title: Axillary web syndrome self-assessment questionnaire: Initial development and validation.
abstract: BACKGROUND
  Despite the great strides made in medical knowledge, surgery still remains a necessary part of the breast cancer treatment. Surgical procedures still lead to post surgical sequelae. The axillary web syndrome (AWS) is one such sequela, which can lead to disability, reduced arm mobility and compromised quality of life. It is often unidentified and the literature regarding its assessment is limited. To improve diagnosis and patient education, the Screening Test AWS (ST-AWS) questionnaire was drafted and applied at the European Institute of Oncology (EIO).
  
  
  METHODS
  We prospectively recruited patients from October 2012 to December 2012. Patients who underwent sentinel lymph node biopsy and/or axillary dissection procedures were registered. Physical examination was set as a gold standard.
  
  
  RESULTS
  88 patients completed the questionnaire. Among these, 32 patients had axillary web syndrome diagnosed, thus a 36% incidence. The questionnaire achieved a sensitivity of 94%, a specificity of 91%, a positive prevalence value (PPV) of 86%, a negative prevalence value (NPV) of 96% and an accuracy of 92%.
  
  
  CONCLUSIONS
  Our questionnaire achieves high sensitivity and predictive values, and we would recommend it as a screening-tool for auto-diagnosis of the AWS. The main objective of the questionnaire is to enhance patient and therapist awareness of the problem, and prompt management to shorten the effects of this disability. Moreover, it may offer a tool to enhance body image acceptance after surgery. Further studies whereby the efficacy of the questionnaire is investigated in a larger, heterogeneous group and in different situations are warranted.
authors.affiliation: Physiotherapy Department, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy. Electronic address: lipejj@hotmail.com.
authors.forename: Luiz Felipe
authors.initials: LF
authors.lastname: Nevola Teixeira
authors.affiliation: Breast Surgery Unit, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Veronesi
authors.affiliation: Department of Surgery, Mahidol University School of Medicine, 2 Prannok Rd., Bangkoknoi, Bangkok, 10700, Thailand.
authors.forename: Visnu
authors.initials: V
authors.lastname: Lohsiriwat
authors.affiliation: Breast Surgery Unit, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Luini
authors.affiliation: Porto Alegre Federal Health Science University, Sarmento Leite St., 245, CEP 90050-170, Porto Alegre, Brazil.
authors.forename: Mario Casales
authors.initials: MC
authors.lastname: Schorr
authors.affiliation: Plastic and Reconstructive Surgery Unit, European Institute of Oncology, Via Giusepe Ripamonti, 435, 20141, Milan, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Garusi
authors.affiliation: Physiotherapy Department, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy.
authors.forename: Maria Claudia
authors.initials: MC
authors.lastname: Simoncini
authors.affiliation: Medical Sciences Departament, University of Campinas, Zeferino Vaz St., Cidade Universitaria, Campinas, 13083-970, Brazil.
authors.forename: Luis Otavio Zanatta
authors.initials: LO
authors.lastname: Sarian
authors.affiliation: Division of Epidemiology and Biostatistics, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Gandini
authors.affiliation: Physiotherapy Department, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Sandrin
authors.affiliation: Plastic and Reconstructive Surgery Unit, European Institute of Oncology, Via Giusepe Ripamonti, 435, 20141, Milan, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Rietjens
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000601:surgery*; D057189:Checklist; D015331:Cohort Studies; D059026:Diagnostic Self Evaluation; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008206:Lymphatic Diseases / Q000175:diagnosis*; D008875:Middle Aged; D059825:Physical Therapists; D011183:Postoperative Complications / Q000175:diagnosis*; D011446:Prospective Studies; D011788:Quality of Life; D016059:Range of Motion, Articular; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy; D011795:Surveys and Questionnaires; D013577:Syndrome; D055815:Young Adult
keywords: Breast neoplasms; Breast reconstruction; Lymph node dissection; Physiotherapy; Rehabilitation