title: Systematic review of breast cancer related lymphoedema: making a balanced decision to perform an axillary clearance.
abstract: OBJECTIVE
  Breast cancer-related lymphoedema (BCRL) is a disabling complication developing after breast cancer treatment in a proportion of patients. Its impact on quality of life becomes more substantial as survival after breast cancer diagnosis increases. The incidence of BCRL following breast cancer treatment varies due to a lack of -uniform definition and measurement criteria. This review aims to determine the prevalence of BCRL following axillary lymph node dissection (ALND) as a benchmark to be used in a risk-benefit medical decision whether to proceed with ALND or not. The risk of leaving unresected non-sentinel metastatic lymph nodes with a presumed inherent risk of local recurrence will be balanced against the risk of BCRL following a potentially unnecessary ALND.
  
  
  METHODS
  Pubmed and Embase databases were searched for all publications on BCRL in order to estimate its -incidence and to decide on the most appropriate measurement method to use in clinical practice.
  
  
  RESULTS
  51 articles were identified on BCRL incidence and measurement technique. Most studies measured BCRL based on differences in arm circumference (n = 18) or by self-reported symptoms (n = 18). The weighted average of BCRL incidence following ALND measured by self-report and circumference method was 28% and 16%, respectively.
  
  
  CONCLUSIONS
  The importance of ALND and irradiation as part of the treatment of operable breast carcinoma is well established, but its morbidity is less well documented. We argue self-report as the most appropriate method to -establish a diagnosis of BCRL. Therefore a 28% risk of finding non-sentinel lymph node metastases in a completion ALND will be regarded as the cut-off in a medical decision to proceed with ALND.
authors.affiliation: Department of Obstetrics & Gynaecology, Ziekenhuis Oost-Limburg Campus St Jan, Schiepse Bos 6, 3600 Genk, -Belgium.
authors.forename: M
authors.initials: M
authors.lastname: Göker
authors.affiliation: Department of Revalidation Sciences, University Hospitals Leuven, Herestraat 49 bus 7003, 3000 Leuven, Belgium.
authors.forename: N
authors.initials: N
authors.lastname: Devoogdt
authors.affiliation: Department of Obstetrics & Gynaecology, Ziekenhuis Oost-Limburg Campus St Jan, Schiepse Bos 6, 3600 Genk, -Belgium.
authors.forename: G
authors.initials: G
authors.lastname: Van de Putte
authors.affiliation: Department of Obstetrics & Gynaecology, Ziekenhuis Oost-Limburg Campus St Jan, Schiepse Bos 6, 3600 Genk, -Belgium.
authors.forename: J C
authors.initials: JC
authors.lastname: Schobbens
authors.affiliation: Department of Obstetrics & Gynaecology, Ziekenhuis Oost-Limburg Campus St Jan, Schiepse Bos 6, 3600 Genk, -Belgium.
authors.forename: J
authors.initials: J
authors.lastname: Vlasselaer
authors.affiliation: Department of Obstetrics & Gynaecology, University Hospital Ghent, De Pintelaan 185, 9000 Ghent, Belgium.
authors.forename: R
authors.initials: R
authors.lastname: Van den Broecke
authors.affiliation: Department of Obstetrics & Gynaecology, Ziekenhuis Oost-Limburg Campus St Jan, Schiepse Bos 6, 3600 Genk, -Belgium.
authors.forename: E T M
authors.initials: ET
authors.lastname: de Jonge
keywords: Breast cancer; axillary lymph node dissection; definition; incidence; lymphoedema; prevalence
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