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Symptom report in detecting breast cancer-related lymphedema

Identifieur interne : 000E41 ( Pmc/Checkpoint ); précédent : 000E40; suivant : 000E42

Symptom report in detecting breast cancer-related lymphedema

Auteurs : Mei R. Fu [États-Unis] ; Deborah Axelrod [États-Unis] ; Charles M. Cleland [États-Unis] ; Zeyuan Qiu [États-Unis] ; Amber A. Guth [États-Unis] ; Robin Kleinman [États-Unis] ; Joan Scagliola [États-Unis] ; Judith Haber [États-Unis]

Source :

RBID : PMC:4621182

Abstract

Breast cancer-related lymphedema is a syndrome of abnormal swelling coupled with multiple symptoms resulting from obstruction or disruption of the lymphatic system associated with cancer treatment. Research has demonstrated that with increased number of symptoms reported, breast cancer survivors’ limb volume increased. Lymphedema symptoms in the affected limb may indicate a latent stage of lymphedema in which changes cannot be detected by objective measures. The latent stage of lymphedema may exist months or years before overt swelling occurs. Symptom report may play an important role in detecting lymphedema in clinical practice. The purposes of this study were to: 1) examine the validity, sensitivity, and specificity of symptoms for detecting breast cancer-related lymphedema and 2) determine the best clinical cutoff point for the count of symptoms that maximized the sum of sensitivity and specificity. Data were collected from 250 women, including healthy female adults, breast cancer survivors with lymphedema, and those at risk for lymphedema. Lymphedema symptoms were assessed using a reliable and valid instrument. Validity, sensitivity, and specificity were evaluated using logistic regression, analysis of variance, and areas under receiver operating characteristic curves. Count of lymphedema symptoms was able to differentiate healthy adults from breast cancer survivors with lymphedema and those at risk for lymphedema. A diagnostic cutoff of three symptoms discriminated breast cancer survivors with lymphedema from healthy women with a sensitivity of 94% and a specificity of 97% (area under the curve =0.98). A diagnostic cutoff of nine symptoms discriminated at-risk survivors from survivors with lymphedema with a sensitivity of 64% and a specificity of 80% (area under the curve =0.72). In the absence of objective measurements capable of detecting latent stages of lymphedema, count of symptoms may be a cost-effective initial screening tool for detecting lymphedema.


Url:
DOI: 10.2147/BCTT.S87854
PubMed: 26527899
PubMed Central: 4621182


Affiliations:


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PMC:4621182

Le document en format XML

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<p>Breast cancer-related lymphedema is a syndrome of abnormal swelling coupled with multiple symptoms resulting from obstruction or disruption of the lymphatic system associated with cancer treatment. Research has demonstrated that with increased number of symptoms reported, breast cancer survivors’ limb volume increased. Lymphedema symptoms in the affected limb may indicate a latent stage of lymphedema in which changes cannot be detected by objective measures. The latent stage of lymphedema may exist months or years before overt swelling occurs. Symptom report may play an important role in detecting lymphedema in clinical practice. The purposes of this study were to: 1) examine the validity, sensitivity, and specificity of symptoms for detecting breast cancer-related lymphedema and 2) determine the best clinical cutoff point for the count of symptoms that maximized the sum of sensitivity and specificity. Data were collected from 250 women, including healthy female adults, breast cancer survivors with lymphedema, and those at risk for lymphedema. Lymphedema symptoms were assessed using a reliable and valid instrument. Validity, sensitivity, and specificity were evaluated using logistic regression, analysis of variance, and areas under receiver operating characteristic curves. Count of lymphedema symptoms was able to differentiate healthy adults from breast cancer survivors with lymphedema and those at risk for lymphedema. A diagnostic cutoff of three symptoms discriminated breast cancer survivors with lymphedema from healthy women with a sensitivity of 94% and a specificity of 97% (area under the curve =0.98). A diagnostic cutoff of nine symptoms discriminated at-risk survivors from survivors with lymphedema with a sensitivity of 64% and a specificity of 80% (area under the curve =0.72). In the absence of objective measurements capable of detecting latent stages of lymphedema, count of symptoms may be a cost-effective initial screening tool for detecting lymphedema.</p>
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<article-id pub-id-type="publisher-id">bctt-7-345</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Original Research</subject>
</subj-group>
</article-categories>
<title-group>
<article-title>Symptom report in detecting breast cancer-related lymphedema</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname>Fu</surname>
<given-names>Mei R</given-names>
</name>
<xref ref-type="aff" rid="af1-bctt-7-345">1</xref>
<xref ref-type="corresp" rid="c1-bctt-7-345"></xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Axelrod</surname>
<given-names>Deborah</given-names>
</name>
<xref ref-type="aff" rid="af2-bctt-7-345">2</xref>
<xref ref-type="aff" rid="af3-bctt-7-345">3</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Cleland</surname>
<given-names>Charles M</given-names>
</name>
<xref ref-type="aff" rid="af1-bctt-7-345">1</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Qiu</surname>
<given-names>Zeyuan</given-names>
</name>
<xref ref-type="aff" rid="af4-bctt-7-345">4</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Guth</surname>
<given-names>Amber A</given-names>
</name>
<xref ref-type="aff" rid="af2-bctt-7-345">2</xref>
