ASCO Breast: Lymphedema Diagnosis Should Take Patient Perception into Account

SAN FRANCISCO, Sept. 10 -- Arm measurements alone may not identify clinically relevant lymphedema for breast cancer patients after axillary lymph node dissection or sentinel biopsy, researchers said.

Lymphedema prevalence was 16% to 27% after axillary lymph node dissection and 3% to 5% after sentinel lymph node biopsy in a large study presented here at the American Society of Clinical Oncology's Breast Cancer Symposium.

However, patient perception of swelling often did not correlate with clinical measurement, reported Sarah A. McLaughlin, M.D., of Memorial Sloan-Kettering Cancer Center in New York, and colleagues.

Only 52% of patients with arm swelling of more than 2 cm reported experiencing it, whereas twice as many reported symptoms in their dominant arm as actually had measurable swelling (P=0.002).

Diagnosis "should incorporate both measurements and patient perceptions," Dr. McLaughlin said.

Although "lymphedema is one of the most feared complications of breast cancer surgery," definition and measurement of this complication have not been standardized, leading to wide ranges for incidence, she noted.

Her group prospectively followed 936 women with clinically node-negative breast cancer for a median of five years after they had sentinel lymph node biopsy (600, mean three nodes removed) or lymph node biopsy followed by axillary lymph node dissection (336, mean 19 nodes removed).

Measurements of both arms were taken for all women before the procedure and at follow-up. Lymphedema was also determined by patient report of perceived arm swelling during a standardized interview that also elicited risk factors and precautionary behaviors.

The prevalence of lymphedema was higher for axillary lymph node dissection than for sentinel lymph node biopsy regardless of the method used to define lymphedema. The respective findings were:

• 16% for axillary lymph node dissection versus 5% for sentinel lymph node biopsy when defined by arm swelling of more than 2 cm (P

The women most commonly avoided intravenous catheters (99% and 81%, respectively), blood pressure measurement (98% and 82%), and blood draws in the affected arm (99% and 82%). They also commonly avoided carrying a purse on the affected arm (33% and 26%) and picking up children (9% and 8%).

A substantial proportion of women who had had an axillary lymph node dissection also wore a compression garment on the affected arm (15%).

The clinical significance of one additional precautionary behavior is unknown and impact on quality of life warrants further study, she said.

Future studies should also correlate the number of nodes removed with lymphedema, commented Emiel J. Rutgers, M.D., Ph.D., of the Netherlands Cancer Institute in Amsterdam, who was a chair of the session at which the study was presented.