Mellor et al.1717 Mellor RH, Bush NL, Stanton AW, Bamber JC, Levick JR, Mortimer PS. Dual-frequency ultrasound examination of skin and subcutis thickness in breast cancer-related lymphedema. Breast J. 2004;10(6):496-503. http://dx.doi.org/10.1111/j.1075-122X.2004.21458.x. PMid:15569205.
http://dx.doi.org/10.1111/j.1075-122X.20...
(United Kingdom) |
10 women with LSBC, aged 48 to 75 years, post-axillary radiotherapy. |
1c |
DUS was used for the assessments. Measurements were conducted in the morning to eliminate the diurnal variation effect on water content, skin thickness, and echogenicity. |
Measurement with high frequency DUS can yield a simple, reliable, and useful result for investigating lymphedema and to assess therapeutic interventions. |
Effective: measurement of skin thickness with DUS is a clinical tool that is useful in the diagnosis of lymphedema, in addition to helping in investigation of therapeutic techniques. |
Two systems were used in the study: |
| 1. Dermascan ultrasound (Dermascan C, Cortex Technology, Smedevaenget, Denmark),at 20 MHz. |
| Subcutaneous thickness measurement encompassed measurements defined for 4.0 cm in width and 4.0 cm in depth. |
| 2. Acuson XP10 (Acuson, Mountain View, CA, United States) with a frequency of 7 MHz |
| The subcutis was considered the principal site of swelling. The results indicate that lymphedema has a considerable impact on the skin around the arm, irrespective of the exact location of the subcutis with edema. |
| Han et al.1818 Han N, Cho YJ, Hwang JS, Kim H, Cho G. Usefulness of Ultrasound Examination in Evaluation of Breast Cancer-Related Lymphedema. Ann Rehabil Med. 2011;35(1):101-9. (South Korea) |
20 healthy individuals and 20 women with LSBC. |
1c |
In the healthy individuals, thickness of the UL dermis and the subcutis was measured bilaterally. |
DUS was able to provide valuable information on the extent of edema and fibrosis of skin and subcutis and is a useful tool to follow the results of lymphedema treatment and its progression over time. |
Effective: DUS is able to provide valuable information on the extent of edema and fibrosis of skin and |
System: 12 MHz linear probe for Logiq E (GE Healthcare Ultrasound, |
| In the patients with lymphedema, staging was defined using the Casley-Smith Lymphedema Staging System. |
| Milwaukee, United States) |
| subcutis. |
| DUS was used to measure the thickness of the dermis and the subcutis. |
Lee et al.99 Lee YL, Huang YL, Chu SY, et al. Characterization of limb lymphedema using the statistical analysis of ultrasound backscattering. Quant Imaging Med Surg. 2020;10(1):48-56. http://dx.doi.org/10.21037/qims.2019.10.12. PMid:31956528.
http://dx.doi.org/10.21037/qims.2019.10....
(Taiwan) |
60 patients with lymphedema post-breast cancer surgery. |
1b |
Tissue thickness was measured with DUS at three points before and after CPT. |
In diagnosis of lymphedema, measures of skin, subcutaneous, and total soft tissue thickness of the upper extremity were greater than for the unaffected side. |
Effective: ultrasonographic assessment was effective for assessment of the results of CPT in LSBC. |
Information not provided. |
| Soft tissue thickness was defined as the sum of skin and subcutaneous tissue thickness. |
| The ultrasound measurements were reliable and revealed that CPT was effective for reducing the thickness of soft tissues. |
Devoogdt et al.1919 Devoogdt N, Pans S, De Groef A, et al. Postoperative evolution of thickness and echogenicity of cutis and subcutis of patients with and without breast cancer-related lymphedema. Lymphat Res Biol. 2014;12(1):23-31. http://dx.doi.org/10.1089/lrb.2013.0028. PMid:24502300.
http://dx.doi.org/10.1089/lrb.2013.0028...
