Researchers have developed a tool that considers several patient and treatment characteristics in order to predict the risk of lymphedema after axillary lymph node dissection (removal of several under-the-arm lymph nodes) for breast cancer. These results will be presented at the 2011 Breast Cancer Symposium.
Lymphedema refers to swelling due to an accumulation of lymph fluid. Women with breast cancer may develop lymphedema in an arm after axillary lymph nodes are removed. More extensive removal of lymph nodes (known as axillary lymph node dissection) is more apt to cause lymphedema than the removal of only a small number of nodes (known as a sentinel lymph node biopsy), but lymphedema can occur following either procedure.
Roughly one-third of women who undergo axillary lymph node dissection develop lymphedema. Tools to help manage lymphedema include manual lymphatic drainage, use of compression bandages and garments, training in skin and nail care (in order to reduce the risk of infection), and instruction in exercises.
Among women who undergo axillary lymph node dissection, it’s been uncertain why some women develop lymphedema and others don’t. In order to predict which women are at highest risk of lymphedema, researchers explored how lymphedema risk varied by patient characteristics and type of cancer treatment.
Factors that were linked with lymphedema risk included age, body mass index, infusion of chemotherapy into the arm on the same side of the body as the breast cancer, extent of lymph node removal, location of the radiotherapy field, postoperative seroma (fluid build-up), infection, and early edema (swelling). An initial estimate of lymphedema risk can be obtained prior to surgery, and risk estimates can then be modified based on information collected after surgery.
The statistical models had an accuracy of more than 70% for the prediction of lymphedema. Although these models continue to be refined, they could eventually provide important tools for counseling and managing women before and after axillary lymph node dissection.
Reference: Bevilacqua JLB, Kattan MW, Yu C et al. Nomograms for predicting the risk of arm lymphedema after axillary dissection in breast cancer. Paper presented at: 2011 Breast Cancer Symposium; September 8-10, 2011; San Francisco, CA. Abstract 8.
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