<xref ref-type="aff" rid="af3-bctt-7-345">3</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Kleinman</surname>
<given-names>Robin</given-names>
</name>
<xref ref-type="aff" rid="af2-bctt-7-345">2</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Scagliola</surname>
<given-names>Joan</given-names>
</name>
<xref ref-type="aff" rid="af2-bctt-7-345">2</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Haber</surname>
<given-names>Judith</given-names>
</name>
<xref ref-type="aff" rid="af1-bctt-7-345">1</xref>
</contrib>
</contrib-group>
<aff id="af1-bctt-7-345">
<label>1</label>
College of Nursing, New York University, New York, NY, USA</aff>
<aff id="af2-bctt-7-345">
<label>2</label>
Department of Surgery, NYU School of Medicine, New York, NY, USA</aff>
<aff id="af3-bctt-7-345">
<label>3</label>
NYU Clinical Cancer Center, New York, NY, USA</aff>
<aff id="af4-bctt-7-345">
<label>4</label>
Department of Chemistry and Environmental Science, New Jersey Institute of Technology, Newark, NJ, USA</aff>
<author-notes>
<corresp id="c1-bctt-7-345">Correspondence: Mei R Fu, College of Nursing, New York University, 433 First Avenue, Fourth Floor, Room 424, New York, NY 10010, USA, Tel +1 212 998 5314, Email
<email>mf67@nyu.edu</email>
</corresp>
</author-notes>
<pub-date pub-type="collection">
<year>2015</year>
</pub-date>
<pub-date pub-type="epub">
<day>15</day>
<month>10</month>
<year>2015</year>
</pub-date>
<volume>7</volume>
<fpage>345</fpage>
<lpage>352</lpage>
<permissions>
<copyright-statement>© 2015 Fu et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License</copyright-statement>
<copyright-year>2015</copyright-year>
<license>
<license-p>The full terms of the License are available at
<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/">http://creativecommons.org/licenses/by-nc/3.0/</ext-link>
. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.</license-p>
</license>
</permissions>
<abstract>
<p>Breast cancer-related lymphedema is a syndrome of abnormal swelling coupled with multiple symptoms resulting from obstruction or disruption of the lymphatic system associated with cancer treatment. Research has demonstrated that with increased number of symptoms reported, breast cancer survivors’ limb volume increased. Lymphedema symptoms in the affected limb may indicate a latent stage of lymphedema in which changes cannot be detected by objective measures. The latent stage of lymphedema may exist months or years before overt swelling occurs. Symptom report may play an important role in detecting lymphedema in clinical practice. The purposes of this study were to: 1) examine the validity, sensitivity, and specificity of symptoms for detecting breast cancer-related lymphedema and 2) determine the best clinical cutoff point for the count of symptoms that maximized the sum of sensitivity and specificity. Data were collected from 250 women, including healthy female adults, breast cancer survivors with lymphedema, and those at risk for lymphedema. Lymphedema symptoms were assessed using a reliable and valid instrument. Validity, sensitivity, and specificity were evaluated using logistic regression, analysis of variance, and areas under receiver operating characteristic curves. Count of lymphedema symptoms was able to differentiate healthy adults from breast cancer survivors with lymphedema and those at risk for lymphedema. A diagnostic cutoff of three symptoms discriminated breast cancer survivors with lymphedema from healthy women with a sensitivity of 94% and a specificity of 97% (area under the curve =0.98). A diagnostic cutoff of nine symptoms discriminated at-risk survivors from survivors with lymphedema with a sensitivity of 64% and a specificity of 80% (area under the curve =0.72). In the absence of objective measurements capable of detecting latent stages of lymphedema, count of symptoms may be a cost-effective initial screening tool for detecting lymphedema.</p>
</abstract>
<kwd-group>
<title>Keywords</title>
<kwd>screening</kwd>
<kwd>risk</kwd>
<kwd>swelling</kwd>
<kwd>pain</kwd>
<kwd>heaviness</kwd>
<kwd>sensitivity</kwd>
</kwd-group>
</article-meta>
</front>
<floats-group>
<table-wrap id="t1-bctt-7-345" position="float">
<label>Table 1</label>
<caption>
<p>Participants’ demographic characteristics (n=250)</p>
</caption>
<table frame="hsides" rules="groups">
<thead>
<tr>
<th rowspan="2" valign="top" align="left" colspan="1">Variable</th>
<th colspan="2" valign="top" align="left" rowspan="1">Lymphedema (n=42)
<hr></hr>
</th>
<th colspan="2" valign="top" align="left" rowspan="1">At risk (n=148)
<hr></hr>
</th>
<th colspan="2" valign="top" align="left" rowspan="1">Healthy (n=60)
<hr></hr>
</th>
<th rowspan="2" valign="top" align="left" colspan="1">
<italic>P</italic>
-value</th>
</tr>
<tr>
<th valign="top" align="left" rowspan="1" colspan="1">Mean</th>
<th valign="top" align="left" rowspan="1" colspan="1">SD</th>
<th valign="top" align="left" rowspan="1" colspan="1">Mean</th>
<th valign="top" align="left" rowspan="1" colspan="1">SD</th>
<th valign="top" align="left" rowspan="1" colspan="1">Mean</th>
<th valign="top" align="left" rowspan="1" colspan="1">SD</th>
</tr>
</thead>
<tbody>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">Age</td>
<td valign="top" align="left" rowspan="1" colspan="1">58.0</td>
<td valign="top" align="left" rowspan="1" colspan="1">10.7</td>
<td valign="top" align="left" rowspan="1" colspan="1">55.8</td>
<td valign="top" align="left" rowspan="1" colspan="1">11.6</td>
<td valign="top" align="left" rowspan="1" colspan="1">36.5</td>
<td valign="top" align="left" rowspan="1" colspan="1">12.8</td>
<td valign="top" align="left" rowspan="1" colspan="1"><0.001</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">Body mass index</td>
<td valign="top" align="left" rowspan="1" colspan="1">28.8</td>
<td valign="top" align="left" rowspan="1" colspan="1">7.11</td>
<td valign="top" align="left" rowspan="1" colspan="1">25.5</td>
<td valign="top" align="left" rowspan="1" colspan="1">4.99</td>
<td valign="top" align="left" rowspan="1" colspan="1">26.9</td>