(Belgium) |
42 patients with unilateral axillary dissection for primary breast cancer took part and were assessed for evolution of lymphedema secondary to breast cancer. |
1b |
Ultrasound was used to investigate evolution of thickness and echogenicity of cutis and subcutis up to 1 year after axillary dissection for breast cancer and compare patients with and without objective lymphedema. Ultrasonographic assessments of both arms were conducted immediately and 6 and 12 months after axillary surgery. Sagittal and transverse images were acquired at each measurement site. The reference point was placed at the center of the probe and minimal pressure was applied. |
The ultrasonographic assessment found that subcutaneous echogenicity was more frequently disturbed on the affected side (in 7-33% of the patients) than on the healthy side (0-19%). The prevalence of changed echogenicity of the subcutaneous of the affected arm (not significant) was clinically relevant and was different between patients with and without lymphedema at the wrist, dorsal forearm, and biceps and triceps. According to the study, it appears that increased subcutaneous thickness at the ventral forearm and triceps and disturbed echogenicity of the cutis at the wrist are good indicators for identifying patients with lymphedema |
Effective: in patients with breast cancer, ultrasonography can be useful to diagnose lymphedema in the arm; but cannot be used as a separate diagnostic test for lymphedema. |
Ultrasound (Siemens Acuson Antares Premium, Erlangen, Germany) machine with a high frequency 13 MHz linear probe. |
Abreu et al.2020 Abreu GF Jr, Pitta GB, Araújo M, Castro A, Azevedo WF Jr, Miranda F Jr. Ultrasonografic changes in the axillary vein of patients with lymphedema after mastectomy. Rev Col Bras Cir. 2015;42(2):81-92. http://dx.doi.org/10.1590/0100-69912015002004. PMid:26176673.
http://dx.doi.org/10.1590/0100-699120150...
(Brazil) |
80 patients post-mastectomy and radiotherapy divided into two groups: 40 patients with LSBC and 40 without the disease. |
1b |
Ultrasonographic abnormalities were assessed in the transverse and longitudinal aspects. |
There was an overall prevalence of 83.8% of ultrasonographic abnormalities in the axillary vein of women with LSBC. |
Effective: the prevalence of ultrasonographic abnormalities was greater among patients with LSBC. |
Ultrasonography system model Sonoace X8 or SA 8000EX Prime, with 5-12 MHz multifrequency linear transducer, both by Medison Co. Ltd., 1003 Daechi-dong, Gangnam-gu, Seoul 135-280 South Korea. |
Bok et al.55 Bok SK, Jeon Y, Hwang PS. Ultrasonographic Evaluation of the Effects of Progressive Resistive Exercise in Breast Cancer-Related Lymphedema. Lymphat Res Biol. 2016;14(1):18-24. http://dx.doi.org/10.1089/lrb.2015.0021. PMid:26824517.
http://dx.doi.org/10.1089/lrb.2015.0021...
(South Korea) |
32 patients with lymphedema secondary to breast cancer were randomized: one group received CPT + PRE and the other group PRE only. |
1b |
The thickness of subcutaneous tissue and muscle was measured with DUS. |
DUS is a good tool for measuring changes in muscle thickness after PRE to confirm the effect of lymphedema treatment. It can be used to diagnose lymphedema and as a method to determine treatment. |
Effective: it was possible to use DUS to assess the effects of PRE in treatment of patients with LSBC. |
Ultrasound machine (MyLab 50, Esaote, Italy). |
| Information on system frequency not provided. |
| Measurements taken at two points: 1) proximal upper limb, 10 cm proximal of the tip of the elbow; and 2) distal upper limb, 10 cm distal of the tip of the elbow. |
Johnson et al.2121 Johnson KC, DeSarno M, Ashikaga T, Dee J, Henry SM. Ultrasound and clinical measures for lymphedema. Lymphat Res Biol. 2016;14(1):8-17. http://dx.doi.org/10.1089/lrb.2015.0001. PMid:26574872.
http://dx.doi.org/10.1089/lrb.2015.0001...
(United States) |
17 women with lymphedema secondary to breast cancer. |
1b |
Ultrasound was used at two sites on all subjects’ involved and uninvolved upper extremities. 55 measures were taken for each site. |
The DUS images were reliable for measurement of mean entropy between involved and uninvolved extremities at the anterior forearm. Compared with clinical edema assessment, DUS demonstrated good correlation for entropy at the inferior posterior arm. |
Effective: DUS as a tool for quantifying subcutaneous tissues is a safe, mobile, and effective method for measuring the texture of lymphedematous tissues. |
Sonosite M-Turbo ultrasound system with 15 MHz linear transducer. |
Suehiro et al.2222 Suehiro K, Yamamoto S, Honda S, et al. Perioperative variations in indices derived from noninvasive assessments to detect postmastectomy lymphedema. J Vasc Surg Venous Lymphat Disord. 2019;7(4):562-9. http://dx.doi.org/10.1016/j.jvsv.2019.02.012. PMid:31203860.
http://dx.doi.org/10.1016/j.jvsv.2019.02...
