Hot of the Press August 2025

Article to ponder

The findings reveal that deltopectoral lymph node drainage is significantly associated with protective collateral lymphatic drainage patterns, potentially reducing BCRL risk. This introduces the ptentail for the deltopectoral lymph node as a functional biomarker for identifying individuals at lower risk of developing lymphedema after breast cancer surgery.

The deltopectoral lymph node: a potential protective biomarker for breast cancer-related lymphedema

James E. Fanning, Angela Chen, Sarah Thomson, Elizabeth Tillotson, Aaron Fleishman, John A. Parker, Kevin Donohoe, Dhruv Singhal. Breast Cancer Res Treat. 2025 Jun 25.

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Key Takeaway: The deltopectoral lymph node may act as a protective biomarker against breast cancer-related lymphedema (BCRL) by facilitating lymphatic drainage via pathways spared during axillary surgery.

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.

Prevalence and Risk Factors

Impact of time elapsed since diagnosis on neuropathic symptoms, sexual function, lymphedema, and overall quality of life in ovarian cancer survivors (KGOG 3068)

Maitreyee Parulekar, Su Min Hyun, Kidong Kim, Hee Seung Kim, Yong-Man Kim, Sang Yoon Park, Chel Hun Choi, Jae-Hoon Kim. Obstet Gynecol Sci. 2025 Jul 2

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Development and validation of a predictive nomogram for postoperative upper limb lymphedema in breast cancer patients: a retrospective cohort study

Xuemei Luo, Jianrui Ye, Ting Xiao, Hu Jun, Tao Yi. Sci Rep. 2025 Jul 9. 

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A 5-year prospective assessment of risk factors for lower limb lymphedema after gynecologic cancer surgery

Kuniko Utsugi, Naoki Ishizuka, Hidetaka Nomura, Atsushi Fusegi, Hiroyuki Kanao. Sci Rep. 2025 Jul 21

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Factors associated with lymphedema volume in patients with unilateral lower extremity lymphedema

Gülbin Ergin, Ertan Şahinoğlu, Didem Karadibak. Phlebology. 2025 Jun 29.

Objective: We aimed to investigate demographic and clinical characteristics associated with lymphedema volume in this patient population.
Methods: This was a single centre, cross-sectional study. Eighty-six patients with unilateral lower extremity lymphedema were included. The dependent variable was lymphedema volume. The independent variables were age, body mass index, gender, employment status, smoking status, duration of lymphedema, history of infection, type of lymphedema, and the interactions between history of infection and smoking status and between history of infection and type of lymphedema.
Results: The interactions between history of infection and smoking status (B = 25.04, 95% CI [8.87, 41.22], p < .01) and between history of infection and type of lymphedema (B = 13.11, 95% CI [0.62, 25.60], p = .04) were associated with lymphedema volume. Being employed was associated with lower lymphedema volume (B = -10.53, 95% CI [-18.36, -2.70], p < .01). Age, body mass index, gender, and duration of lymphedema were not associated with lymphedema volume (p > .05).
Conclusions: In patients with unilateral lower extremity lymphedema, smokers or patients with primary lymphedema tend to have higher lymphedema volume when they experience an infection. Employed patients exhibit lower lymphedema volume compared to non-employed patients. Age, body mass index, gender, and duration of lymphedema are not associated with lymphedema volume.:10.1177/02683555251357141

Characterization of Physical Activity Levels in Female Breast Cancer Survivors: Relationship With Lymphedema (AtiLinf)

Alice Ralheta Duarte, Carla Martinho Neto, Leonor Prates, Pablo Lobo, Maria Teresa Tomás. J Phys Act Health. 2025 Jul 7:1-7.

The development of lymphedema (LE) is a major concern in breast cancer treatment, and it is crucial to understand the best ways to prevent and treat it. Physical activity has shown to be effective, safe, and feasible in controlling complications arising from treatments, as well as improving function and quality of life in breast cancer survivors. This study aimed to investigate the relationship between physical activity with grip strength and LE development in breast cancer survivors. A cross-sectional analytical study was conducted and women who had survived breast cancer between 1 and 5 years after surgery were selected. Participants completed the International Physical Activity Questionnaire Short Form, the volume of upper limb (UL) was measured by perimetry, handgrip strength was assessed with the JAMAR dynamometer, and the Actigraph accelerometer was placed on the waist. It was found that 50% of the sample was overweight, 28.3% were obese, and 52% of the participants had grip strength below the recommended level. They had an average energy expenditure of 1.2 (0.1) metabolic equivalents, 8.3 (1.8) hours/day of sedentary activity, and spent an average of 61% of their awake time in sedentary activity per day. Significant correlations were found between grip strength on the affected side and the difference in volume between the UL (rp = -.303, P = .041) as well as between body mass index (BMI) and the difference in volume between the UL (rp = .341; P = .020). Moreover, a significant correlation between BMI and the volume of the affected UL was found (rp = .848, P = .000). BMI and grip strength of the affected side were identified as significant predictors of LE, both with P values less than .05. Although physical activity cannot directly prevent LE, it may contribute by helping to control BMI and promote higher levels of grip strength, both of which are important factors in the prediction of LE.:10.1123-0509

