Name: ultrasonographic evaluation of breast cancer-related lymphedema
Uploaded: 2017-01-12T13:00:00
Description: Watch this Scientific Journal Video about Ultrasonographic Evaluation of Breast Cancer-related Lymphedema at JoVE.com

The authors have nothing to acknowledge.

All of the procedures were reviewed and approved by the Institutional Review Board of Chungnam National University Hospital.
1. Measurement with Ultrasonography
<ol>
	<li>Set the posture of the patient.
	<ol>
		<li>Lay the patient&#39;s arm in a supine position, with both arms on the bed.</li>
	</ol>
	</li>
	<li>Determine the measurement sites on the patient&#39;s upper limb.
	<ol>
		<li>Mark in the mid-point of the wrist crease, the mid-point between the medial and lateral epicondyles at the level of the elbow,...

<ol>
	<li>Lasinski, B. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Complete+decongestive+therapy+for+treatment+of+lymphedema.">Complete decongestive therapy for treatment of lymphedema.</a> Seminars in Oncology Nursing. 29 (1), 20-27 (2013).</li><li>Clark, B., Sitzia, J., Harlow, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Incidence+and+risk+of+arm+oedema+following+treatment+for+breast+cancer:+a+three-year+follow-up+study.">Incidence and risk of arm oedema following treatment for breast cancer: a three-year follow-up study.</a> Q J Med. 98 (5), 343-348 (2005).</li><li>Hayes, S. C., Speck, R. M., Reimet, E., Stark, A., Schmitz, K. 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G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ultrasonography+in+the+Evaluation+of+Breast+Cancer-Related+Lymphedema.">Ultrasonography in the Evaluation of Breast Cancer-Related Lymphedema.</a> Lymphatic Research and Biology. 14 (1), 1 (2016).</li><li>Suehiro, K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Significance+of+Ultrasound+Examination+of+Skin+and+Subcutaneous+Tissue+in+Secondary+Lower+Extremity+Lymphedema.">Significance of Ultrasound Examination of Skin and Subcutaneous Tissue in Secondary Lower Extremity Lymphedema.</a> Ann Vasc Dis. 6 (2), 180-188 (2013).</li><li>Lee, J. H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ultrasonographic+Evaluation+of+Therapeutic+Effects+of+Complex+Decongestive+Therapy+in+Breast+Cancer-Related+Lymphedema.">Ultrasonographic Evaluation of Therapeutic Effects of Complex Decongestive Therapy in Breast Cancer-Related Lymphedema.</a> Ann Rehabil Med. 37 (5), 683-689 (2013).</li><li>DiSipio, T., Rye, S., Newman, B., Hayes, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Incidence+of+unilateral+arm+lymphoedema+after+breast.">Incidence of unilateral arm lymphoedema after breast.</a> Lancet Oncol. 14 (6), 500-515 (2013).</li><li>Stanton, A. W., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Lymphatic+drainage+in+the+muscle+and+subcutis+of+the+arm+after+breast+cancer+treatment.">Lymphatic drainage in the muscle and subcutis of the arm after breast cancer treatment.</a> Breast Cancer Res Treat. 117 (3), 549-557 (2008).</li><li>Godoy, M. F. G., Pereira, M. R., Oliani, A. H., Godoy, J. M. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Synergic+Effect+of+Compression+Therapy+and+Controlled+Active+Exercises+Using+a+Facilitating+Device+in+the+Treatment+of+Arm+Lymphedema.">Synergic Effect of Compression Therapy and Controlled Active Exercises Using a Facilitating Device in the Treatment of Arm Lymphedema.</a> Int J Med Sci. 9 (4), 280-284 (2012).</li><li>Cormie, P., Pumpa, K., Galv&#227;o, D. A., Turner, E., Spry, N., Saunders, C., Zissiadis, Y., Newton, R. U. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Is+it+safe+and+efficacious+for+women+with+lymphedema+secondary+to+breast+cancer+to+lift+heavy+weights+during+exercise:+a+randomised+controlled+trial.">Is it safe and efficacious for women with lymphedema secondary to breast cancer to lift heavy weights during exercise: a randomised controlled trial.</a> J Cancer Surviv. 7 (3), 413-424 (2013).</li><li>Bok, S. K., Jeon, Y., Hwang, P. 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Evaluations of BCRL can be conducted through various techniques, including arm circumferences tape measurement, water displacement measurement, bioimpedance spectroscopy, perometry (optoelectronic volumeter), lymphoscintigraphy, clinician diagnosis, or swelling self-reports by the patient. However, there are no standards for the measurement of BCRL; the diagnosis and duration of treatment can be determined empirically in a number of ways, depending upon the clinic.
Clinically, measuring arm ci...

Lymphedema is defined as a condition of localized protein-rich fluid retention and tissue swelling caused by a compromised lymphatic system1,2. As lymphedema progresses, fibrocytes and/or adipocytes proliferate in the affected areas, leading to changes in the texture of the skin and subcutaneous tissue and an increased vulnerability to bacterial and fungal infections3,4. The observation of these changes in various parts of the extremities may further elucidate the severity and extent of lymphedema. The subfascial lymphatic system contributes to the severity of lymphedema more than the epifascial lymphatic system.
Recent research has mainly focused on the use of ultrasonography in the diagnosis of lymphedema5,6. Ultrasonography is a relatively inexpensive method to observe soft-tissue characteristics. A previous study reported that lymphedema can be reliably diagnosed with ultrasonography by comparing the thickness of the skin and subcutaneous tissue and also by evaluating the compliance of the subcutaneous tissue in a clinical setting7,8. In addition, ultrasonography is widely used in the clinic because of its easy accessibility, safety from radiation exposure, and inexpensiveness5,6. In spite of these benefits, studies on ultrasonography for lymphedema have only been focused on diagnosis, not on evaluation of therapeutic intervention.
Therefore, the current study aimed to determine not only the usefulness of ultrasonography in elucidating the effects of PRE&#160;on BCRL, but also whether ultrasonography has a clinical significance as a follow-up test in confirming treatment efficacy. This study was conducted to establish the protocol for ultrasounds performed to examine lymphedema.