(Japan) |
30 patients with unilateral stage II breast cancer-related lymphedema of the arm took part in the study. |
1b |
Ultrasonography was used to investigate skin thickness, SELEB, and SCT, and the degree of increase in SEG and SEFS in arms with lymphedema. Skin and subcutaneous tissue of both arms of 30 patients with unilateral stage II lymphedema secondary to breast cancer were examined at five points (medial/lateral upper arm and forearm and back of the hand). The degrees of SEG and SEFS were determined according to severity (interval: 0-2). |
All of the parameters measured, except SEFS in the medial arm, were significantly higher on the side with lymphedema than on the normal side. Parameters differed most noticeably at the medial forearm. It was not possible to confirm an increase in SEG/SEFS scores according to severity, i.e., higher SEG/SEFS scores in the forearm than in the arm. |
Effective: ultrasound showed good capacity to demonstrate skin thickness, SELEB and SCT, and SEG and SEFS grades in arms with lymphedema and normal arms in patients with LSBC and also showed that increases in these parameters were greater in the medial forearm of the arm with lymphedema. |
Ultrasound system (LOGIQ S6; GE Healthcare, Little Chalfont, Buckinghamshire, United Kingdom) with a 7 to 12 MHz linear transducer. |
Dai et al.2323 Dai M, Sato A, Maeba H, et al. Dermal structure in lymphedema patients with history of acute dermatolymphangioadenitis evaluated by histogram analysis of ultrasonography findings: a case-control study. Lymphat Res Biol. 2016;14(1):2-7. http://dx.doi.org/10.1089/lrb.2015.0020. PMid:26982711.
http://dx.doi.org/10.1089/lrb.2015.0020...
(Japan) |
10 UL with LSBC with a history of ADLA and 14 UL with LSBC. |
1c |
Asymmetry was calculated by histogram analysis for ROI defined in images of the dermis, using the same technique for both limbs. |
Distribution of collagen in the papillary layer of the dermis was different after ADLA episodes, based on the results for asymmetry and elevated pixel echogenicity. |
Effective: DUS is effective for identification of structural changes in ADLA, a risk factor for increased lymphedema. |
Ultrasound Derma scan C (Cortex Technology, Smedevaenget, Denmark) at 20 MHz. |
| DUS is useful for assessing asymmetry and confirming dermal structure. |
Hansdorfer-korzon et al.2424 Hansdorfer-Korzon R, Teodorczyk J, Gruszecka A, Lass P. Are compression corsets beneficial for the treatment of breast cancer-related lymphedema? New opportunities in physiotherapy treatment: a preliminary report. OncoTargets Ther. 2016;9:2089-98. http://dx.doi.org/10.2147/OTT.S100120. PMid:27103835.
http://dx.doi.org/10.2147/OTT.S100120...
(Poland) |
35 women with LSBC were enrolled and 29 completed the study. |
1b |
Ultrasonography (B-mode) was used to assess lymphedema in the side of the chest after mastectomy. This test was performed three times at a specific site on the operated side and symmetrically on the opposite side. Subsequently, patients were fit with an appropriate compression corset and reassessed with ultrasonography. |
Ultrasonography identified subcutaneous changes caused by lymphedema. |
Effective: ultrasound was effective for assessment of the effects of the proposed treatment. |
Ultrasound (Voluson E8, ML6-15 probe; GE Healthcare, Piscataway NJ, United States). Transducer and frequency were not reported. |
Jeon et al.33 Jeon Y, Beom J, Ahn S, Bok SK. Ultrasonographic evaluation of breast cancer-related lymphedema. J Vis Exp. 2017;(119):e54996. http://dx.doi.org/10.3791/54996. PMid:28117779.
http://dx.doi.org/10.3791/54996...
