Abstract

Breast cancer-related lymphedema is a growing concern for patients and clinicians as it is chronic and leads to debilitating physical and social effects. The condition characterized by a swelling in the arm and hand is accompanied by numerous changes including fibrosis, adipose tissue deposits and fluid accumulation that are not easily detectible in clinical practice. There is no standardized affordable method that is used to objectively detect and assess the underlying tissue changes. Patients are staged based on subjective palpation and circumferential measures. The aim of this project was to obtain a better understanding of the muscle, fat and skin changes that occur in the lymphedematous limb. A total of 20 women with unilateral stage 2 breast cancer related lymphedema as well as 20 healthy control women were recruited to participate. They underwent a DXA body composition scan, a Perometer arm volume determination as well as circumferential arm measurements along 6 pre-determined landmarks, and handgrip strength measures. Of the 20 patients, 7 were randomly selected to collect muscle, fat and skin strain values along the same 6 landmarks through ultrasound elastography. This study suggested that the onset of lymphedema may be localized in the mid-forearm spreading proximally and raised questions regarding simultaneous development of lymphedematous fluid in the unaffected arm. Furthermore, results showed that ultrasound elastography is a tool that can be used to assess elastic tissue properties in a safe and time-efficient manner and can provide details on the pathology, thus helping clinicians determine more detailed staging of the lymphedema and the best treatment alternative for their patients.