Introduction: Breast cancer is the number one malignancy affecting females in Saudi Arabia with a prevalence of 22.4%. Breast cancer incidence increases annually due to the aid of established screening programs, leadi...Introduction: Breast cancer is the number one malignancy affecting females in Saudi Arabia with a prevalence of 22.4%. Breast cancer incidence increases annually due to the aid of established screening programs, leading to the discovery of breast cancer in its early stages. Surgical treatment is an integral part of early breast cancer management to achieve local control. Axillary surgical interventions such sentinel lymph node biopsy (SLNB) and axillary lymph node clearance (ALND) aim to stage the axilla as an adjunct to the management of the primary breast tumor. In this paper, we reviewed female breast cancer patients aged 30 - 60 who underwent surgical treatment of SLNB and/or ALND with reporting the prevalence of lymphedema and other associated complications and risk factors. Methodology: A cross-sectional non-interventional study, with a sample size of 250 including breast cancer cases from 2016 to 2019 at National Guard Hospital (NGH) in Jeddah, Saudi Arabia. Results: A total of 253 breast cancer cases were included in this study, with a mean age of 53 years, 52.7% were postmenopausal and positive family history was present among 21% of cases. Further, 90.9% of the cases had unilateral disease. Staging was as follows: stage I 14.5%, stage II 45.2%, stage III 37.1%, and stage IV 3.2%. Mastectomy was done in 73.4% cases and lumpectomy was performed in 34.1% of cases. In addition, 93.3% of patients had SLNB and 49% of them were positive. Axillary dissection was performed in 69.6% of our patients. Radiotherapy and chemotherapy were given to 71.8% and 80.4% of cases respectively. Among the chemotherapy (chemo) recipients, 40.2% received adjuvant chemo, 54.5% received neoadjuvant chemo, and the remaining 5.3% received both. Further, the most prevalent complication was pain accounting for 42.1% of total complications, and the least prevalent was cellulitis 4%. Also, seroma developed in 18.3% cases, paresthesia noted in 5.6% of cases, winged scapula was reported as 2%, weakness and necrosis were seen in 6% and 13.1% of cases respectively. Axillary vein thrombosis and lymphangiosarcoma were reported in none of the patients (0%). Lymphoedema accounted for 16.1% of overall complications, 85% of the patients who developed lymphedema had undergone ALND, and 12.9% and 14.4% received radiotherapy and chemotherapy respectively. Lymphedema was observed in breast cancer stages as follows: stage I 1.2%, stage II 7.2%, and stage III 5.2%. Patients with body mass index (BMI) of 30 - 39 kg/m<sup>2</sup> had 7.2% prevalence of lymphedema compared to other BMI groups. Overall mortality was 8.3%. Conclusion: The findings of our study suggest that the prevalence of lymphedema was higher in ALND patients with locally advanced tumors, and higher BMI, compared to patients with stage I breast cancer and low BMI. Further, the prevalence of lymphedema in patients who underwent ALND was significantly lower than those who were treated by lumpectomy 10.3% (p-value = 0.034) in comparison to mastectomy 19.3%.展开更多
目的明确腋窝逆行淋巴示踪术(ARM)中示踪剂注射剂量与上肢淋巴结检出率、阳性率的相关性及保留上肢淋巴结对减轻乳腺癌相关水肿的影响。方法 2014年1月—2015年6月就诊于天津医科大学肿瘤医院乳腺肿瘤一科的70例临床分期为T1~2N0~1M0的...目的明确腋窝逆行淋巴示踪术(ARM)中示踪剂注射剂量与上肢淋巴结检出率、阳性率的相关性及保留上肢淋巴结对减轻乳腺癌相关水肿的影响。方法 2014年1月—2015年6月就诊于天津医科大学肿瘤医院乳腺肿瘤一科的70例临床分期为T1~2N0~1M0的乳腺癌患者,随机分成示踪剂低剂量(0.5 m L)组40例与高剂量(2 m L)组30例,对上肢淋巴结进行示踪。切除的上肢淋巴结及腋窝淋巴结均行病理学检查。患者于术前、术后6个月、12个月接受患肢水肿随访。结果 (1)低剂量组和高剂量组的上肢淋巴结检出率分别为60%(24/40)和96.7%(29/30),差异有统计学意义。(2)摘取1枚上肢淋巴结肿瘤阳性率为4.54%(1/22),摘取≥2枚上肢淋巴肿瘤阳性率为38.7%(12/31),两者差异有统计学意义。但摘取淋巴结>2枚时并未能提高病理阳性率(P=0.717)。(3)摘取>2枚上肢淋巴结患者在随访6个月和12个月时患肢相对体积变化(RVC)明显高于≤2枚者。结论增加示踪剂注射剂量可以提高上肢淋巴结检出率。在ARM中摘取2枚上肢淋巴结既能准确评估病理状况,又能最大程度地预防患肢水肿的发生。展开更多
