title: Preoperative Lymphedema-Related Risk Factors in Early-Stage Breast Cancer.
abstract: Prolongation of survival in patients with breast cancer due to early diagnosis and modern methods of treatment has turned the attention on lymphedema, which is the most important morbidity secondary to the treatment of the disease. Determination of lymphedema and related risk factors in patients before a surgical intervention may provide protection for patients and early treatment. The aim of this study was to determine the presence of lymphedema before surgery by bioimpedance analysis in patients with breast cancer and to establish risk factors associated with lymphedema.
  
  
  
  A total of 277 patients who were diagnosed as having breast cancer, were planned to undergo a surgical intervention, and had no clinical lymphedema were included in the study. The presence of lymphedema was evaluated with clinical examination, measurement of arm circumference, and bioimpedance analysis.
  
  
  
  Lymphedema was found in 59 (21.3%) patients with no detected differences in arm circumferences. A significant relationship was found between the presence of lymphedema and body mass index (BMI), number of positive lymph nodes, and capsule invasion of the tumor (p = 0.001, p = 0.003, p = 0.002, respectively). Multiple regression analysis revealed that BMI and the number of positive lymph nodes were independent variables (p = 0.024, p = 0.002). ROC curve analysis resulted in an increased risk of preoperative lymphedema when the number of positive lymph nodes was ≥8. Correlation analysis revealed a positive correlation between the number of positive lymph nodes and L-dex score (p = 0.001, r = 0.219).
  
  
  
  Preoperative bioimpedance analysis demonstrated that ∼1/5 of the patients had subclinical lymphedema. Preoperative subclinical lymphedema is associated with obesity and the number of positive lymph nodes, and thus, treatment of the axilla in patients who are preoperatively detected to have subclinical lymphedema should be revised.
authors.affiliation: 1 Department of Physical Theraphy and Rehabilitation, Istanbul Bilim University School of Medicine , Istanbul, Turkey .
authors.forename: Zeynep Erdogan
authors.initials: ZE
authors.lastname: Iyigun
authors.affiliation: 1 Department of Physical Theraphy and Rehabilitation, Istanbul Bilim University School of Medicine , Istanbul, Turkey .
authors.forename: Tomris
authors.initials: T
authors.lastname: Duymaz
authors.affiliation: 2 Department of General Surgery, Gaziosmanpaşa Taksim Training and Research Hospital , Istanbul, Turkey .
authors.forename: Ahmet Serkan
authors.initials: AS
authors.lastname: Ilgun
authors.affiliation: 3 Department of Radiation Oncology, Gayrettepe Florence Nightingale Hospital , Istanbul, Turkey .
authors.forename: Gul
authors.initials: G
authors.lastname: Alco
authors.affiliation: 4 Department of Medical Oncology, Gayrettepe Florence Nightingale Hospital , Istanbul, Turkey .
authors.forename: Cetin
authors.initials: C
authors.lastname: Ordu
authors.affiliation: 5 Department of Breast Surgery, Istanbul Florence Nightingale Hospital , Istanbul, Turkey .
authors.forename: Dauren
authors.initials: D
authors.lastname: Sarsenov
authors.affiliation: 5 Department of Breast Surgery, Istanbul Florence Nightingale Hospital , Istanbul, Turkey .
authors.forename: Ayse Esra
authors.initials: AE
authors.lastname: Aydin
authors.affiliation: 6 Department of Radiology, Gayrettepe Florence Nightingale Hospital , Istanbul, Turkey .
authors.forename: Filiz Elbuken
authors.initials: FE
authors.lastname: Celebi
authors.affiliation: 7 Department of Psychiatry, Istanbul Bilim University School of Medicine , Istanbul, Turkey .
authors.forename: Filiz
authors.initials: F
authors.lastname: Izci
authors.affiliation: 8 Department of Medical Oncology, Oncology Institute, Istanbul University , Istanbul, Turkey .
authors.forename: Yeşim
authors.initials: Y
authors.lastname: Eralp
authors.affiliation: 9 Department of Breast Surgery, Istanbul University Istanbul Medical Faculty , Istanbul, Turkey .
authors.forename: Vahit
authors.initials: V
authors.lastname: Ozmen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001365:Axilla / Q000000981:diagnostic imaging / Q000473:pathology; D015992:Body Mass Index; D000072656:Breast Cancer Lymphedema / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology; D001943:Breast Neoplasms / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D042241:Early Diagnosis; D017097:Electric Impedance; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D008408:Mastectomy / Q000009:adverse effects; D008875:Middle Aged; D009367:Neoplasm Staging; D009765:Obesity / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D012372:ROC Curve; D012307:Risk Factors; D021701:Sentinel Lymph Node Biopsy
keywords: bioimpedance analysis; lymphedema; preoperative measurement