Breast Cancer-Related Lymphedema (BCRL):

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • Breast cancer-related lymphedema (BCRL):
    • Has been a significant concern for breast cancer patients undergoing axillary surgery
  • The development of BCRL is associated with:
    • Significantly lower physical and psychosocial well-being and increased health care utilization
  • The risk of BCRL:
    • Is a function of the extent of axillary intervention:
      • Ranging from about 12% following a sentinel node biopsy to about 30% after an axillary lymph node dissection (ALND)
  • The highest risk of BCRL (51%) has been reported in patients with inflammatory breast cancer:
    • Who receive trimodality therapy (neoadjuvant taxane-containing chemotherapy, modified radical mastectomy, and adjuvant radiation):
      • Therefore, adjuvant radiotherapy is associated with an increased risk of BCRL
  • The value of routine screening for BCRL in patients at risk is controversial
  • There is growing evidence that subclinical lymphedema:
    • Defined as relative volume change of the affected arm of 5% to 10% compared to the baseline measurement:
      • Is strongly associated with the development of more symptomatic BCRL:
        • Which correlates with a relative volume change of greater than 10%
  • Consequently, identifying patients with subclinical lymphedema is a potential opportunity for early intervention and long-term improvement in quality of life
  • Furlan et al prospectively evaluated 85 breast cancer patients (n=40 had an ALND and n=45 had a sentinel node biopsy) by obtaining serial circumferential arm measurements preoperatively, then 1 month, 3, 6, 12, and 24 months after surgery:
    • Study results showed that the earliest signs of subclinical lymphedema were detected no sooner than the 6-month assessment, and those with subclinical lymphedema were promptly referred for decongestive therapy
  • An international randomized trial comparing bioimpedance spectroscopy (BIS) and tape measurement to detect subclinical lymphedema:
    • Showed that BIS had a higher sensitivity and was associated with an earlier referral for decongestive therapy
    • In the same study, earlier administration of decongestive therapy was associated with a lower risk of progression to symptomatic BCRL
    • The practical aspects of implementing BCRL screening with BIS versus tape measurements and other techniques warrant further study
  • References
    • Coriddi M, Kim LN, Haglich K, et al. The impact of lymphedema on patient-reported outcomes after breast reconstruction: a preliminary propensity score-matched analysis. Ann Surg Oncol. 2023;30(5):3061-3071. doi: 10.1245/s10434-022-12994-z
    • Cheville A, Lee M, Moynihan T, et al. The impact of arm lymphedema on healthcare utilization during long-term breast cancer survivorship: a population-based cohort study. J Cancer Surviv. 2020;14(3):347-355. doi: 10.1007/s11764-019-00851-0
    • Bucci LK, Brunelle CL, Bernstein MC, et al. Subclinical lymphedema after treatment for breast cancer: risk of progression and considerations for early intervention. Ann Surg Oncol. 2021;28(13):8624-8633. doi: 10.1245/s10434-021-10173-0
    • Farley CR, Irwin S, Adesoye T, et al. Lymphedema in inflammatory breast cancer patients following trimodal treatment. Ann Surg Oncol. 2022;29(10):6370-6378. doi: 10.1245/s10434-022-12142-7
    • Furlan C, Matheus CN, Jales RM, Derchain SFM, Bennini JR Jr, Sarian LO. Longitudinal, long-term comparison of single-versus multipoint upper limb circumference periodical measurements as a tool to predict persistent lymphedema in women treated surgically for breast cancer: an optimized strategy to early diagnose lymphedema and avoid permanent sequelae in breast cancer survivors. Ann Surg Oncol. 2021;28(13):8665-8676. doi: 10.1245/s10434-021-10290-w
    • Ridner SH, Dietrich MS, Boyages J, et al. A comparison of bioimpedance spectroscopy or tape measure triggered compression intervention in chronic breast cancer lymphedema prevention. Lymphat Res Biol. 2022;20(6):618-628. doi: 10.1089/lrb.2021.0084
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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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