Impact of internet-based nursing interventions on the prevention of postoperative lymphedema in breast cancer patients: a cohort study

Jia Yao, Rui Chen, Haiping Xu. Support Care Cancer. 2025 Jul 11.

PURPOSE: This study aimed to investigate the association between internet-based nursing guidance frequency and postoperative upper limb lymphedema risk in breast cancer patients, and identify influencing factors.
METHODS: A retrospective cohort study included 208 female patients who underwent breast and lymph node surgery (2020-2021). Univariate and multivariate logistic regression analyses were used to assess associations with lymphedema, defined as an arm circumference difference ≥ 2 cm. Internet-based guidance via WeChat included daily education manuals, weekly video exercises, and monthly assessments, with frequency categorized as 0, 1-2, or ≥ 3 times/week.
RESULTS: During a 12-month period, 24% (50/208) developed lymphedema. Multivariate analysis identified the following independent risk factors: high BMI (OR 7.924, 95% CI 3.197-19.638), axillary lymph node dissection (OR 6.144, 95% CI 2.117-17.838), radiotherapy (OR 4.209, 95% CI 1.615-10.971). Urban residents had a lower risk of lymphedema compared to rural residents (OR 0.394, 95% CI 0.168-0.923). Receiving guidance 1-2 times per week, compared with ≥3 times per week, was associated with a higher risk of lymphedema (OR 9.752, 95% CI 3.158-30.111); receiving no guidance, compared with ≥3 times per week, was also associated with an increased risk (OR 4.068, 95% CI 1.346-12.296). Socioeconomic factors (including lower education level and income) were correlated with a higher risk.
CONCLUSION: High BMI, axillary lymph node dissection, and radiotherapy are highly associated with the occurrence of lymphedema after breast cancer surgery, while urban residence and high-frequency internet-based nursing guidance are associated with a lower probability of lymphedema. Future randomized controlled trials are needed to validate the preventive effects of digital health interventions.:10.1007

Preventing Secondary Lymphedema: A Systematic Review and Meta-Analysis on the Efficacy of Immediate Lymphovenous Anastomosis

Chandler Hinson, Matthew Sink, Dominic Henn, Douglas Sammer, Andrew Y. Zhang, Jessica I. Billig, Edward Chang, Andrei Odobescu. J Surg Oncol. 2025 Jul 17.

BACKGROUND: Secondary lymphedema is a debilitating condition following oncologic lymphadenectomy. Despite advancements in rehabilitation and microsurgical interventions, there is no cure for lymphedema. Performing a lymphovenous anastomosis (LVA) at the time of a regional node dissection has been purported to reduce the risks of secondary lymphedema; however, there are conflicting studies and no clear consensus about the routine use of LVA for preventing lymphedema after lymphadenectomy. The present study aims to perform a comprehensive review and meta-analysis on immediate LVA for the prevention of secondary lymphedema.
METHODS: A systematic review and literature search were performed using PubMed, Embase, Web of Science, and Cochrane databases. Studies evaluating primary or immediate LVA in oncologic surgery were included. Studies with a control group were included in the meta-analysis.
RESULTS: Overall, 39 studies, including 3697 patients (1,722 LVA; 1975 control), met inclusion criteria. Seventeen of the studies were included in the meta-analysis. Pooled analysis across all studies revealed a secondary lymphedema incidence of 7.1% in the LVA cohort versus 35.0% in controls. Meta-analysis demonstrated a significant reduction in lymphedema risk with immediate LVA (RR: 0.31). Subgroup analysis confirmed strong protective effects in breast cancer patients (RR: 0.28) and a significant but lesser benefit in dermatologic malignancies (RR: 0.35).
CONCLUSION: Based on the current literature, immediate LVA at time of lymphadenectomy significantly reduces the risk of secondary lymphedema in patients undergoing oncologic treatment. Given these findings, patients undergoing multimodal oncologic treatment including radiation and surgical lymphadenectomy should be considered candidates for immediate LVA.:10.1002

Assessment

A New Indocyanine Green Lymphography Protocol for Assessment of Lymphedema in the Head and Neck

Hiroo Suami, Katrina Gaitatzis, Helen Mackie, Belinda Thompson, Fiona T. Blake, Dion Forstner, Puma Sundaresan, Roman Skoracki, Louise Koelmeyer. Otolaryngol Head Neck Surg. 2025 Jul 14.