目的探讨负压淋巴回流促进系统联合结构性康复训练对乳腺癌患者腋窝淋巴结清扫术后上肢淋巴水肿和生存质量的影响。方法选取2018年10月至2020年10月于海南医学院第二附属医院行乳腺癌改良根治术及腋窝淋巴结清扫术的乳腺癌患者106例为...目的探讨负压淋巴回流促进系统联合结构性康复训练对乳腺癌患者腋窝淋巴结清扫术后上肢淋巴水肿和生存质量的影响。方法选取2018年10月至2020年10月于海南医学院第二附属医院行乳腺癌改良根治术及腋窝淋巴结清扫术的乳腺癌患者106例为研究对象,采用随机数字表法将其分为观察组和对照组,每组各53例。对照组患者采用结构性康复训练,观察组患者在对照组基础上联合负压淋巴回流促进系统治疗。两组患者均干预4周。观察并比较两组患者上肢淋巴水肿发生情况、双上肢周径差以及干预前后患侧上肢淋巴流量、上肢功能障碍评定量表(disability of the arm,shoulder and hand questionnaire,DASH量表)和Karnofsky功能状态(Karnofsky performance status,KPS)评分。结果观察组患者上肢淋巴水肿发生率(22.64%)显著低于对照组(41.51%)(χ^(2)=4.330,P=0.037)。观察组患者干预2周、4周双上肢周径差均显著小于同期对照组(均P<0.05)。干预4周,两组患者患侧上肢淋巴流量、KPS评分均显著高于本组干预前(均P<0.05),DASH量表上肢症状、上肢活动功能、日常社会功能评分及总分均显著低于本组干预前(均P<0.05),且观察组患者患侧上肢淋巴流量、KPS评分均显著高于对照组(均P<0.05),DASH量表上肢症状,上肢活动功能、日常社会功能评分及总分均显著低于对照组(均P<0.05)。结论负压淋巴回流促进系统联合结构性康复训练可降低乳腺癌患者腋窝淋巴结清扫术后上肢淋巴水肿发生率,改善患者生存质量。展开更多
文摘Introduction: Breast cancer is the number one malignancy affecting females in Saudi Arabia with a prevalence of 22.4%. Breast cancer incidence increases annually due to the aid of established screening programs, leading to the discovery of breast cancer in its early stages. Surgical treatment is an integral part of early breast cancer management to achieve local control. Axillary surgical interventions such sentinel lymph node biopsy (SLNB) and axillary lymph node clearance (ALND) aim to stage the axilla as an adjunct to the management of the primary breast tumor. In this paper, we reviewed female breast cancer patients aged 30 - 60 who underwent surgical treatment of SLNB and/or ALND with reporting the prevalence of lymphedema and other associated complications and risk factors. Methodology: A cross-sectional non-interventional study, with a sample size of 250 including breast cancer cases from 2016 to 2019 at National Guard Hospital (NGH) in Jeddah, Saudi Arabia. Results: A total of 253 breast cancer cases were included in this study, with a mean age of 53 years, 52.7% were postmenopausal and positive family history was present among 21% of cases. Further, 90.9% of the cases had unilateral disease. Staging was as follows: stage I 14.5%, stage II 45.2%, stage III 37.1%, and stage IV 3.2%. Mastectomy was done in 73.4% cases and lumpectomy was performed in 34.1% of cases. In addition, 93.3% of patients had SLNB and 49% of them were positive. Axillary dissection was performed in 69.6% of our patients. Radiotherapy and chemotherapy were given to 71.8% and 80.4% of cases respectively. Among the chemotherapy (chemo) recipients, 40.2% received adjuvant chemo, 54.5% received neoadjuvant chemo, and the remaining 5.3% received both. Further, the most prevalent complication was pain accounting for 42.1% of total complications, and the least prevalent was cellulitis 4%. Also, seroma developed in 18.3% cases, paresthesia noted in 5.6% of cases, winged scapula was reported as 2%, weakness and necrosis were seen in 6% and 13.1% of cases respectively. Axillary vein thrombosis and lymphangiosarcoma were reported in none of the patients (0%). Lymphoedema accounted for 16.1% of overall complications, 85% of the patients who developed lymphedema had undergone ALND, and 12.9% and 14.4% received radiotherapy and chemotherapy respectively. Lymphedema was observed in breast cancer stages as follows: stage I 1.2%, stage II 7.2%, and stage III 5.2%. Patients with body mass index (BMI) of 30 - 39 kg/m<sup>2</sup> had 7.2% prevalence of lymphedema compared to other BMI groups. Overall mortality was 8.3%. Conclusion: The findings of our study suggest that the prevalence of lymphedema was higher in ALND patients with locally advanced tumors, and higher BMI, compared to patients with stage I breast cancer and low BMI. Further, the prevalence of lymphedema in patients who underwent ALND was significantly lower than those who were treated by lumpectomy 10.3% (p-value = 0.034) in comparison to mastectomy 19.3%.
