Meme kanseri ilişkili lenfödemde lenfödem şiddeti ve elastografi ile ölçülen biseps kası sertliği arasında bir korelasyon var mı?

Öz

Amaç: Meme kanseri ilişkili lenfödem (MKİL) etkilenen el ve kolda şişme, ağırlık hissi, katılık, ağrı, uyuşukluk ve hareket kısıtlılığına neden olur. MKİL bu olgularda fibrozis, selülüt, lenfadenit ve sepsise yatkınlık yapar. Bu çalışmanın amacı biseps kasında “makaslama dalgası elastografi” (SWE) ile ölçülen sertlik ve lenfödem şiddeti arasındaki korelasyonu değerlendirmektir.

Yöntemler: Üst ekstremitede MKİL olan 20 olgu (ortalama yaş; 54,6±5,4 yıl) prospektif olarak çalışmaya dâhil edilmiştir. Biseps kası sertliği SWE ile değerlendirilmiştir. Her bir olguda etkilenen taraftaki biseps kasında “makaslama dalgası” hız değerleri ölçülmüştür.

Lenfödem şiddetine lenfödemden etkilenen tarafla etkilenmeyen taraf arasındaki hacim ve çap farkı hesaplanılarak karar verilmiştir.  Her olguda biseps kasında “Shear Wave” hız değeri (SWH) ölçülmüştür. SWE ile ölçülen biseps kası sertliği ve etkilenen tarafla etkilenmeyen taraf arasındaki hacim ve çap farkları arasındaki korelasyon değerlendirilmiştir.

Bulgular: Etkilenen kolda biseps kasında ölçülen SWH değerleri ile etkilenen ve etkilenmeyen ekstremiteler arasındaki hacim ve çap farkı arasında orta derecede bir korelasyon saptanmıştır (0,70≥ r≥ 0,51).

Sonuç: Çalışmamızda lenfödem şiddeti arttıkça biseps kası sertliğinde artış olduğunu gösterdik. SWE ile ölçülen biseps kası sertliği MKİL tanılı olgularda takipte kullanılabilecek kantitatif bir metot olabilir.

Anahtar Kelimeler

• Lenfödem,elastografi,meme kanseri,biseps

: Is there a correlation between the biceps brachii muscle stiffness measured by elastography and severity of lymphedema in patients with breast cancer-related lymphedema?

Öz

Aim: Breast-cancer-related lymphedema (BCRL) causes symptoms such as swelling, heaviness, tightness, firmness, pain, numbness, or impaired mobility in the affected arm and hand. It also predisposes patients to fibrosis, cellulitis, infections, lymphadenitis, and septicemia. Aim of this study was to analyze correlation between the biceps brachii muscle stiffness measured by shear wave elastography (SWE) and severity of the lymphedema.

Methods: This prospective study included 20 consecutive patients (mean age, 54.6±5.4 years) with having BCRL in the upper limb. Stiffness of the biceps brachii muscle was assessed by SWE. Shear wave speeds (SWS) of the biceps muscle on the affected side for each patient were measured. Severity of the lymphedema was determined by difference between diameters and volumes of affected and unaffected extremities. Correlations between the biceps brachii muscle stiffness measured by SWE and difference between diameters and volumes of affected and unaffected extremities were analyzed.

Results: SWS of the biceps muscle on the affected side showed positive fair correlation with difference between diameters and volumes of affected and unaffected extremities (0.70≥ r≥ 0.51).

Conclusion: Our results suggest that the biceps muscle stiffness increases with increase in severity of lymphedema. The biceps muscle stiffness measured by SWE could provide a quantitative tool for following-up patients with BCRL.

Anahtar Kelimeler

• Lymphedema,elastography,breast cancer,biceps brachii

Kaynakça

1. 1. Mortimer P. Arm lymphoedema after breast cancer. Lancet Oncol. 2013;14:423–42.
2. 2. McLaughlin SA, Bagaria S, Gibson T, Arnold M, Diehl N, Crook J, et al. Trends in risk reduction practices for the prevention of lymphedema in the first 12 months after breast cancer surgery. J Am Coll Surg. 2013;216:380–9.
3. 3. Fu MR, Ridner SH, Hu SH, Stewart BR, Cormier JN, Armer JM. Psychosocial impact of lymphedema: a systematic review of literature from 2004 to 2011. Psychooncology. 2013;22:1466–84.
4. 4.Fu MR, Kang Y. Psychosocial impact of living with cancer-related lymphedema. Semin Oncol Nurs. 2013;29:50–60.
5. 5. Shiina T, Nightingale KR, Palmeri ML, Hall TJ, Bamber JC, Barr RG, et al. WFUMB guidelines and recommendations for clinical use of ultrasound elastography: Part 1: basic principles and terminology. Ultrasound Med Biol. 2015;41:1126-47.
6. 6.Barr RG. Sonographic breast elastography: A primer. J Ultrasound Med. 2012; 31:773-83.
7. 7. Kim YS, Park JG, Kim BS, Lee CH, Ryu DW. Diagnostic value of elastography using acoustic radiation force impulse imaging and strain ratio for breast tumors. J Breast Cancer. 2014; 17:76-82.
8. 8. Zhai L, Palmeri ML, Bouchard RR, Nightingale RW, Nightingale KR. An integrated indenter-ARFI imaging system for tissue stiffness quantification. Ultrason Imaging. 2008;30:95-111.

