title: Surgical outcomes after breast cancer surgery: measuring acute lymphedema.
abstract: BACKGROUND
  Studies of lymphedema have used inconsistent measures and criteria. The purpose of this pilot study was to measure the onset and incidence of acute lymphedema in breast cancer survivors using strict criteria for limb evaluation.
  
  
  METHODS
  Eligible women were those undergoing breast cancer surgery that included axillary staging and/or radiation therapy of the breast. Arm volume, strength, and flexibility were measured preoperatively and quarterly. Lymphedema was defined as a greater than 10% increase in limb volume. Additional strength and flexibility assessments were done at these times.
  
  
  RESULTS
  In 30 evaluable patients, half underwent modified radical mastectomy and half lumpectomy, with half of the lumpectomy patients undergoing axillary node staging. Of the 30 patients 27% were Stage 0; the rest were Stage I (27%), IIA (13%), IIB (23%), and IIIA (7%). One subject was IIIB postoperatively. There were 2 women with a 10% or greater change in limb volume; the change was detected in one woman at 3 months (5% incidence) and in the second woman at 6 months (11% incidence). Both had undergone mastectomy and axillary dissection and one of these two women had symptoms of tingling and numbness in the affected arm that began at 3 months. Overall, 35% of the sample experienced symptoms by 3 months, which included numbness, aching, and tingling of the entire upper extremity, but without volume changes. The relationship between undergoing modified radical mastectomy and experiencing symptoms in the affected limb at 3 months was significant (P = 0.05).
  
  
  CONCLUSIONS
  In this interim report strict methods of measurement and limb volume comparisons detected acute lymphedema at 3 months in 5% of the sample, and at 6 months in 11% of the sample. Furthermore, symptoms were detected in 35% without volume changes at 3 months postoperatively, which may warn of lymphedema occurrence within the next 3 months. This may assist clinical evaluation of symptoms in the postoperative period and support early referral to lymphedema experts.
authors.affiliation: Surgical Section, John D. Dingell VA Medical Center, Detroit, Michigan, USA. Mary.kosir@med.va.gov
authors.forename: M A
authors.initials: MA
authors.lastname: Kosir
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authors.lastname: Northouse
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008209:Lymphedema / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology*; D015411:Mastectomy, Modified Radical / Q000009:adverse effects; D015412:Mastectomy, Segmental / Q000009:adverse effects; D008824:Michigan; D008875:Middle Aged; D009367:Neoplasm Staging; D044469:Racial Groups; D012959:Socioeconomic Factors; D013997:Time Factors; D016896:Treatment Outcome