Lymphoedema study

31 March 2012

Purpose

The main purpose of this study was to assess the Waikato incidence of lymphoedema in patients who had undergone axillary node dissection and how the individual symptoms described by patients compare with measurements (using a tape measure) of arm circumferences. Other aims of this Waikato study were to investigate the relationship between risk factors and the incidence of lymphoedema and to establish an easy and convenient way to detect lymphoedema in patients seen in surgical clinics.

Scientific Title

A cross-sectional study to evaluate the local incidence of lymphoedema and sensory changes following surgery for breast cancer.

Background

A serious side effect of axillary node dissection surgery is lymphoedema (arm swelling). Lymphoedema is a build-up of lymphatic fluid in the arm caused by damage to arm lymphatic drainage when axillary lymph nodes are removed. With moderate or severe lymphoedema, the affected arm can be painful, tired and heavy.

There are several different measurement techniques in use, and consensus on the definition of lymphoedema, particularly with arm circumference measures, is poor. The incidence of lymphoedema is also changing over time as surgery and treatment techniques change. Due to these two factors the reported incidence ranges from 2–56%.1 This wide variation makes it difficult to compare studies and to know how a particular cancer center measures up to the published literature. It is important for both patients and surgeons to know the local risk for developing lymphoedema after axillary node dissection. There is only one study to date in New Zealand to report local incidence of lymphoedema and it was a retrospective study based on postal questionnaires. 

Results

193 Waikato women who had undergone axillary node dissection were analyzed. The average age was 61 years and the average time since surgery was 56 months. The overall incidence of lymphoedema was 23.3%. Circumference measures are a simple office method of screening for lymphoedema. A patient history and ≥10% increase in any circumference are optimal for determining lymphoedema after axillary node dissection. Significant risk factors for lymphoedema were age, radiotherapy, and infection to the operated arm.

Publication

Difficulties with defining lymphoedema after axillary dissection for breast cancer. Muhammad Asim, Alvin Cham, Sharmana Banerjee, Rachael Nancekivell, Gaelle Dutu, Catherine McBride, Shelley Cavanagh, Ross Lawrenson, Ian Campbell. New Zealand Medical Journal March 2012, 125; 1351, 29-39.