<td valign="top" align="left" rowspan="1" colspan="1">7.12</td>
<td valign="top" align="left" rowspan="1" colspan="1">0.02</td>
</tr>
<tr>
<td colspan="8" align="left" valign="bottom" rowspan="1">
<hr></hr>
</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1"></td>
<td valign="top" align="left" rowspan="1" colspan="1">
<bold>n</bold>
</td>
<td valign="top" align="left" rowspan="1" colspan="1">
<bold>%</bold>
</td>
<td valign="top" align="left" rowspan="1" colspan="1">
<bold>n</bold>
</td>
<td valign="top" align="left" rowspan="1" colspan="1">
<bold>%</bold>
</td>
<td valign="top" align="left" rowspan="1" colspan="1">
<bold>n</bold>
</td>
<td valign="top" align="left" rowspan="1" colspan="1">
<bold>%</bold>
</td>
<td valign="top" align="left" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">Education</td>
<td valign="top" align="left" rowspan="1" colspan="1"></td>
<td valign="top" align="left" rowspan="1" colspan="1"></td>
<td valign="top" align="left" rowspan="1" colspan="1"></td>
<td valign="top" align="left" rowspan="1" colspan="1"></td>
<td valign="top" align="left" rowspan="1" colspan="1"></td>
<td valign="top" align="left" rowspan="1" colspan="1"></td>
<td valign="top" align="left" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">Less than high school</td>
<td valign="top" align="left" rowspan="1" colspan="1">1</td>
<td valign="top" align="left" rowspan="1" colspan="1">2.4</td>
<td valign="top" align="left" rowspan="1" colspan="1">0</td>
<td valign="top" align="left" rowspan="1" colspan="1">0</td>
<td valign="top" align="left" rowspan="1" colspan="1">0</td>
<td valign="top" align="left" rowspan="1" colspan="1">0</td>
<td valign="top" align="left" rowspan="1" colspan="1">0.292</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1"> High school</td>
<td valign="top" align="left" rowspan="1" colspan="1">6</td>
<td valign="top" align="left" rowspan="1" colspan="1">14.3</td>
<td valign="top" align="left" rowspan="1" colspan="1">12</td>
<td valign="top" align="left" rowspan="1" colspan="1">8.2</td>
<td valign="top" align="left" rowspan="1" colspan="1">5</td>
<td valign="top" align="left" rowspan="1" colspan="1">8.3</td>
<td valign="top" align="left" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1"> Partial college</td>
<td valign="top" align="left" rowspan="1" colspan="1">8</td>
<td valign="top" align="left" rowspan="1" colspan="1">19.0</td>
<td valign="top" align="left" rowspan="1" colspan="1">29</td>
<td valign="top" align="left" rowspan="1" colspan="1">19.7</td>
<td valign="top" align="left" rowspan="1" colspan="1">17</td>
<td valign="top" align="left" rowspan="1" colspan="1">28.3</td>
<td valign="top" align="left" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1"> College graduate</td>
<td valign="top" align="left" rowspan="1" colspan="1">15</td>
<td valign="top" align="left" rowspan="1" colspan="1">35.7</td>
<td valign="top" align="left" rowspan="1" colspan="1">43</td>
<td valign="top" align="left" rowspan="1" colspan="1">29.3</td>
<td valign="top" align="left" rowspan="1" colspan="1">21</td>
<td valign="top" align="left" rowspan="1" colspan="1">35.0</td>
<td valign="top" align="left" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1"> Graduate degree</td>
<td valign="top" align="left" rowspan="1" colspan="1">12</td>
<td valign="top" align="left" rowspan="1" colspan="1">28.6</td>
<td valign="top" align="left" rowspan="1" colspan="1">62</td>
<td valign="top" align="left" rowspan="1" colspan="1">42.2</td>
<td valign="top" align="left" rowspan="1" colspan="1">17</td>
<td valign="top" align="left" rowspan="1" colspan="1">28.3</td>
<td valign="top" align="left" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">Marital status</td>
<td valign="top" align="left" rowspan="1" colspan="1"></td>
<td valign="top" align="left" rowspan="1" colspan="1"></td>
<td valign="top" align="left" rowspan="1" colspan="1"></td>
<td valign="top" align="left" rowspan="1" colspan="1"></td>
<td valign="top" align="left" rowspan="1" colspan="1"></td>
<td valign="top" align="left" rowspan="1" colspan="1"></td>
<td valign="top" align="left" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1"> Single/divorced/separated</td>
<td valign="top" align="left" rowspan="1" colspan="1">20</td>
<td valign="top" align="left" rowspan="1" colspan="1">47.6</td>
<td valign="top" align="left" rowspan="1" colspan="1">69</td>
<td valign="top" align="left" rowspan="1" colspan="1">46.6</td>
<td valign="top" align="left" rowspan="1" colspan="1"></td>
<td valign="top" align="left" rowspan="1" colspan="1"></td>
<td valign="top" align="left" rowspan="1" colspan="1">1.000</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1"> Married</td>
<td valign="top" align="left" rowspan="1" colspan="1">22</td>
<td valign="top" align="left" rowspan="1" colspan="1">52.4</td>
<td valign="top" align="left" rowspan="1" colspan="1">79</td>
<td valign="top" align="left" rowspan="1" colspan="1">53.4</td>
<td valign="top" align="left" rowspan="1" colspan="1"></td>
<td valign="top" align="left" rowspan="1" colspan="1"></td>
<td valign="top" align="left" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">Employment
<xref ref-type="table-fn" rid="tfn1-bctt-7-345">a</xref>
</td>
<td valign="top" align="left" rowspan="1" colspan="1"></td>
<td valign="top" align="left" rowspan="1" colspan="1"></td>
<td valign="top" align="left" rowspan="1" colspan="1"></td>
<td valign="top" align="left" rowspan="1" colspan="1"></td>
<td valign="top" align="left" rowspan="1" colspan="1"></td>
<td valign="top" align="left" rowspan="1" colspan="1"></td>
<td valign="top" align="left" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1"> No</td>
<td valign="top" align="left" rowspan="1" colspan="1">20</td>
<td valign="top" align="left" rowspan="1" colspan="1">48.8</td>
<td valign="top" align="left" rowspan="1" colspan="1">43</td>
<td valign="top" align="left" rowspan="1" colspan="1">29.3</td>
<td valign="top" align="left" rowspan="1" colspan="1">0</td>
<td valign="top" align="left" rowspan="1" colspan="1">0</td>
