Ultrasound elastography as an objective diagnostic measurement tool for lymphoedema of the treated breast in breast cancer patients following breast conserving surgery and radiotherapy.

Ultrasound elastography as an objective diagnostic measurement tool for lymphoedema of the treated breast in breast cancer patients following breast conserving surgery and radiotherapy.

2012

Adriaenssens N, Belsack D, Buyl R, Ruggiero L, Breucq C, De Mey J, Lievens P, Lamote J.

Source

Physical Therapy Department, Universitair Ziekenhuis Brussel, Belgium ; Physical Therapy Department, Vrije Universiteit Brussel, Belgium.

Abstract

BACKGROUND:

Lymphoedema of the operated and irradiated breast is a common complication following early breast cancer treatment. There is no consensus on objective diagnostic criteria and standard measurement tools. This study investigates the use of ultrasound elastography as an objective quantitative measurement tool for the diagnosis of parenchymal breast oedema. 

PATIENTS AND METHODS: 

The elasticity ratio of the subcutis, measured with ultrasound elastography, was compared with high-frequency ultrasound parameters and subjective symptoms in twenty patients, bilaterally, prior to and following breast conserving surgery and breast irradiation. 

RESULTS: 

Elasticity ratio of the subcutis of the operated breast following radiation therapy increased in 88.9% of patients, was significantly higher than prior to surgery, unlike the non operated breast and significantly higher than the non operated breast, unlike preoperative results. These results were significantly correlated with visibility of the echogenic line, measured with high-frequency ultrasound. Big preoperative bra cup size was a significant risk factor for the development of breast oedema. 

CONCLUSIONS: 

Ultrasound elastography is an objective quantitative measurement tool for the diagnosis of parenchymal breast oedema, in combination with other objective diagnostic criteria. Further research with longer follow-up and more patients is necessary to confirm our findings.

PubMed

Omental flap for treatment of long standing lymphoedema of the lower limb: can it end the suffering? Report of four cases with review of literatures.

Feb 2013

Attash SM, Al-Sheikh MY.

Source

Department of Surgery, Ninava Medical College, Mosul University, Mosul, Iraq.

Abstract

We report our experience of four cases of long-standing unilateral, secondary lymphoedema of the lower limb, for which conservative treatment has failed, that were treated in our centre using pedicled omental flap. The four patients were followed for a period of 1 year after the procedures and frequent measurements of the circumference of the affected limb revealed a reduction in the circumference ranging between 50% in the first patient to 75% in the fourth patient together with an excellent functional improvement in terms of resuming walking, daily activities, sports and work. We think that pedicled omental flap is an important, relatively easy and safe option that deserves consideration in refractory cases of lymphoedema of the lower limb.

BMJ Case Reports

π-Shaped lymphaticovenular anastomosis for head and neck lymphoedema: A preliminary study.

Oct 2012

Ayestaray B, Bekara F, Andreoletti JB.

Source

Department of Plastic and Reconstructive Surgery, Nimes University Hospital, pl Pr Robert Debré, 30000 Nimes, France; Department of Plastic and Reconstructive Surgery, Breast Institute, 15, av Jean Jaurès, 90000 Belfort, France. Electronic address: bayestaray@yahoo.fr.

Abstract

BACKGROUND:

Head and neck lymphoedema secondary to jugular lymphadenectomy is a severe issue, without efficient solution. Successful treatment of lymphoedema of the upper and lower limbs has become possible with supermicrosurgical lymphaticovenular anastomosis. The technique based on two end-to-side anastomosis is named π-shaped lymphaticovenular anastomosis. We have evaluated this method for chronic head and neck lymphoedema.

METHODS:

From November 2010 to April 2011, four patients with a chronic head and neck lymphoedema were treated by π-shaped lymphaticovenular anastomosis. Three patients had a unilateral lymphoedema, and one patient had a bilateral lymphoedema. The mean age of the patients was 63.2 years (range, 46-77 years). The mean duration of the lymphoedemawas 2.6 years (range, 1-5). Every patient was operated under local anaesthesia through a face-lift skin incision. One π-shaped lymphaticovenular anastomosis was performed at each operative site.

RESULTS:

The average operative time to perform one π-shaped lymphaticovenular anastomosis was 1.9 h (range, 1.8-2.5). The calibre of lymphatic vessels used for lymphaticovenular anastomosis ranged from 0.3 to 0.7 mm (average, 0.5). A venous back-flow was found in seven lymphaticovenular anastomosis (70%). Three patients (75%) had a qualitative improvement of skin tissue and a significant circumferential reduction after surgery. The average circumferential differential reduction rate was 3.7% (range, 0.6-7.8) (p = 0.006). The average cross-sectional area differential reduction rate was 7.2% (range, 1.2-15.1) (p = 0.007). The average volume differential reduction rate was 6.9% (range, 2-14.8) (p = 0.05).

CONCLUSIONS:

The authors present a new option to treat head and neck lymphoedema. π-Shaped lymphaticovenular anastomosis is an effective method to reduce the severity of skin tissue fibrosis and lymphoedema volume. Further studies with larger groups of patients are required to confirm the outcome of this preliminary study. EBM Level = level 4.

Elsevier