(South Korea) |
32 patients with LSBC randomized into 2 groups: PRE and no PRE. |
1b |
Thickness of muscle and subcutaneous tissue were measured with DUS. Muscle and subcutaneous tissue thicknesses were measured at baseline and at 4 weeks and 8 weeks after PRE. |
Initial muscle thickness of all participants was significantly smaller in the lymphedematous arm compared with the unaffected UL. The subcutaneous tissue was thicker in the UL with LSBC. |
Effective: DUS is one of the best tools for diagnosis and to determine efficacy of treatment for LSBC. |
Information not provided. |
Yang et al.1313 Yang X, Torres M, Kirkpatrick S, Curran WJ, Liu T. Ultrasound 2D strain measurement for arm lymphedema using deformable registration: a feasibility study. PLoS One. 2017;12(8):e0181250. http://dx.doi.org/10.1371/journal.pone.0181250. PMid:28854199.
http://dx.doi.org/10.1371/journal.pone.0...
(United States) |
Clinical feasibility was tested with four participants: two patients with LSBC and two healthy volunteers. |
1c |
2D deformation imaging method using registration of pre- and post-compression ultrasound B-mode images The method was tested through a series of experiments using elastography under various pressures. |
The initial findings are encouraging and a large clinical study is needed to further evaluate this 2D ultrasound strain imaging technology. |
Effective: DUS 2D was effective for identification of UL changes caused by lymphedema. |
Clinical scanner (SonixTouch, Ultrasonix, British Columbia, Canada) with a linear matrix transducer (L14-5 / 38). 10 MHz central frequency. |
Hashemi et al.2525 Hashemi HS, Fallone S, Boily M, Towers A, Kilgour RD, Rivaz H. Ultrasound elastography of breast cancer-related lymphedema. In: Proceedings of the 2018 IEEE 15th International Symposium on Biomedical Imaging (ISBI 2018); 2018; Washington, DC, USA. New York: IEEE; 2018. p. 1491-5. http://dx.doi.org/10.1109/ISBI.2018.8363855.
http://dx.doi.org/10.1109/ISBI.2018.8363...
(Canada) |
7 women with stage 2 LSBC were assessed. |
1b |
DUS identified the properties of tissues in women with LSBC. |
Ultrasonographic elastography assessment was effective for staging LSBC and assessing tissues. |
Effective: new DUS elastography techniques can be used to better evaluate o LSBC and provide treatments to reduce progression of the condition. |
Ultrasound system: Alpinion E-Cube (Bothell, WA, United States) using an L3-8 transducer with a central frequency of 10 MHz and sampling rate of 40 MHz. |
| Quasi-static ultrasound elastography techniques were used to investigate their usefulness in staging lymphedema. |
Yang et al.2626 Yang EJ, Kim SY, Lee WH, Lim JY, Lee J. Diagnostic accuracy of clinical measures considering segmental tissue composition and volume changes of breast cancer-related lymphedema. Lymphat Res Biol. 2018;16(4):368-76. http://dx.doi.org/10.1089/lrb.2017.0047. PMid:29338541.
http://dx.doi.org/10.1089/lrb.2017.0047...
(South Korea) |
158 women at least 6 months after treatment for unilateral breast cancer with or without lymphedema were recruited retrospectively. |
1b |
DUS was used to assess subcutaneous echogenicity of the medial arm and forearm on both sides and graded by subcutaneous echogenicity grade. |
DUS is indicated for assessment of lymphedema, primarily in the medial forearm. |
Effective: ultrasound subcutaneous echogenicity can improve the precision of diagnosis of lymphedema of the forearm. |
Ultrasound equipped with a 11 MHz transducer. |
| The system used was not reported. |
Iyigun et al.2727 Iyigun ZE, Duymaz T, Ilgun AS, et al. Preoperative lymphedema-related risk factors in early-stage breast cancer. Lymphat Res Biol. 2018;16(1):28-35. http://dx.doi.org/10.1089/lrb.2016.0045. PMid:28346852.
http://dx.doi.org/10.1089/lrb.2016.0045...
(Turkey) |
36 female patients with stage 1 or 2 lymphedema of upper limbs secondary to breast cancer. |
1b |
Ultrasonography was used to make a total of three measurements of the arm with lymphedema and the normal extremity, one 10 cm proximal of the styloid apophysis of the ulna, for the forearm, and 10 cm proximal of the medial epicondyle, for the arm. Images were acquired of 10 different subcutaneous regions and used to calculate the mean shear wave velocities. |
The shear wave elastography ultrasound technique was able to identify areas with lymphedema. |
Effective: ultrasonography is a useful tool for distinction and diagnosis of initial and late stages of lymphedema. |
SWE ultrasound (Acuson S 3000 US) 9L4 transducer with frequency range of 4-9 MHz. |
Mander et al.2828 Mander A, Venosi S, Menegatti E, et al. Upper limb secondary lymphedema ultrasound mapping and characterization. Int Angiol. 2019;38(4):334-42. http://dx.doi.org/10.23736/S0392-9590.19.04176-2. PMid:31203598.
http://dx.doi.org/10.23736/S0392-9590.19...
