The clinical and demographical characteristics of Turkish pediatric lymphedema patients: a multicenter study.

BACKGROUND: Reducing lymphedema-associated burden and disability in the pediatric setting requires improved awareness and understanding clinical properties of the lymphedema. The aim of this study was to evaluate the clinical and demographic characteristics of patients with pediatric lymphedema presented to different lymphedema centers in Turkey. METHODS: The socio-demographic and clinical characteristics of the children including age, gender, presence of genetic syndromes, duration of edema, site and stage of lymphedema and the received therapies were determined. Parental and children education on self-management techniques were recorded. RESULTS: A total of 122 children (female: 66, male: 56) with a mean age of 120.7 ± 71.2 months were included from 7 centers. Of them; 92% had primary, 8% had secondary lymphedema mostly due to infection and trauma. Lymphedema was part of a syndrome in 18% of the children. The most common site of involvement was the lower extremity, followed by upper extremity and genital involvement. Lymphedema was complicated in 17 % of children, mainly with a clinical picture of cellulitis, infection, and pain. The median duration of lymphedema was 41 (5-216) months. Although most of the children had stage 2 lymphedema, only 40% of them received treatment. The most commonly received treatment was compression therapy. No family or child was educated for self- care management before. DISCUSSION: In conclusion, pediatric lymphedema has a comparable gender distribution and usually involves the lower extremities. Although most of the children had advanced disease, more than half of the patients did not receive any treatment indicating the unmet need for management of lymphedema. The education of patients and/or children about self-management methods were lacking. We suggest educational activities for both families of children with lymphedema and health care providers, in order to facilitate early reference to lymphedema units and to receive prompt preventive and therapeutic approaches for this suffering condition.

The Comparative Frequency of Breast Cancer-Related Lymphedema Determined by Bioimpedance Spectroscopy and Circumferential Measurements.

Objective: The survival of patients with breast cancer has prolonged due to early diagnosis and modern methods of treatment and lymphedema has become the most important morbidity secondary to the treatment of the disease. Early detection and timely intervention have potential to reduce advanced breast cancer-related lymphedema. The aims of this study were to comparatively determine the frequency of subclinical/clinical lymphedema by using prospective monitoring with bioimpedance spectroscopy (BIS) and circumferential measurements in a group of patients who underwent breast cancer surgery. Materials and Methods: Patients having breast cancer surgery were recruited between October 2018 and December 2019. Demographical and surgical properties were recorded. Extremity volumes by circumferential and BIS measurements were performed after surgery (baseline) and monitorizations were carried out at third and sixth months, in order to determine the frequency of subclinical/clinical lymphedema. L-Dex value of >6.5 was recently taken attention as subclinical lymphedema and values >7 were considered as clinical lymphedema. The presence of subclinical and clinic lymphedema was assessed by inter-limb volume difference (>5% and >10 respectively) based on the serial circumferential measurements in both affected and non-affected extremities. The functional status and quality of Life (QoL) were determined by quick-DASH and LYMQOL-Arm questionnaires respectively. The relationship between volume measurements, functional status and QoL scores were determined. Results: Eighty-two female patients with a mean age of 49.6 years were included to the study. 30 (36.5%) and 21 (25.6%) of patients were determined as having subclinical/clinical lymphedema by BIS, while 18 (21.9%) and 19 (23.1%) of patients had subclinical/clinical lymphedema by circumferentialmeasurements at third-and-sixth months respectively. The functional and QoL scores were not correlated with circumferential volume measurements and BIS scores. There was a moderate-high correlation with BIS and circumferential measurements. Conclusion: In conclusion 36.5% and 25.6% of our study group had subclinical and clinical lymphedema by BIS respectively during the 6 months surveillance period. Periodic monitoring of women with BIS allows early detection for lymphedema in more patients than in circumferential volume measurements, which may have implications for timely and necessary management.