<td valign="top" align="left" rowspan="1" colspan="1">0.025</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1"> Yes</td>
<td valign="top" align="left" rowspan="1" colspan="1">21</td>
<td valign="top" align="left" rowspan="1" colspan="1">51.2</td>
<td valign="top" align="left" rowspan="1" colspan="1">104</td>
<td valign="top" align="left" rowspan="1" colspan="1">70.7</td>
<td valign="top" align="left" rowspan="1" colspan="1">60</td>
<td valign="top" align="left" rowspan="1" colspan="1">100</td>
<td valign="top" align="left" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">Race
<xref ref-type="table-fn" rid="tfn1-bctt-7-345">a</xref>
</td>
<td valign="top" align="left" rowspan="1" colspan="1"></td>
<td valign="top" align="left" rowspan="1" colspan="1"></td>
<td valign="top" align="left" rowspan="1" colspan="1"></td>
<td valign="top" align="left" rowspan="1" colspan="1"></td>
<td valign="top" align="left" rowspan="1" colspan="1"></td>
<td valign="top" align="left" rowspan="1" colspan="1"></td>
<td valign="top" align="left" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1"> White</td>
<td valign="top" align="left" rowspan="1" colspan="1">22</td>
<td valign="top" align="left" rowspan="1" colspan="1">53.7</td>
<td valign="top" align="left" rowspan="1" colspan="1">119</td>
<td valign="top" align="left" rowspan="1" colspan="1">82.1</td>
<td valign="top" align="left" rowspan="1" colspan="1">24</td>
<td valign="top" align="left" rowspan="1" colspan="1">40.0</td>
<td valign="top" align="left" rowspan="1" colspan="1"><0.001</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1"> Nonwhite</td>
<td valign="top" align="left" rowspan="1" colspan="1">19</td>
<td valign="top" align="left" rowspan="1" colspan="1">46.3</td>
<td valign="top" align="left" rowspan="1" colspan="1">26</td>
<td valign="top" align="left" rowspan="1" colspan="1">17.9</td>
<td valign="top" align="left" rowspan="1" colspan="1">36</td>
<td valign="top" align="left" rowspan="1" colspan="1">60.0</td>
<td valign="top" align="left" rowspan="1" colspan="1"></td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn>
<p>
<bold>Note:</bold>
</p>
</fn>
<fn id="tfn1-bctt-7-345">
<label>a</label>
<p>Missing data for one at-risk woman and one woman with lymphedema.</p>
</fn>
<fn id="tfn2-bctt-7-345">
<p>
<bold>Abbreviation:</bold>
SD, standard deviation.</p>
</fn>
</table-wrap-foot>
</table-wrap>
<table-wrap id="t2-bctt-7-345" position="float">
<label>Table 2</label>
<caption>
<p>Clinical characteristics for breast cancer survivors (n=190)</p>
</caption>
<table frame="hsides" rules="groups">
<thead>
<tr>
<th rowspan="2" valign="top" align="left" colspan="1">Variable</th>
<th colspan="2" valign="top" align="left" rowspan="1">At risk (n=148)
<hr></hr>
</th>
<th colspan="2" valign="top" align="left" rowspan="1">Lymphedema (n=42)
<hr></hr>
</th>
<th rowspan="2" valign="top" align="left" colspan="1">
<italic>P</italic>
-value</th>
</tr>
<tr>
<th valign="top" align="left" rowspan="1" colspan="1">n</th>
<th valign="top" align="left" rowspan="1" colspan="1">%</th>
<th valign="top" align="left" rowspan="1" colspan="1">n</th>
<th valign="top" align="left" rowspan="1" colspan="1">%</th>
</tr>
</thead>
<tbody>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">Mastectomy</td>
<td valign="top" align="left" rowspan="1" colspan="1">71</td>
<td valign="top" align="left" rowspan="1" colspan="1">48.0</td>
<td valign="top" align="left" rowspan="1" colspan="1">31</td>
<td valign="top" align="left" rowspan="1" colspan="1">73.8</td>
<td valign="top" align="left" rowspan="1" colspan="1"><0.01</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">Lumpectomy</td>
<td valign="top" align="left" rowspan="1" colspan="1">97</td>
<td valign="top" align="left" rowspan="1" colspan="1">65.5</td>
<td valign="top" align="left" rowspan="1" colspan="1">16</td>
<td valign="top" align="left" rowspan="1" colspan="1">38.1</td>
<td valign="top" align="left" rowspan="1" colspan="1"><0.01</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">Radiotherapy</td>
<td valign="top" align="left" rowspan="1" colspan="1">74</td>
<td valign="top" align="left" rowspan="1" colspan="1">51.0</td>
<td valign="top" align="left" rowspan="1" colspan="1">28</td>
<td valign="top" align="left" rowspan="1" colspan="1">66.7</td>
<td valign="top" align="left" rowspan="1" colspan="1">0.08</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">Chemotherapy</td>
<td valign="top" align="left" rowspan="1" colspan="1">67</td>
<td valign="top" align="left" rowspan="1" colspan="1">45.3</td>
<td valign="top" align="left" rowspan="1" colspan="1">34</td>
<td valign="top" align="left" rowspan="1" colspan="1">81.0</td>
<td valign="top" align="left" rowspan="1" colspan="1"><0.01</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">Sentinel lymph nodes biopsy</td>
<td valign="top" align="left" rowspan="1" colspan="1">134</td>
<td valign="top" align="left" rowspan="1" colspan="1">90.5</td>
<td valign="top" align="left" rowspan="1" colspan="1">23</td>
<td valign="top" align="left" rowspan="1" colspan="1">54.8</td>
<td valign="top" align="left" rowspan="1" colspan="1"><0.01</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">Axillary lymph nodes dissection</td>
<td valign="top" align="left" rowspan="1" colspan="1">85</td>
<td valign="top" align="left" rowspan="1" colspan="1">57.4</td>
<td valign="top" align="left" rowspan="1" colspan="1">39</td>
<td valign="top" align="left" rowspan="1" colspan="1">92.9</td>
<td valign="top" align="left" rowspan="1" colspan="1"><0.01</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1"></td>
<td valign="top" align="left" rowspan="1" colspan="1">
<bold>Mean</bold>
</td>
<td valign="top" align="left" rowspan="1" colspan="1">
<bold>SD</bold>
</td>
<td valign="top" align="left" rowspan="1" colspan="1">
<bold>Mean</bold>
</td>
<td valign="top" align="left" rowspan="1" colspan="1">
<bold>SD</bold>
</td>
<td valign="top" align="left" rowspan="1" colspan="1"></td>
</tr>
<tr>
<td colspan="6" align="left" valign="bottom" rowspan="1">
