Perioperative variations in indices derived from noninvasive assessments to detect postmastectomy lymphedema.

OBJECTIVE: This study aimed to clarify the variations in indices derived from noninvasive assessments for the early detection of postmastectomy lymphedema (LE) from 1 month preoperatively until 2 years postoperatively. METHODS: In total, 120 patients who underwent surgery for breast cancer in our institution were prospectively followed up with a questionnaire for arm swelling as well as with tape measurements, bioimpedance analysis (BIA), and skin and subcutaneous tissue ultrasound at 1 month before and 3, 6, 12, 18, and 24 months after surgery. RESULTS: Ninety-seven patients completed the study. Among 93 patients who did not present with LE, 9% complained of arm swelling even before surgery, and the incidence peaked at 17% at 6 months after surgery. There were no differences in the circumferences of the upper arm, forearm, and hand between sides throughout the study period. However, the postoperative circumference values of the upper arm only on the operation side were slightly increased compared with the preoperative values. The mean excess fluid in the arm on the operation side compared with the contralateral side, as assessed by BIA, was nearly zero throughout the study period. There were no differences in subcutaneous echogenicity or skin and subcutaneous thicknesses between the sides throughout the study period. However, time-dependent increases in subcutaneous thicknesses were noticed on both sides. Four patients (4.1%) developed LE. In three of these patients, abnormality in the BIA was recorded 6 to 12 months before presentation. Immediately after presentation, the common findings included BIA abnormality and increased subcutaneous echogenicity and skin thickness in the medial forearm. CONCLUSIONS: In this study, a complaint of arm swelling was not sensitive enough for detection of the early onset of LE because a certain number of patients constantly complained of this symptom. Measurements of circumference might help in the diagnosis of LE onset, but this method is not specific enough because these measurements are also affected by various factors. However, BIA and skin and subcutaneous ultrasound were identified as potential tools for the early detection of LE.

A novel arm sleeve for upper extremity lymphedema: a pilot study.

OBJECTIVE: To investigate the safety and efficacy of a novel arm sleeve composed of a conventional arm sleeve extending to a wider area of the body. MATERIALS AND METHODS: Five subjects with post-mastectomy upper extremity lymphedema, who had already been using their own arm sleeve, used a brand-new conventional arm sleeve for 2 weeks, followed by a novel arm sleeve for 2 weeks. The adverse events, arm-related symptoms, interface pressures, and subcutaneous fluid distributions observed by magnetic resonance imaging (MRI) were assessed. RESULTS: The use of the novel arm sleeve resulted in a graduated compression extending to the shoulder (forearm, 21.8 ± 3.7 mmHg; upper arm, 15.2 ± 3.3 mmHg; shoulder, 8.8 ± 3.1 mmHg). By eliminating the wring seen in the conventional arm sleeve, the disturbed proximal diffusion of the subcutaneous fluid and venous occlusion were successfully avoided, as confirmed by MRI. No adverse event or worsening of arm-related symptoms was reported. CONCLUSION: The novel arm sleeve seemed to provide graduated compression to a wider area, allowing improved subcutaneous fluid and venous drainage without any adverse events. Therefore, the novel arm sleeve may be recommended as a compression therapy option for upper extremity lymphedema.