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ICG Lymphography Confirms the Presence of an Alternative Lymph Drainage Pathway Following Long-Term Manual Therapy: A Case for Preserving Traditional MLD Approaches

Mary Wakefield, Jan Douglass, Diane Lacey, Neil B. Piller, Linda C. Blanchfield. Reports (MDPI). 2025 May 6

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Evaluation of Smartphones Equipped with Light Detection and Ranging Technology for Circumferential and Volumetric Measurements in Lower Extremity Lymphedema

Masato Tsuchiya, Kanako Abe, Satoshi Kubo, Ryuichi Azuma. Biosensors (Basel). 2025 Jun 12

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Establishing a Standard Method for Screening Lymphatic Ultrasound in Lymphedema Patients

Hisako Hara, Makoto Mihara. Plast Reconstr Surg Glob Open. 2025 Jun 25. Jun.

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High-Frequency Ultrasonography Imaging: Anatomical Measuring Site as Potential Clinical Marker for Early Identification of Breast Cancer-Related Lymphedema

Ivana Klarić-Kukuz, Danijela Budimir Mršić, Antonela Matana, Blaž Barun, Jure Aljinović, Maja Marinović-Guić, Ana Poljičanin. Biomedicines. 2025 Jun 6.

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At-Home Bioelectrical Impedance Analysis (BIA) Monitoring of Adult Females at Risk of Breast Cancer-Related Lymphedema: Nonrandomized One-Year Longitudinal Feasibility Study

Cheri Teranishi-Hashimoto, Monica Padilla, Yoomi Heo, Lori Bravi. JMIR Form Res. 2025 Jul 24

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Knowledge, belief, and practice in prevention of lymphedema in postoperative breast cancer patients and analysis of associated factors

Qinqin Li, Yunli Yan, Ying Luo, Xiaoli Chen. Front Public Health. 2025 Jun 2.

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The Qaly study: Quality of life and lower extremity lymphedema in 174 patients after inguinal lymphadenectomy

Brett A. Hahn, Alieske Kleeven, Milan C. Richir, Arjen J. Witkamp, Anke M. J. Kuijpers, Kristien B. M. I. Keymeulen, J. Henk Coert, Shan Shan Qiu, David D. Krijgh. Surg Oncol. 2025 Jul 7.

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The Importance of a Pre-treatment Baseline When Screening Patients for Breast-Cancer-Related Lymphedema

Steven L. Chen, Chirag Shah, John Boyages, Louise Koelmeyer, Frank A. Vicini, Sheila H. Ridner, Ann Surg Oncol. 2025 Jul 23.

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Development and Psychometric Testing of a Low Extremity Lymphedema Risk Management Behaviours Questionnaire for Patients With Gynecologic Cancer

Jing Chen, Xiaomin Zhang, Zijun Guo, Chaonan Jiang, Huiling Zhang, Zhiqi Yang, Siyu Guan, Yaqian Huang, Mingfang Li, Jun Yan. J Adv Nurs. 2025 Jul 7.

BACKGROUND: Lower extremity lymphedema (LEL) is a debilitating complication for patients with gynecologic cancer. A series of strategies have been recommended to mitigate the risk of LEL and improve patient outcomes; however, investigation into LEL risk management behaviours in this population is limited, and the absence of reliable and valid tools is an important reason.
AIMS: To develop and evaluate the psychometric properties of the lower extremity lymphedema risk management behaviours questionnaire (LELRMBQ) for Chinese patients with gynaecologic cancer. DESIGN: This was a methodological study.
METHODS: Initial items were generated using a literature review. The initial LELRMBQ was refined, and its content validity was evaluated by conducting two rounds of expert consultation and a pilot study. Psychometric testing of 389 participants recruited by convenience sampling was conducted from December 2022 to June 2023. Exploratory factor analysis (EFA; subsample 1, N = 158) and confirmatory factor analysis (CFA; subsample 2, N = 231) were performed separately to determine the multi-dimensional structure of the questionnaire. Known-group validity, internal consistency reliability, and test-retest reliability were also evaluated.
RESULTS: A total of 25 items with satisfactory content validity were included in psychometric testing. The EFA identified a four-factor structure, comprising 18 items, which explained 74.49% of the total variance. The CFA supported this structure with acceptable fit indices. Known-group validity was partially supported by significant differences in total LELRMBQ scores among groups with different education levels, residence, cancer type, and LEL awareness. Internal consistency and temporal stability were acceptable.
CONCLUSIONS: The 18-item LELRMBQ demonstrated sufficient reliability and validity as a tool for measuring LEL risk management behaviours in patients with gynaecologic cancer.
IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: The LELRMBQ has potential applicability in assessing LEL risk management behaviours, identifying gaps in educational practices, tailoring effective interventions, and evaluating intervention effectiveness.
REPORTING METHOD: This manuscript followed the STROBE guidelines.
PATIENT OR PUBLIC CONTRIBUTION: Patients with gynecologic cancer participated in this study and provided the data through the survey.:10.1111