<hr></hr>
</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">Number of nodes removed</td>
<td valign="top" align="left" rowspan="1" colspan="1">8.0</td>
<td valign="top" align="left" rowspan="1" colspan="1">8.7</td>
<td valign="top" align="left" rowspan="1" colspan="1">19.4</td>
<td valign="top" align="left" rowspan="1" colspan="1">11.9</td>
<td valign="top" align="left" rowspan="1" colspan="1"><0.01</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">Years since cancer diagnosis</td>
<td valign="top" align="left" rowspan="1" colspan="1">2.0</td>
<td valign="top" align="left" rowspan="1" colspan="1">2.3</td>
<td valign="top" align="left" rowspan="1" colspan="1">6.9</td>
<td valign="top" align="left" rowspan="1" colspan="1">8.5</td>
<td valign="top" align="left" rowspan="1" colspan="1"><0.01</td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn id="tfn3-bctt-7-345">
<p>
<bold>Abbreviation:</bold>
SD, standard deviation.</p>
</fn>
</table-wrap-foot>
</table-wrap>
<table-wrap id="t3-bctt-7-345" position="float">
<label>Table 3</label>
<caption>
<p>Lymphedema symptoms</p>
</caption>
<table frame="hsides" rules="groups">
<thead>
<tr>
<th rowspan="2" valign="top" align="left" colspan="1">Symptoms
<xref ref-type="table-fn" rid="tfn4-bctt-7-345">a</xref>
,
<xref ref-type="table-fn" rid="tfn5-bctt-7-345">b</xref>
</th>
<th rowspan="2" valign="top" align="left" colspan="1">Mean + SD</th>
<th rowspan="2" valign="top" align="left" colspan="1">Median</th>
<th colspan="2" valign="top" align="left" rowspan="1">Range
<hr></hr>
</th>
</tr>
<tr>
<th valign="top" align="left" rowspan="1" colspan="1">Min</th>
<th valign="top" align="left" rowspan="1" colspan="1">Max</th>
</tr>
</thead>
<tbody>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">Healthy adults</td>
<td valign="top" align="left" rowspan="1" colspan="1">0.50+1.58</td>
<td valign="top" align="left" rowspan="1" colspan="1">0</td>
<td valign="top" align="left" rowspan="1" colspan="1">0</td>
<td valign="top" align="left" rowspan="1" colspan="1">8</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">At-risk survivors</td>
<td valign="top" align="left" rowspan="1" colspan="1">4.81+4.56</td>
<td valign="top" align="left" rowspan="1" colspan="1">4</td>
<td valign="top" align="left" rowspan="1" colspan="1">0</td>
<td valign="top" align="left" rowspan="1" colspan="1">20</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">Survivors with lymphedema</td>
<td valign="top" align="left" rowspan="1" colspan="1">9.76+4.48</td>
<td valign="top" align="left" rowspan="1" colspan="1">10</td>
<td valign="top" align="left" rowspan="1" colspan="1">1</td>
<td valign="top" align="left" rowspan="1" colspan="1">18</td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn>
<p>
<bold>Notes:</bold>
</p>
</fn>
<fn id="tfn4-bctt-7-345">
<label>a</label>
<p>Mean scores differ significantly at
<italic>P</italic>
<0.05 between healthy and lymphedema group by the Tukey multiple comparisons of means;</p>
</fn>
<fn id="tfn5-bctt-7-345">
<label>b</label>
<p>mean scores differ significantly at
<italic>P</italic>
<0.05 between lymphedema and at-risk group by the Tukey multiple comparisons of means.</p>
</fn>
<fn id="tfn6-bctt-7-345">
<p>
<bold>Abbreviations:</bold>
SD, standard deviation; Min, minimum; Max, maximum.</p>
</fn>
</table-wrap-foot>
</table-wrap>
<table-wrap id="t4-bctt-7-345" position="float">
<label>Table 4</label>
<caption>
<p>Symptom profiles</p>
</caption>
<table frame="hsides" rules="groups">
<thead>
<tr>
<th valign="top" align="left" rowspan="1" colspan="1">Symptoms</th>
<th valign="top" align="left" rowspan="1" colspan="1">Healthy (n=60), n (%)</th>
<th valign="top" align="left" rowspan="1" colspan="1">At risk (n=150), n (%)</th>
<th valign="top" align="left" rowspan="1" colspan="1">Lymphedema (n=42), n (%)</th>
<th valign="top" align="left" rowspan="1" colspan="1">
<italic>P</italic>
-value, lymphedema vs healthy</th>
<th valign="top" align="left" rowspan="1" colspan="1">
<italic>P</italic>
-value, lymphedema vs at risk</th>
</tr>
</thead>
<tbody>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">1. Arm swelling
<xref ref-type="table-fn" rid="tfn7-bctt-7-345">a</xref>
,
<xref ref-type="table-fn" rid="tfn8-bctt-7-345">b</xref>
</td>
<td valign="top" align="left" rowspan="1" colspan="1">1 (1.7)</td>
<td valign="top" align="left" rowspan="1" colspan="1">26 (17.3)</td>
<td valign="top" align="left" rowspan="1" colspan="1">42 (100)</td>
<td valign="top" align="left" rowspan="1" colspan="1"><0.001</td>
<td valign="top" align="left" rowspan="1" colspan="1"><0.001</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">2. Limited shoulder movement
<xref ref-type="table-fn" rid="tfn7-bctt-7-345">a</xref>
,
<xref ref-type="table-fn" rid="tfn8-bctt-7-345">b</xref>
</td>
<td valign="top" align="left" rowspan="1" colspan="1">4 (6.7)</td>
<td valign="top" align="left" rowspan="1" colspan="1">42 (28.0)</td>
<td valign="top" align="left" rowspan="1" colspan="1">22 (52.4)</td>
<td valign="top" align="left" rowspan="1" colspan="1"><0.001</td>
<td valign="top" align="left" rowspan="1" colspan="1">0.005</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">3. Limited fingers movement
<xref ref-type="table-fn" rid="tfn7-bctt-7-345">a</xref>
,
<xref ref-type="table-fn" rid="tfn8-bctt-7-345">b</xref>
</td>
<td valign="top" align="left" rowspan="1" colspan="1">0 (0)</td>
<td valign="top" align="left" rowspan="1" colspan="1">15 (10)</td>
<td valign="top" align="left" rowspan="1" colspan="1">11 (26.2)</td>
<td valign="top" align="left" rowspan="1" colspan="1"><0.001</td>
<td valign="top" align="left" rowspan="1" colspan="1">0.011</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">4. Limited arm movement
<xref ref-type="table-fn" rid="tfn7-bctt-7-345">a</xref>
,
<xref ref-type="table-fn" rid="tfn8-bctt-7-345">b</xref>
</td>
<td valign="top" align="left" rowspan="1" colspan="1">2 (3.3)</td>
<td valign="top" align="left" rowspan="1" colspan="1">36 (24)</td>
<td valign="top" align="left" rowspan="1" colspan="1">24 (57.1)</td>