文摘目的明确腋窝逆行淋巴示踪术(ARM)中示踪剂注射剂量与上肢淋巴结检出率、阳性率的相关性及保留上肢淋巴结对减轻乳腺癌相关水肿的影响。方法 2014年1月—2015年6月就诊于天津医科大学肿瘤医院乳腺肿瘤一科的70例临床分期为T1~2N0~1M0的乳腺癌患者,随机分成示踪剂低剂量(0.5 m L)组40例与高剂量(2 m L)组30例,对上肢淋巴结进行示踪。切除的上肢淋巴结及腋窝淋巴结均行病理学检查。患者于术前、术后6个月、12个月接受患肢水肿随访。结果 (1)低剂量组和高剂量组的上肢淋巴结检出率分别为60%(24/40)和96.7%(29/30),差异有统计学意义。(2)摘取1枚上肢淋巴结肿瘤阳性率为4.54%(1/22),摘取≥2枚上肢淋巴肿瘤阳性率为38.7%(12/31),两者差异有统计学意义。但摘取淋巴结>2枚时并未能提高病理阳性率(P=0.717)。(3)摘取>2枚上肢淋巴结患者在随访6个月和12个月时患肢相对体积变化(RVC)明显高于≤2枚者。结论增加示踪剂注射剂量可以提高上肢淋巴结检出率。在ARM中摘取2枚上肢淋巴结既能准确评估病理状况,又能最大程度地预防患肢水肿的发生。
文摘目的探讨负压淋巴回流促进系统联合结构性康复训练对乳腺癌患者腋窝淋巴结清扫术后上肢淋巴水肿和生存质量的影响。方法选取2018年10月至2020年10月于海南医学院第二附属医院行乳腺癌改良根治术及腋窝淋巴结清扫术的乳腺癌患者106例为研究对象,采用随机数字表法将其分为观察组和对照组,每组各53例。对照组患者采用结构性康复训练,观察组患者在对照组基础上联合负压淋巴回流促进系统治疗。两组患者均干预4周。观察并比较两组患者上肢淋巴水肿发生情况、双上肢周径差以及干预前后患侧上肢淋巴流量、上肢功能障碍评定量表(disability of the arm,shoulder and hand questionnaire,DASH量表)和Karnofsky功能状态(Karnofsky performance status,KPS)评分。结果观察组患者上肢淋巴水肿发生率(22.64%)显著低于对照组(41.51%)(χ^(2)=4.330,P=0.037)。观察组患者干预2周、4周双上肢周径差均显著小于同期对照组(均P<0.05)。干预4周,两组患者患侧上肢淋巴流量、KPS评分均显著高于本组干预前(均P<0.05),DASH量表上肢症状、上肢活动功能、日常社会功能评分及总分均显著低于本组干预前(均P<0.05),且观察组患者患侧上肢淋巴流量、KPS评分均显著高于对照组(均P<0.05),DASH量表上肢症状,上肢活动功能、日常社会功能评分及总分均显著低于对照组(均P<0.05)。结论负压淋巴回流促进系统联合结构性康复训练可降低乳腺癌患者腋窝淋巴结清扫术后上肢淋巴水肿发生率,改善患者生存质量。