(United States/Italy) |
287 women with LSBC. |
1a |
Tissue thickness was measured and compared considering the contralateral limb as the control. The limb was considered affected by lymphedema if there were two consecutive circumference measurements more than 2 cm larger than the contralateral limb. |
Traditional DUS can provide secondary upper limb lymphedema characterization with related mapping and useful data for better lymphatic physiopathology understanding and for a properly addressed therapeutic protocol. |
Effective: DUS proved effective for characterization of LSBC. |
Ultrasound (Sono Scape S22, linear probe 12L-A, 192 elements, 6-16 MHz). |
Polat et al.2929 Polat AV, Ozturk M, Polat AK, Karabacak U, Bekci T, Murat N. Efficacy of ultrasound and shear wave elastography for the diagnosis of breast cancer-related lymphedema. J Ultrasound Med. 2020;39(4):795-803. http://dx.doi.org/10.1002/jum.15162. PMid:31705687.
http://dx.doi.org/10.1002/jum.15162...
(Turkey) |
41 women with a history of unilateral breast surgery and axillary dissection or excision of sentinel lymph nodes. |
1b |
The thickness and stiffness of cutaneous and subcutaneous tissues of the forearm and arm were measured with ultrasound and SWE. The affected limb was compared with the contralateral limb. |
In the latent lymphedema group, the thickness measurements of the cutaneous tissue of the affected forearm and the cutaneous and subcutaneous tissue of the affected arm were significant. |
Effective: DUS was effective for diagnose of LSBC even at a latent stage. |
B-mode ultrasound -Acuson S2000 US system (Siemens Medical Solutions, Mountain View, CA, United States) equipped with a 9 MHz probe |
Suehiro et al.3030 Suehiro K, Morikage N, Yamashita O, et al. Skin and subcutaneous tissue ultrasonography features in breast cancer-related lymphedema. Ann Vasc Dis. 2016;9(4):312-6. http://dx.doi.org/10.3400/avd.oa.16-00086. PMid:28018504.
http://dx.doi.org/10.3400/avd.oa.16-0008...
(Japan) |
120 patients who had undergone surgery for breast cancer and were monitored for emergence of lymphedema. |
1b |
Ultrasonography of skin and subcutaneous tissue was used to assess the echogenicity of the limbs assessed with the objective of determining its diagnostic capacity for early detection of post-mastectomy lymphedema from 1 preoperative month up to 2 years during the postoperative period. Assessment of diffuse increases in echogenicity in the subcutaneous layer and echogenic lines. |
Ultrasound found evidence of differences in subcutaneous echogenicity between the regions assessed in the upper limbs assessed for development of lymphedema secondary to breast cancer. |
Effective: ultrasonography was able to identify areas with increased cellular density and increased tissue collagen content, which indicates presence of subcutaneous inflammation, which shows presence of lymphedema. |
Ultrasound System Logiq S6 (GE Healthcare, Little Chalfont, Buckinghamshire, United Kingdom) with a 7 to 12 MHz linear transducer. |
Giray and Yağcı88 Giray E, Yağcı İ. Interrater and intrarater reliability of subcutaneous echogenicity grade and subcutaneous echo-free space grade in breast cancer-related lymphedema. Lymphat Res Biol. 2019;17(5):518-24. http://dx.doi.org/10.1089/lrb.2018.0053. PMid:30570358.
http://dx.doi.org/10.1089/lrb.2018.0053...