<td valign="top" align="left" rowspan="1" colspan="1"><0.001</td>
<td valign="top" align="left" rowspan="1" colspan="1"><0.001</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">5. Arm tenderness
<xref ref-type="table-fn" rid="tfn7-bctt-7-345">a</xref>
</td>
<td valign="top" align="left" rowspan="1" colspan="1">1 (1.7)</td>
<td valign="top" align="left" rowspan="1" colspan="1">71 (47.3)</td>
<td valign="top" align="left" rowspan="1" colspan="1">22 (52.4)</td>
<td valign="top" align="left" rowspan="1" colspan="1"><0.001</td>
<td valign="top" align="left" rowspan="1" colspan="1">0.603</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">6. Pain in the affected arm
<xref ref-type="table-fn" rid="tfn7-bctt-7-345">a</xref>
</td>
<td valign="top" align="left" rowspan="1" colspan="1">2 (3.3)</td>
<td valign="top" align="left" rowspan="1" colspan="1">60 (40)</td>
<td valign="top" align="left" rowspan="1" colspan="1">19 (45.2)</td>
<td valign="top" align="left" rowspan="1" colspan="1"><0.001</td>
<td valign="top" align="left" rowspan="1" colspan="1">0.596</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">7. Arm firmness
<xref ref-type="table-fn" rid="tfn7-bctt-7-345">a</xref>
,
<xref ref-type="table-fn" rid="tfn8-bctt-7-345">b</xref>
</td>
<td valign="top" align="left" rowspan="1" colspan="1">0 (0)</td>
<td valign="top" align="left" rowspan="1" colspan="1">36 (24)</td>
<td valign="top" align="left" rowspan="1" colspan="1">29 (69)</td>
<td valign="top" align="left" rowspan="1" colspan="1"><0.001</td>
<td valign="top" align="left" rowspan="1" colspan="1"><0.001</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">8. Arm tightness
<xref ref-type="table-fn" rid="tfn7-bctt-7-345">a</xref>
,
<xref ref-type="table-fn" rid="tfn8-bctt-7-345">b</xref>
</td>
<td valign="top" align="left" rowspan="1" colspan="1">2 (3.3)</td>
<td valign="top" align="left" rowspan="1" colspan="1">52 (34.7)</td>
<td valign="top" align="left" rowspan="1" colspan="1">30 (71.4)</td>
<td valign="top" align="left" rowspan="1" colspan="1"><0.001</td>
<td valign="top" align="left" rowspan="1" colspan="1"><0.001</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">9. Arm heaviness
<xref ref-type="table-fn" rid="tfn7-bctt-7-345">a</xref>
,
<xref ref-type="table-fn" rid="tfn8-bctt-7-345">b</xref>
</td>
<td valign="top" align="left" rowspan="1" colspan="1">2 (3.3)</td>
<td valign="top" align="left" rowspan="1" colspan="1">23 (15.4)</td>
<td valign="top" align="left" rowspan="1" colspan="1">30 (71.4)</td>
<td valign="top" align="left" rowspan="1" colspan="1"><0.001</td>
<td valign="top" align="left" rowspan="1" colspan="1"><0.001</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">10. Numbness in the affected arm
<xref ref-type="table-fn" rid="tfn7-bctt-7-345">a</xref>
</td>
<td valign="top" align="left" rowspan="1" colspan="1">2 (3.3)</td>
<td valign="top" align="left" rowspan="1" colspan="1">51 (34.2)</td>
<td valign="top" align="left" rowspan="1" colspan="1">19 (45.2)</td>
<td valign="top" align="left" rowspan="1" colspan="1"><0.001</td>
<td valign="top" align="left" rowspan="1" colspan="1">0.208</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">11. Stiffness in the affected arm
<xref ref-type="table-fn" rid="tfn7-bctt-7-345">a</xref>
,
<xref ref-type="table-fn" rid="tfn8-bctt-7-345">b</xref>
</td>
<td valign="top" align="left" rowspan="1" colspan="1">3 (5)</td>
<td valign="top" align="left" rowspan="1" colspan="1">33 (22.1)</td>
<td valign="top" align="left" rowspan="1" colspan="1">18 (42.9)</td>
<td valign="top" align="left" rowspan="1" colspan="1"><0.001</td>
<td valign="top" align="left" rowspan="1" colspan="1">0.010</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">12. Arm aching
<xref ref-type="table-fn" rid="tfn7-bctt-7-345">a</xref>
,
<xref ref-type="table-fn" rid="tfn8-bctt-7-345">b</xref>
</td>
<td valign="top" align="left" rowspan="1" colspan="1">4 (6.7)</td>
<td valign="top" align="left" rowspan="1" colspan="1">45 (30)</td>
<td valign="top" align="left" rowspan="1" colspan="1">26 (61.9)</td>
<td valign="top" align="left" rowspan="1" colspan="1"><0.001</td>
<td valign="top" align="left" rowspan="1" colspan="1"><0.001</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">13. Burning in the affected arm
<xref ref-type="table-fn" rid="tfn7-bctt-7-345">a</xref>
</td>
<td valign="top" align="left" rowspan="1" colspan="1">0 (0)</td>
<td valign="top" align="left" rowspan="1" colspan="1">17 (11.3)</td>
<td valign="top" align="left" rowspan="1" colspan="1">8 (19)</td>
<td valign="top" align="left" rowspan="1" colspan="1"><0.001</td>
<td valign="top" align="left" rowspan="1" colspan="1">0.202</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">14. Stabbing in the affected arm
<xref ref-type="table-fn" rid="tfn7-bctt-7-345">a</xref>
</td>
<td valign="top" align="left" rowspan="1" colspan="1">0 (0)</td>
<td valign="top" align="left" rowspan="1" colspan="1">27 (18)</td>
<td valign="top" align="left" rowspan="1" colspan="1">10 (23.8)</td>
<td valign="top" align="left" rowspan="1" colspan="1"><0.001</td>
<td valign="top" align="left" rowspan="1" colspan="1">0.507</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">15. Tingling in the affected arm
<xref ref-type="table-fn" rid="tfn7-bctt-7-345">a</xref>
,
<xref ref-type="table-fn" rid="tfn8-bctt-7-345">b</xref>
</td>
<td valign="top" align="left" rowspan="1" colspan="1">3 (5)</td>
<td valign="top" align="left" rowspan="1" colspan="1">41 (27.3)</td>
<td valign="top" align="left" rowspan="1" colspan="1">25 (59.5)</td>
<td valign="top" align="left" rowspan="1" colspan="1"><0.001</td>
<td valign="top" align="left" rowspan="1" colspan="1"><0.001</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">16. Seroma formation
<xref ref-type="table-fn" rid="tfn7-bctt-7-345">a</xref>
,
<xref ref-type="table-fn" rid="tfn8-bctt-7-345">b</xref>
</td>
<td valign="top" align="left" rowspan="1" colspan="1">0 (0)</td>
<td valign="top" align="left" rowspan="1" colspan="1">10 (6.7)</td>
