42 Transitional Lymphedema: Understanding the Temporal Dynamics Post-Axillary Surgery

Publication
Article
Miami Breast Cancer Conference® Abstracts Supplement41st Annual Miami Breast Cancer Conference® - Abstracts
Volume 38
Issue 4
Pages: 49

Background

Lymphedema poses a significant challenge for patients with breast cancer who have undergone axillary lymph node dissection (ALND). Traditional techniques for lymphedema assessment, such as arm circumference measurement and bioimpedance spectroscopy (Lymphedema Index [L-Dex]), have been useful but limited in scope. One underexamined facet of this condition is its temporal characteristics—specifically, the period between surgery and the onset of lymphedema symptoms. Our study aims to elucidate the concept of transitional lymphedema, a term we propose to describe lymphedema occurring between 3 to 6 months after axillary surgery that would be resolved with longer follow-up.

Methods

A retrospective cohort study included patients with breast cancer undergoing ALND with Simplified Lymphatic Microsurgical Preventing Healing Approach (SLYMPHA) between January 2019 and June 2022 at a single institution. Patient demographics and treatment characteristics were collected. An L-Dex score outside the normal range (±10 L-Dex unit) or an increase of at least 10 L-Dex units above the patient’s baseline was considered abnormal.

Results

L-Dex Score at Each Postoperative Visit

L-Dex Score at Each Postoperative Visit

A total of 51 patients met the inclusion criteria, with a mean (SD) age of 56.8 (12.6) years and a mean (SD) body mass index (BMI) of 29.5 (7.2) kg/m2. A total of 41 patients (80.4%) received adjuvant radiation, and 41 patients (80.4%) received neoadjuvant chemotherapy. Of the 18 patients with abnormal L-Dex scores, an abnormal L-Dex developed in 5 patients (27.7%) at 3 months, 6 patients (33.3%) at 6 months, 3 patients (16.6%) at 9 months, and 4 patients (22.2%) at 12 months. There was a decrease in the mean absolute L-Dex score at each postoperative visit. When comparing the L-Dex difference from the baseline, it was lower at 12 months (4.67) compared with the 3-month (10.12) postoperative visit (CI, 0.1086-9.968; P = .0432). Additionally, 88.2% of patients who developed an abnormal L-Dex score at some time had adjuvant radiation compared with 76.4% of patients who never had an abnormal L-Dex reading; however, it was not significant. Of note, 52.17% of patients with BMI of at least 30 kg/m2 developed abnormal L-Dex scores compared with 22.2% of patients with a BMI below 30 kg/m2 (P = .02). From patients with at least 20 axillary lymph nodes removed, 45% developed abnormal L-Dex, whereas it was 28.5% when fewer than 20 lymph nodes were removed (P = .04).

Conclusions

Most increases in L-Dex scores seen in the first 6 postoperative months showed resolution after a follow-up of more than 12 months. Higher BMI (≥ 30 kg/m2) and removal of at least 20 axillary lymph nodes were associated with higher L-Dex measurements during postoperative follow-up visits.

Articles in this issue

38 Influence of Race on Attainment of Textbook Oncologic Outcome Following Modified Radical Mastectomy for Breast Cancer
38 Influence of Race on Attainment of Textbook Oncologic Outcome Following Modified Radical Mastectomy for Breast Cancer
39 The Influence of Reconstruction Type on Outcomes in Women Undergoing Mastectomy With Immediate Reconstruction:  A Nationwide Study
39 The Influence of Reconstruction Type on Outcomes in Women Undergoing Mastectomy With Immediate Reconstruction: A Nationwide Study
40 Ethnic Disparities in Complication Rates and Outcomes  of Nipple-Sparing Mastectomy:  A Comprehensive Analysis
40 Ethnic Disparities in Complication Rates and Outcomes of Nipple-Sparing Mastectomy: A Comprehensive Analysis
41 A Case Series of Sarcomas
41 A Case Series of Sarcomas
42 Transitional Lymphedema: Understanding the Temporal Dynamics Post-Axillary Surgery
42 Transitional Lymphedema: Understanding the Temporal Dynamics Post-Axillary Surgery
43 Impact of Lymphatic Microsurgical Preventing Healing Approach (LYMPHA) on Postoperative Complication Rates in Mastectomy With Immediate Prosthetic-Based Breast Reconstruction
43 Impact of Lymphatic Microsurgical Preventing Healing Approach (LYMPHA) on Postoperative Complication Rates in Mastectomy With Immediate Prosthetic-Based Breast Reconstruction
44 Variant of Uncertain Significance (VUS) Genetic Testing Results and Mastectomy Choice in Lumpectomy-Eligible Patients
44 Variant of Uncertain Significance (VUS) Genetic Testing Results and Mastectomy Choice in Lumpectomy-Eligible Patients
45 Application of the 7-Gene Biosignature in Palpable Versus Nonpalpable Ductal Carcinoma In Situ in a Black Patient Population: Does Palpability Suggest a More Aggressive Genomic Risk?
45 Application of the 7-Gene Biosignature in Palpable Versus Nonpalpable Ductal Carcinoma In Situ in a Black Patient Population: Does Palpability Suggest a More Aggressive Genomic Risk?
46 Comparative Analysis of Breast Conserving Therapy vs Mastectomy in Multifocal and Multicentric Breast Cancer: A Review of the Literature
46 Comparative Analysis of Breast Conserving Therapy vs Mastectomy in Multifocal and Multicentric Breast Cancer: A Review of the Literature
47 Can We Identify Factors That Predict DCIS Upgrade to Invasive Cancer at Mastectomy?
47 Can We Identify Factors That Predict DCIS Upgrade to Invasive Cancer at Mastectomy?
48 The Era ‘or Error’ of Second Localization Procedures
48 The Era ‘or Error’ of Second Localization Procedures
49 The Influence of Race on Complications in Breast Conservation Surgery: A Single Institution Study
49 The Influence of Race on Complications in Breast Conservation Surgery: A Single Institution Study
51 Ductal Carcinoma In Situ With Microinvasion on Biopsy—What Are the Predictors of Upstaging?
51 Ductal Carcinoma In Situ With Microinvasion on Biopsy—What Are the Predictors of Upstaging?
52 UK Experience of Non-Radioisotope, Non-Magnetic Guided Breast Wide Local Excision and Sentinel Node Biopsy
52 UK Experience of Non-Radioisotope, Non-Magnetic Guided Breast Wide Local Excision and Sentinel Node Biopsy
53 The Utility of Sentinel Lymph Node Biopsy in High-Grade Ductal Carcinoma In Situ
53 The Utility of Sentinel Lymph Node Biopsy in High-Grade Ductal Carcinoma In Situ
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