(Turkey) |
50 women with breast cancer-related lymphedema of the arm. |
1b |
Ultrasound was used to assess interrater and intrarater reliability for diagnosis of lymphedema by identification of degree of subcutaneous echogenicity and the degree of lymphedema secondary to breast cancer, which enables semiquantification of nonspecific inflammation of the subcutaneous tissue and fluid accumulation in lymphedema secondary to breast cancer. The probe was maintained in an axial position on the medial forearm over the flexor carpi radialis muscle. The depth of image acquisition was set at 2 cm. |
Ultrasonography showed that SEG grade and SEFS grade are both reliable according to intraexaminer and interexaminer assessments, but it should be considered that examiners had lower agreement when classifying SEG in patients at intermediate clinical stages and higher agreement when classifying SEFS grade in patients at intermediate clinical stages. |
Effective: based on the findings of this study, SEG and SEFS demonstrated acceptable reliability. The ultrasound SEG and SEFS classification system can be useful for monitoring progression, composition, and management of lymphedema secondary to breast cancer. |
Esaote MyLab ultrasound system with 6-18 MHz linear matrix probe. |
Hashemi et al.3131 Hashemi HS, Fallone S, Boily M, Towers A, Kilgour RD, Rivaz H. Assessment of mechanical properties of tissue in breast cancer-related lymphedema using ultrasound elastography. IEEE Trans Ultrason Ferroelectr Freq Control. 2019;66(3):541-50. http://dx.doi.org/10.1109/TUFFC.2018.2876056. PMid:30334756.
http://dx.doi.org/10.1109/TUFFC.2018.287...
(Canada) |
The study population comprised 7 women with stage 2 breast cancer-related lymphedema. |
1c |
Ultrasound elastography was used to compare the mechanical properties of the affected and unaffected arms to offer an alternative to current subjective assessment of lymphedema secondary to breast cancer. The method was compared to the pitting test habitually used to assess lymphedema. Ultrasound data were collected from both arms of seven patients with stage 2 lymphedema, at six different locations in each arm to identify changes to the mechanical properties of tissues related to detection and staging of lymphedema. |
Ultrasound elastography was able to visualize differences in the tissue properties of the unaffected limb (not lymphedematous) and the affected limb (lymphedematous). The values for deformation rate in the affected limb are consistent and significantly lower in skin than in subcutaneous fat and skeletal muscle layers. Lower deformation rates were observed in affected skin compared with the unaffected limb. |
Effective: the elastography technique proposed is more sensitive than the pitting test. |
Ultrasound system Alpinion E-Cube (Bothell, WA, United States) using an L3-12H transducer with a central frequency of 10 MHz and sampling rate of 40 MHz. |
Seo et al.77 Seo D, Lee S, Choi W. Comparison of real-time ultrasound imaging for manual lymphatic drainage on breast cancer-related lymphedema in individuals with breast cancer: a preliminary study. Phys Ther Rehabil Sci. 2020;9(1):43-8. http://dx.doi.org/10.14474/ptrs.2020.9.1.43.
http://dx.doi.org/10.14474/ptrs.2020.9.1...
(South Korea) |
6 women who had undergone surgery for breast cancer and were diagnosed with unilateral upper limb lymphedema. |
1c |
Ultrasonography was used to assess the effects of an intervention with MLD, pre-intervention and post-intervention. Limb volume measurements were performed of the affected and contralateral limbs, which were compared. |
Ultrasound images showed significant differences in the volume of the affected limb compared to the unaffected side. On the affected side, although ultrasonography showed a significant reduction after MLD, there was no significant difference when compared to baseline. |
Effective: ultrasonography proved effective for assessment of the treatment approach employed (MLD). |
Ultrasound (MySono U5; Samsung Medison Co., Seul, South Korea) with a 7.5 MHz linear transducer. |
Niwa et al.3232 Niwa S, Mawaki A, Hisano F, et al. Prediction of the presence of fluid accumulation in the subcutaneous tissue in BCRL using texture analysis of ultrasound images. Lymphat Res Biol. 2022;20(1):11-6. http://dx.doi.org/10.1089/lrb.2020.0121. PMid:33625885.
http://dx.doi.org/10.1089/lrb.2020.0121...
(Japan) |
The study enrolled 20 women who had been treated for unilateral breast cancer and later developed upper limb lymphedema. |
1b |
Subcutaneous tissue was scanned with an ultrasound system using a 6 to 15 MHz linear transducer to assess the capacity of tissue texture characteristics to discriminate the presence of accumulated fluid within the subcutaneous tissue of breast cancer-related lymphedema. Fluid accumulation was observed using a 3-Tesla MR system under double-echo steady-state conditions. |
There was a significant difference in textural features among the three groups (with hyperintense area, without hyperintense area, and unaffected side), revealing significant differences in seven textural features within the hyperintense area, showing it was possible to discriminate presence of fluid accumulation in subcutaneous tissue of LSBC with ultrasound images. |
Effective: the study showed that seven textural features quantified with US imaging data can provide information on fluid accumulation in subcutaneous tissue with lymphedema. |
Ultrasound: Sonosite Edge II; Sonosite, Inc., FUJIFILM) using a 6 to 15 MHz linear transducer. |
Kim et al.3333 Kim SY, Lee CH, Heo SJ, Moon MH. The clinical usefulness of lymphedema measurement technique using ultrasound. Lymphat Res Biol. 2021;19(4):340-6. http://dx.doi.org/10.1089/lrb.2019.0070. PMid:33404351.
http://dx.doi.org/10.1089/lrb.2019.0070...