<td valign="top" align="left" rowspan="1" colspan="1">13 (31)</td>
<td valign="top" align="left" rowspan="1" colspan="1"><0.001</td>
<td valign="top" align="left" rowspan="1" colspan="1"><0.001</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">17. Arm soreness
<xref ref-type="table-fn" rid="tfn7-bctt-7-345">a</xref>
</td>
<td valign="top" align="left" rowspan="1" colspan="1">2 (3.)</td>
<td valign="top" align="left" rowspan="1" colspan="1">49 (32.7)</td>
<td valign="top" align="left" rowspan="1" colspan="1">13 (31)</td>
<td valign="top" align="left" rowspan="1" colspan="1"><0.001</td>
<td valign="top" align="left" rowspan="1" colspan="1">1.000</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">18. Limited elbow movement
<xref ref-type="table-fn" rid="tfn7-bctt-7-345">a</xref>
,
<xref ref-type="table-fn" rid="tfn8-bctt-7-345">b</xref>
</td>
<td valign="top" align="left" rowspan="1" colspan="1">0 (0)</td>
<td valign="top" align="left" rowspan="1" colspan="1">9 (6.1)</td>
<td valign="top" align="left" rowspan="1" colspan="1">7 (16.7)</td>
<td valign="top" align="left" rowspan="1" colspan="1">0.001</td>
<td valign="top" align="left" rowspan="1" colspan="1">0.052</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">19. Limited wrist movement
<xref ref-type="table-fn" rid="tfn7-bctt-7-345">a</xref>
</td>
<td valign="top" align="left" rowspan="1" colspan="1">0 (0)</td>
<td valign="top" align="left" rowspan="1" colspan="1">11 (7.3)</td>
<td valign="top" align="left" rowspan="1" colspan="1">8 (19)</td>
<td valign="top" align="left" rowspan="1" colspan="1">0.001</td>
<td valign="top" align="left" rowspan="1" colspan="1">0.038</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">20. Arm redness
<xref ref-type="table-fn" rid="tfn7-bctt-7-345">a</xref>
</td>
<td valign="top" align="left" rowspan="1" colspan="1">1 (1.7)</td>
<td valign="top" align="left" rowspan="1" colspan="1">20 (13.3)</td>
<td valign="top" align="left" rowspan="1" colspan="1">9 (21.4)</td>
<td valign="top" align="left" rowspan="1" colspan="1">0.001</td>
<td valign="top" align="left" rowspan="1" colspan="1">0.224</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">21. Blistering in the affected arm</td>
<td valign="top" align="left" rowspan="1" colspan="1">0 (0)</td>
<td valign="top" align="left" rowspan="1" colspan="1">2 (1.3)</td>
<td valign="top" align="left" rowspan="1" colspan="1">0 (0)</td>
<td valign="top" align="left" rowspan="1" colspan="1"></td>
<td valign="top" align="left" rowspan="1" colspan="1">1.000</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">22. Increased arm temperature
<xref ref-type="table-fn" rid="tfn7-bctt-7-345">a</xref>
,
<xref ref-type="table-fn" rid="tfn8-bctt-7-345">b</xref>
</td>
<td valign="top" align="left" rowspan="1" colspan="1">0 (0)</td>
<td valign="top" align="left" rowspan="1" colspan="1">5 (3.4)</td>
<td valign="top" align="left" rowspan="1" colspan="1">8 (19)</td>
<td valign="top" align="left" rowspan="1" colspan="1">0.001</td>
<td valign="top" align="left" rowspan="1" colspan="1">0.002</td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn>
<p>
<bold>Notes:</bold>
</p>
</fn>
<fn id="tfn7-bctt-7-345">
<label>a</label>
<p>Fisher’s exact test followed by Bonferroni adjustment, significant difference between the lymphedema group and healthy group. The Bonferroni critical value indicates
<italic>P</italic>
<0.002 to be significant;</p>
</fn>
<fn id="tfn8-bctt-7-345">
<label>b</label>
<p>Fisher’s exact test followed by Bonferroni adjustment, significant difference between the lymphedema group and at-risk group. The Bonferroni critical value indicates
<italic>P</italic>
<0.002 to be significant.</p>
</fn>
</table-wrap-foot>
</table-wrap>
<table-wrap id="t5-bctt-7-345" position="float">
<label>Table 5</label>
<caption>
<p>Bivariate association between each symptom and lymphedema</p>
</caption>
<table frame="hsides" rules="groups">
<thead>
<tr>
<th valign="top" align="left" rowspan="1" colspan="1">Symptom</th>
<th valign="top" align="left" rowspan="1" colspan="1">Odds ratio</th>
<th valign="top" align="left" rowspan="1" colspan="1">95% CI</th>
<th valign="top" align="left" rowspan="1" colspan="1">
<italic>P</italic>
-value</th>
</tr>
</thead>
<tbody>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">1. Arm swelling</td>
<td valign="top" align="left" rowspan="1" colspan="1">561.00</td>
<td valign="top" align="left" rowspan="1" colspan="1">76.04–71,644.49</td>
<td valign="top" align="left" rowspan="1" colspan="1"><0.0001</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">2. Arm heaviness</td>
<td valign="top" align="left" rowspan="1" colspan="1">17.46</td>
<td valign="top" align="left" rowspan="1" colspan="1">8.22–39.25</td>
<td valign="top" align="left" rowspan="1" colspan="1"><0.0001</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">3. Arm firmness</td>
<td valign="top" align="left" rowspan="1" colspan="1">10.33</td>
<td valign="top" align="left" rowspan="1" colspan="1">5.04–22.16</td>
<td valign="top" align="left" rowspan="1" colspan="1"><0.0001</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">4. Increased arm temperature</td>
<td valign="top" align="left" rowspan="1" colspan="1">9.07</td>
<td valign="top" align="left" rowspan="1" colspan="1">2.98–29.94</td>
<td valign="top" align="left" rowspan="1" colspan="1">0.0001</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">5. Seroma formation</td>
<td valign="top" align="left" rowspan="1" colspan="1">8.61</td>
<td valign="top" align="left" rowspan="1" colspan="1">3.54–21.54</td>
<td valign="top" align="left" rowspan="1" colspan="1"><0.0001</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">6. Arm tightness</td>
<td valign="top" align="left" rowspan="1" colspan="1">7.78</td>
<td valign="top" align="left" rowspan="1" colspan="1">3.84–16.84</td>
<td valign="top" align="left" rowspan="1" colspan="1"><0.0001</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">7. Limited arm movement</td>
<td valign="top" align="left" rowspan="1" colspan="1">5.86</td>