Healthcare professionals understanding, perceptions and experiences of head and neck lymphoedema to promote self-management for patients following completion of head and neck cancer treatment: a qualitative study

Lauren J. Mullan, Nicole E. Blackburn, Jackie Gracey, Lynn Dunwoody, Jill Lorimer, Cherith J. Semple. J Cancer Surviv. 2025 Jul 16.

PURPOSE: Head and neck lymphoedema (HNL) is a chronic and often debilitating consequence of head and neck cancer (HNC) treatment. Despite the chronicity, it is often under-recognised and under-treated. There is a finite resource of specialists to provide HNL intervention, necessitating self-management as an important pillar of patient management. This study aims to explore healthcare professionals (HCPs) understanding, perceptions and experiences of HNL management to promote self-management and adherence to HNL interventions in patients following completion of HNC treatment.
METHODS: Eight focus groups were conducted with HCPs (n = 39) from different professional disciplines, acute and community settings and countries. Reflexive thematic analysis was adhered to in the development of key themes using an inductive approach.
RESULTS: Two main themes were established: (1) ‘Raising awareness of HNL as a chronic and complex condition’ and (2) ‘What are the solutions for promoting HNL self-management?’ Data demonstrated that HCPs lack confidence and understanding in providing HNL support. There was a lack of clarity towards roles and responsibilities of HNL management among HCPs, with many having a desire to be better equipped to promote patient self-management and adherence.
CONCLUSION: HCPs involved in care delivery of patients with HNC require education and training on HNL, to support patient and family engagement with HNL self-management. To advance adherence and compliance of HNL self-management, there is a need to develop a dedicated HNL self-management intervention, integrating theory and evidence.:10.1007

Magnetic resonance imaging in lymphedema: Opportunities, challenges, and future perspectives

Xiaolu Ren, Ling Li. Magn Reson Imaging. 2025 Jul 19.

Magnetic resonance imaging (MRI) has become a pivotal non-invasive tool in the evaluation and management of lymphedema. This review systematically summarizes its current applications, highlighting imaging techniques, comparative advantages over other modalities, MRI-based staging systems, and emerging clinical roles. A comprehensive literature review was conducted, covering comparisons with lymphoscintigraphy, ultrasound, and computed tomography (CT), as well as studies on the feasibility of multiparametric MRI sequences. Compared to conventional imaging, MRI offers superior soft tissue contrast and enables detailed assessment of lymphatic anatomy, tissue composition, and fluid distribution through sequences such as T2-weighted imaging, diffusion-weighted imaging (DWI), and magnetic resonance lymphangiography (MRL). Standardized grading systems have been proposed to support clinical staging. MRI is increasingly applied in preoperative planning and postoperative surveillance.These findings underscore MRI’s diagnostic precision and clinical utility. Future research should focus on protocol standardization, incorporation of quantitative biomarkers, and development of AI-driven tools to enable personalized, scalable lymphedema care.:10.1016/j.mri.2025.110461

Management Strategies

The Application Effect of Manual Lymphatic Drainage Combined with Adjustable Foam Particle Arm Sleeves in Patients with Stage I Upper Limb Lymphedema
Liping Zhang*, Qinghua Luo, Huizhen Zhang, Jinlan Li, Lijuan Zhang, Qiaoling Zhong# . Journal of Cancer Therapy > Vol.15 No.12, December 2024

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Using Virtual Therapy for Lymphedema and Disability Post-Mastectomy: Meta-Analysis with Systematic Review

Islam Bani Mohammad, Muayyad Ahmad. Breast Care (Basel). 2025 Jun 11

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