(South Korea) |
69 female patients with a diagnosis of stage 1 lymphedema secondary to advanced breast cancer. |
1b |
Ultrasonography was performed on both arms of each subject, with the patients lying down. The examiner marked the regions to measure a cross-sectional area. |
The cross-sectional area measurement method showed high coefficients for lymphedema assessment. Stiffness of soft tissues, which reflects their histological status, can be measured and reveal different characteristics to tissues with the same volume and lymphedema. |
Effective: a combination of these two ultrasonographic methods appears to show not only structural changes but also histological changes in soft tissues after development of lymphedema. |
Ultrasound (LOGIQ E9; General Electric, Boston, MA, United States) with a 7.5 MHz transducer. |
| Subcutaneous tissue stiffness was also obtained by measuring thickness differences of soft tissue when applying minimal and maximal pressure to the skin (compliance) and its ratio to the initial thickness. |
Erdinç Gündüz et al.3434 Erdinç Gündüz N, Dilek B, Şahin E, Ellidokuz H, Akalın E. Diagnostic contribution of ultrasonography in breast cancer-related lymphedema. Lymphat Res Biol. 2021;19(6):517-23. http://dx.doi.org/10.1089/lrb.2020.0068. PMid:33601960.
http://dx.doi.org/10.1089/lrb.2020.0068...
(Turkey) |
34 female patients with lymphedema secondary to breast cancer. Unilateral breast cancer-related lymphedema. |
1b |
Skin and subcutaneous thicknesses were measured ultrasonographically from four quadrants at the marked points and also subcutaneous tissue changes were graded according to the subcutaneous echogenicity grade (SEG) scale ultrasonographically. Ultrasonographic measures performed were subcutaneous ultrasonographic echogenicity and skin and subcutaneous thickness measurement. |
Lymphedema severity was graded ultrasonographically according to the SEG scale as stage 0, stage 1, and stage 2, assessing the echogenic lines of echogenicity. Ultrasonographic assessment of the difference between the two upper extremities had a high (0.83%) sensitivity and an acceptable (0.75%) specificity in the differentiation of Grade II and Grade III lymphedema. |
Effective: a correlation was established between circumferential measurements and ultrasonographic measurements. Ultrasonography can be used complementary to circumferential measurements in diagnosing lymphedema. |
Information not provided. |
Duyur Çakit et al.1616 Duyur Çakıt B, Ayhan FF, Gümrük Aslan S, Genç H. The role of ultrasonography in follow-up of effectiveness of Complex Decongestive Therapy (CDT) in different subgroups of patients with breast cancer-related lymphoedema. Eur J Cancer Care. 2021;30(2):e13376. http://dx.doi.org/10.1111/ecc.13376. PMid:33219612.
http://dx.doi.org/10.1111/ecc.13376...
(Turkey) |
The study enrolled 47 patients with unilateral upper limb lymphedema secondary to breast cancer. |
1b |
Ultrasound was conducted to determine its role in the follow-up of effectiveness of CDT in different subgroups of patients with breast cancer-related lymphedema. All patients underwent CDT, the circumference measurements and ultrasonographic soft tissue thicknesses evaluations were performed at two anatomic sites, and upper extremity limb volumes were calculated using the truncated cone formula before and after CDT. |
There were significant decreases in both circumferential measurements and ultrasonographic soft tissue thicknesses in non-obese patients and stage 2 lymphedema patients after 15 sessions of CDT. The ultrasonographic soft tissue thickness values were correlated with the upper arm and forearm circumference values before and after CDT. |
Relative efficacy: ultrasonography is a reliable method to measure the soft tissue thickness and treatment efficacy after CDT in non-obese and stage 2 patients with LSBC only. |
Ultrasound system with 7-12 MHz linear transducer: Logic P5, GE medical systems, Wisconsin, United States. |
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