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			<td>ACUSON S2000</td>
			<td>Siemens</td>
			<td>10041461</td>
			<td></td>
		</tr>
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			<td>Eco Gel 99</td>
			<td>Seung Won Medical Corp.</td>
			<td></td>
			<td></td>
		</tr>
	</tbody>
</table>

ultrasonographic evaluation of breast cancer-related lymphedema

Lymphedema is one of the most common complications after breast cancer surgery. There are many diagnostic tools for lymphedema, but no standard method yet exists. Progressive Resistance Exercise (PRE) is expected to improve lymphedema without additional swelling. This study showed the therapeutic effects of PRE on lymphedema by using ultrasonography to measure the change in thickness of the muscle and subcutaneous tissue. The thickness of subcutaneous tissue decreased more in the PRE group than in the non-PRE group. Ultrasonography is widely used in many clinics because of its easy accessibility, safety, and inexpensiveness. Ultrasound is one of the best tools for diagnosing and determining treatment efficacy on breast cancer-related lymphedema (BCRL).

This study included 32 patients diagnosed with BCRL. The thickness of muscle and subcutaneous tissue and the circumferences of proximal and distal upper limbs were measured at baseline, 4 weeks, and 8 weeks after PRE. Examiners measured the circumference of upper limbs with a tape measure, and then the thickness of the muscle and subcutaneous tissue were measured by ultrasonography. Patients were randomly divided into a PRE group and a non-PRE group. Participants were reminded to not reve...

Watch this Scientific Journal Video about Ultrasonographic Evaluation of Breast Cancer-related Lymphedema at JoVE.com

Ultrasonographic Evaluation of Breast Cancer-related Lymphedema

This study utilized ultrasonography for diagnosis and follow-up tests to confirm treatment efficacy of Progressive Resistance Exercise (PRE) in breast cancer-related lymphedema (BCRL). Ultrasonography can be applied effectively to ensure diagnosis and treatment of lymphedema.

Lymphedema is one of the most common complications after breast cancer surgery. There are many diagnostic tools for lymphedema, but no standard method yet ...

The overall goal of this procedure is to diagnose breast cancer-related lymphedema and evaluate the therapeutic effect of resistive exercise by using ultrasonography to measure the thickness of subcutaneous tissue. Begin by laying the patient's arm in a supine position with both arms on the bed. Use a pen to mark the midpoint of the wrist crease, the midpoint of the medial and lateral epicondyles at the level of the elbow, in the bicipital groove.Then connect these points using a ruler. Next, mark the first target area 10 centimeters proximal to the elbow point along the line between the elbow and bicipital groove. In the second target area, 10 centimeters distal to the elbow point along the line between the elbow and the wrist.Then, switch on the ultrasound system. Enter the 2-D mode of the soft tissue via the keyboard. Set the depth to five centimeters and choose the 14L5 linear array transducer.Apply sufficient gel to the ultrasound transducer and place it perpendicularly to the upper limb ventral axis. The short axis view to capture the image where the thickness of the gel is at least one centimeter and the soft tissue contours are not distorted. Next, select the calibrator and the software via the keyboard of the ultrasounds system to draw a line between the muscle and the subcutaneous tissue.Then, measure the thickness of the muscle, defined at the distance between the highest point on the boundary of the bone to the highest point on the boundary portion of the fascia. Finally, measure the thickness of the subcutaneous tissue, defined as the distance from the skin to the fascia. After measuring the upper limb muscle and subcutaneous tissue thickness at baseline, give the patient a 5 kilogram dumbbell and have him or her put on a compression stocking.Ask the patient to perform the progressive resistant exercises, or PRE, in the following order. Dumbbell fly, tricep extension, one arm bent-over row, bicep curls, dumbbell side raise, and lifting the arms forward. Next, instruct the patient to complete the six exercises twice a day according to the following schedule.Five times each during the first week, 10 times each during the second week, 15 times each during the third week, 20 times each during the forth week, and 25 times each during the fifth through eighth weeks. Inform the subject to return at four and eight weeks later to measure the thickness of the subcutaneous tissue and muscle of the upper limb again. Finally, after all measurements are collected, analyze the data by comparing the difference between both arms using a paired T test.Compare the changes in subcutaneous tissue and muscle thickness using a repeated measures ANOVA. According to the tape measurement, arm circumference did not significantly change in the PRE group after four weeks of exercise. However, both proximal and distal arm circumferences showed a significant reduction after eight weeks.As measured by ultrasonography in the PRE group, the thickness of muscle in the distal part showed a significant increase at four weeks and eight weeks. and the proximal part demonstrated a significant increase in thickness at eight weeks. Lastly, in the PRE group, the thickness of subcutaneous tissue in the affected upper limb significantly decreased after eight weeks.No significant difference in these parameters was observed in the control group.

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