9. 9. Modi S, Stanton AW, Mortimer PS, Levick JR. Clinical assessment of human lymph flow using removal rate constants of interstitial macromolecules: A critical review of lymphoscintigraphy. Lymphat Res Biol. 2007;5:183–202.
10. 10. Suami H, Chang D, Skoracki R, Yamada K, Kimata Y. Using indocyanine green fluorescent lymphography to demonstrate lymphatic architecture. J Lymphoedema. 2012;7:25–9.
11. 11. Sevick-Muraca EM, Kwon S, Rasmussen JC. Emerging lymphatic imaging technologies for mouse and man. J Clin Invest. 2014; 124:905–14.
12. 12. Rockson, SG. Ultrasonography in the Evaluation of Breast Cancer-Related Lymphedema. Lymphatic Research and Biology. 2016;14:1.
13. 13. Suehiro K, Morikage N, Murakami M, Yamashita O, Samura M, Hamano K. Significance of ultrasound examination of skin and subcutaneous tissue in secondary lower extremity lymphedema. Ann Vasc Dis. 2013;6:180-8.
14. 14. Lee JH, Shin BW, Jeong HJ, Kim GC, Kim DK, Sim YJ. Ultrasonographic evaluation of therapeutic effects of complex decongestive therapy in breast cancer-related lymphedema. Ann Rehabil Med. 2013;37:683-9.
15. 15. DiSipio T, Rye S, Newman B, Hayes S. Incidence of unilateral arm lymphoedema after breast cancer: a systematic review and meta-analysis. Lancet Oncol. 2013;14:500-15.
16. 16. 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;10:496-503.
17. 17. Stanton AW, Modi S, Bennett Britton TM, Purushotham AD, Peters AM, Levick JR, Mortimer PS.Lymphatic drainage in the muscle and subcutis of the arm after breast cancer treatment. Breast Cancer Res Treat. 2009;117:549-57.
18. 18. Yuan S, Magarik M, Lex AM, Fleischer AC. Clinical applications of sonoelastography. Expert Rev Med Devices. 2016;13:1107-17.
19. 19. Righetti R, Garra BS, Mobbs LM, Kraemer-Chant CM, Ophir J, Krouskop TA. The feasibility of using poroelastographic techniques for distinguishing between normal and lymphedematous tissues in vivo. Phys Med Biol. 2007;52:6525–41.
20. 20. Ebaugh D, Spinelli B, Schmitz KH. Shoulder impairments and their association with symptomatic rotator cuff disease in breast cancer survivors. Med Hypotheses.2011;77:481-7.
21. 21. Jang DH, Kim MW, Oh SJ, Kim JM. The Influence of Arm Swelling Duration on Shoulder Pathology in Breast Cancer Patients with Lymphedema.PLoS One. 2015;10:e0142950.
22. 22. Czerniec SA, Ward LC, Refshauge KM, Beith J, Lee MJ, York S, Kilbreath SL. Assessment of breast cancer-related arm lymphedema comparison of physical measurement methods and self-report. Cancer Invest. 2010;28:54-62.
23. 23. Fu MR, Axelrod D, Cleland CM, Qiu Z, Guth AA, Kleinman R, et al. Symptom report in detecting breast cancer-related lymphedema. Breast Cancer (Dove Med Press). 2015;7:345-52.
24. 24. International Society of Lymphology. The diagnosis and treatment of peripheral lymphedema. Consensus document of the International Society of Lymphology. Lymphology. 2003;36:84-91.
25. 25. Armer JM, Radina ME, Porock D, Culbertson SD. Predicting breast cancer-related lymphedema using self-reported symptoms. Nurs Res. 2003;52:370-9.
26. 26. Cormier JN, Xing Y, Zaniletti I, Askew RL, Stewart BR, Armer JM. Minimal limb volume change has a significant impact on breast cancer survivors. Lymphology. 2009;42:161-75.
27. 27. Yoon JA, Shin YB, Shin MJ, Yun RY, Kim KY, Song YS, et al. An Assessment of the Relationship Between Abdominal Obesity and the Severity of Upper Extremity Lymphedema. Lymphat Res Biol. 2018;16:458-63.
28. 28. de Fátima Guerreiro Godoy M, Silva EB, de Godoy JM. Bioimpedance to screen for abdominal fat in patients with breast cancer treatment-related lymphedema. Breast Dis. 2016;36:73-6.
29. 29. Ribeiro Pereira ACP, Koifman RJ, Bergmann A. Incidence and risk factors of lymphedema after breast cancer treatment: 10 years of follow-up. Breast. 2017;36:67-73.
30. 30. Armer JM. The problem of post-breast cancer lymphedema: Impact and measurement issues. Cancer Investig. 2005;23:76–83.
31. 31. Passik S, Newman M, Brennan M, Holland J. Psychiatric consultation for women undergoing rehabilitation for upper-extremity lymphedema following breast cancer treatment. J Pain Symptom Manage. 1993;8:226-33.