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| |  Lymphoedema Index Useful for Lymphoedema Evaluation Following Breast Cancer Surgery: Presented at SSO By Jill Stein ST. LOUIS, Mo -- March 8, 2010 -- Investigators are proposing the lymphoedema index (LI) as a new objective instrument for evaluating lymphoedema. The recommendation was made on March 6 at the 2010 Society of Surgical Oncology Annual Cancer Symposium (SSO) by Julia Bulatova, MD, Lankenau Hospital, Philadelphia, Pennsylvania. Her team developed the LI and then tested its usefulness in evaluating the incidence of lymphoedema in a single practice. “One of the challenges we faced was defining lymphoedema,” Dr. Bulatova pointed out. For many years, lymphoedema has been a well-known complication of breast cancer surgery, she said. Lymphoedema has been accepted as a normal event following surgical intervention yet this complication is significant for physiologic, functional, and cosmetic reasons, and no firm data are available on its true incidence. The development of the LI was prompted by the difficulty in objectively quantifying lymphoedema, she added. Her group believes that the most objective measurement of arm swelling is the difference in water displacement between affected and nonaffected arms (Delta). With the LI, control arm displacement (CAD) is subtracted from affected arm displacement (AAD) to achieve the Delta. The LI is derived from the formula LI = Delta/CAD. A statistically significant difference was observed with Delta >=200 cm3 and the investigators used this value as the threshold for defining oedema. The study included 491 patients with a mean age of 67 years who had undergone cancer operations for stage 0-IIIb breast cancer. Procedures included total mastectomy in 118 patients, partial mastectomy in 368, and partial mastectomy with subsequent complete mastectomy in 5 patients. The investigators decided to limit the study to women who had unilateral breast cancer so that the unoperated side could serve as an internal control. Using the LI, the incidence of lymphoedema in the investigators’ clinical practice was 13.8%, which is less than most series to date. Risk factors shown to be statistically significant for the development of lymphoedema included body mass index (P < .0006) and number of axillary lymph nodes removed. No other variables were found to contribute to the development of lymphoedema. No women had significant limitations in arm motion. Dr. Bulatova said that the findings show that LI has promise as a tool for objectively defining lymphoedema. She added that more research is needed to correlate its predictive utility with clinical signs of lymphoedema. [Presentation title: An Objective Parameter for Evaluation of Lymphedema. Abstract P59]
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