<td valign="top" align="left" rowspan="1" colspan="1">2.94–11.93</td>
<td valign="top" align="left" rowspan="1" colspan="1"><0.0001</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">8. Tingling in affected arm</td>
<td valign="top" align="left" rowspan="1" colspan="1">5.54</td>
<td valign="top" align="left" rowspan="1" colspan="1">2.79–11.26</td>
<td valign="top" align="left" rowspan="1" colspan="1"><0.0001</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">9. Arm aching</td>
<td valign="top" align="left" rowspan="1" colspan="1">5.14</td>
<td valign="top" align="left" rowspan="1" colspan="1">2.60–10.46</td>
<td valign="top" align="left" rowspan="1" colspan="1"><0.0001</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">10. Limited fingers movement</td>
<td valign="top" align="left" rowspan="1" colspan="1">4.56</td>
<td valign="top" align="left" rowspan="1" colspan="1">1.92–10.66</td>
<td valign="top" align="left" rowspan="1" colspan="1">0.0008</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">11. Limited elbow movement</td>
<td valign="top" align="left" rowspan="1" colspan="1">4.39</td>
<td valign="top" align="left" rowspan="1" colspan="1">1.53–12.21</td>
<td valign="top" align="left" rowspan="1" colspan="1">0.0069</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">12. Limited wrist movement</td>
<td valign="top" align="left" rowspan="1" colspan="1">4.23</td>
<td valign="top" align="left" rowspan="1" colspan="1">1.58–10.99</td>
<td valign="top" align="left" rowspan="1" colspan="1">0.0049</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">13. Limited shoulder movement</td>
<td valign="top" align="left" rowspan="1" colspan="1">3.84</td>
<td valign="top" align="left" rowspan="1" colspan="1">1.94–7.64</td>
<td valign="top" align="left" rowspan="1" colspan="1">0.0001</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">14. Stiffness in the affected arm</td>
<td valign="top" align="left" rowspan="1" colspan="1">3.55</td>
<td valign="top" align="left" rowspan="1" colspan="1">1.75–7.16</td>
<td valign="top" align="left" rowspan="1" colspan="1">0.0005</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">15. Burning in the affected arm</td>
<td valign="top" align="left" rowspan="1" colspan="1">2.86</td>
<td valign="top" align="left" rowspan="1" colspan="1">1.11–6.93</td>
<td valign="top" align="left" rowspan="1" colspan="1">0.0299</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">16. Arm redness</td>
<td valign="top" align="left" rowspan="1" colspan="1">2.47</td>
<td valign="top" align="left" rowspan="1" colspan="1">1.02–5.66</td>
<td valign="top" align="left" rowspan="1" colspan="1">0.0450</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">17. Numbness in the affected arm</td>
<td valign="top" align="left" rowspan="1" colspan="1">2.40</td>
<td valign="top" align="left" rowspan="1" colspan="1">1.21–4.71</td>
<td valign="top" align="left" rowspan="1" colspan="1">0.0124</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">18. Stabbing in the affected arm</td>
<td valign="top" align="left" rowspan="1" colspan="1">2.12</td>
<td valign="top" align="left" rowspan="1" colspan="1">0.92–4.64</td>
<td valign="top" align="left" rowspan="1" colspan="1">0.0769</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">19. Tenderness in the affected arm</td>
<td valign="top" align="left" rowspan="1" colspan="1">2.07</td>
<td valign="top" align="left" rowspan="1" colspan="1">1.06–4.03</td>
<td valign="top" align="left" rowspan="1" colspan="1">0.0320</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">20. Pain in the affected arm</td>
<td valign="top" align="left" rowspan="1" colspan="1">1.99</td>
<td valign="top" align="left" rowspan="1" colspan="1">1.01–3.89</td>
<td valign="top" align="left" rowspan="1" colspan="1">0.0463</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">21. Arm soreness</td>
<td valign="top" align="left" rowspan="1" colspan="1">1.44</td>
<td valign="top" align="left" rowspan="1" colspan="1">0.68–2.92</td>
<td valign="top" align="left" rowspan="1" colspan="1">0.3285</td>
</tr>
<tr>
<td valign="top" align="left" rowspan="1" colspan="1">22. Blistering in the affected arm</td>
<td valign="top" align="left" rowspan="1" colspan="1">0.97</td>
<td valign="top" align="left" rowspan="1" colspan="1">0.01–12.22</td>
<td valign="top" align="left" rowspan="1" colspan="1">0.9853</td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn id="tfn9-bctt-7-345">
<p>
<bold>Abbreviation:</bold>
CI, confidence interval.</p>
</fn>
</table-wrap-foot>
</table-wrap>
</floats-group>
</pmc>
<affiliations>
<list>
<country>
<li>États-Unis</li>
</country>
</list>
<tree>
<country name="États-Unis">
<noRegion>
<name sortKey="Fu, Mei R" sort="Fu, Mei R" uniqKey="Fu M" first="Mei R" last="Fu">Mei R. Fu</name>
</noRegion>
<name sortKey="Axelrod, Deborah" sort="Axelrod, Deborah" uniqKey="Axelrod D" first="Deborah" last="Axelrod">Deborah Axelrod</name>
<name sortKey="Axelrod, Deborah" sort="Axelrod, Deborah" uniqKey="Axelrod D" first="Deborah" last="Axelrod">Deborah Axelrod</name>
<name sortKey="Cleland, Charles M" sort="Cleland, Charles M" uniqKey="Cleland C" first="Charles M" last="Cleland">Charles M. Cleland</name>
<name sortKey="Guth, Amber A" sort="Guth, Amber A" uniqKey="Guth A" first="Amber A" last="Guth">Amber A. Guth</name>
<name sortKey="Guth, Amber A" sort="Guth, Amber A" uniqKey="Guth A" first="Amber A" last="Guth">Amber A. Guth</name>
<name sortKey="Haber, Judith" sort="Haber, Judith" uniqKey="Haber J" first="Judith" last="Haber">Judith Haber</name>
<name sortKey="Kleinman, Robin" sort="Kleinman, Robin" uniqKey="Kleinman R" first="Robin" last="Kleinman">Robin Kleinman</name>
<name sortKey="Qiu, Zeyuan" sort="Qiu, Zeyuan" uniqKey="Qiu Z" first="Zeyuan" last="Qiu">Zeyuan Qiu</name>
<name sortKey="Scagliola, Joan" sort="Scagliola, Joan" uniqKey="Scagliola J" first="Joan" last="Scagliola">Joan Scagliola</name>
</country>
</tree>
</affiliations>
</record>

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