Breast lymphedema following breast-conserving treatment for breast cancer: current status and future directions

Cheryl L. Brunelle, John Boyages, Amanda W. Jung, Hiroo Suami, Brooke C. Juhel, Asha Heydon-White, Helen Mackie, Shinn-Huey Shirley Chou, Vincent S. Paramanandam, Louise Koelmeyer, Alphonse G. Taghian

Research output: Contribution to journalReview articlepeer-review

Abstract

Purpose: To examine the current evidence on breast lymphedema (BL) diagnosis and treatment after breast-conserving surgery, identify gaps in the literature, and propose future research directions.

Methods: A comprehensive literature review was conducted using Ovid, PubMed, and Cochrane, including studies published between 2000 and 2023. References were reviewed manually for eligible studies. Inclusion criteria were as follows: patients who underwent breast conserving treatment (surgery ± radiation) for breast cancer, goals of the paper included analyzing or reviewing BL measurement with ultrasound or tissue dielectric constant, or BL treatment. Twenty-seven manuscripts were included in the review.

Results: There is variation in incidence, time course, and risk factors for BL. Risk factors for BL included breast size, primary and axillary surgery extent, radiation, and chemotherapy but require further investigation. Diagnostic methods for BL currently rely on patient report and lack standardized criteria. Tissue dielectric constant (TDC) and ultrasound (US) emerged as promising ambulatory BL assessment tools; however, diagnostic thresholds and validation studies with ICG lymphography are needed to establish clinical utility. The evidence base for treatment of BL is weak, lacking high-quality studies.

Conclusion: The natural history of BL is not well defined. TDC and US show promise as ambulatory assessment tools for BL; however, further validation with lymphatic imaging is required. BL treatment is not established in the literature. Longitudinal, prospective studies including pre-radiation measurements and validating with lymphatic imaging are required. These data will inform screening, diagnostic criteria, and evidence-based treatment parameters for patients with BL after breast-conserving surgery and radiation.

Original languageEnglish
Pages (from-to)193-222
Number of pages30
JournalBreast Cancer Research and Treatment
Volume204
Issue number2
Early online date15 Dec 2023
DOIs
Publication statusPublished - Apr 2024

Keywords

  • Breast lymphedema
  • Lymphatic imaging
  • Indocyanine green
  • Ultrasonography
  • Mammary
  • Tissue dielectric constant
  • Review

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