing the frequency and duration of exercise. Additionally, patients are encouraged to exercise for at least 12 weeks to ensure the effects.:10.1007

The effect of exercise in patients with lower limb lymphedema: a systematic review

Merete Celano Wittenkamp, Jan Christensen, Anders Vinther, Carsten Bogh Juhl. Acta Oncol. 2025 Mar 31.-498

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The effect of muscles in the treatment of lower limb lymphedema: respiratory muscles or leg muscles?

Ahmet Akgul, İlknur Mazi, Gamze Aydin, Mumine Yavuz, İpek Yeldan. Support Care Cancer. 2025 Apr 11.

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The promising application of acupressure for management of cancer-related lymphedema: A scoping review

Aomei Shen, Mingfang Li, Hongting Ning, Gyumin Han, Giulia Castelli, Wanmin Qiang, Qian Lu, Nada Lukkahatai. Asia Pac J Oncol Nurs. 2025 Feb 13

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Exercise and cancer-related lymphedema in the lower limbs-a randomized cross-over trial on high-intensity interval training (HIIT) with and without compression garments

Merete Celano Wittenkamp, Carsten Bogh Juhl, Bo Zerahn, Anders Vinther. Support Care Cancer. 2025 Apr 16. 

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Adherence to Compression Garments in Lymphedema Patients: A Cross-Sectional Study.

Medina Rodríguez, M.E.; Socorro Suárez, R.; Albornoz Cabello, M.; Aranda Rodríguez, C.; Domínguez Trujillo, P.D.; Peña Curbelo, V.Medicina 2025, 61, 685

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A comprehensive review of photobiomodulation in cancer treatment.

Wang Q, Oh PS, Jeong HJ. From molecular mechanisms to clinical applications: Photochem Photobiol. 2025 Apr 21. doi: 10.1111/php.14107. Epub ahead of print. PMID: 40259459.

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