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Lymph Node Status and Breast Cancer-related Lymphedema

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Lymph Node Status and Breast Cancer-related Lymphedema

Auteurs : Anand D. Purushotham ; Thomas M. Bennett Britton ; Manfred B. Klevesath ; Patrick Chou ; Olorunsola F. Agbaje ; Stephen W. Duffy

Source :

Annals of Surgery [ 0003-4932 ] ; 2007.

RBID : PMC:1899199

Abstract

Objective:

This study examines the association between nodal positivity and risk of developing breast cancer-related lymphedema (BCRL) in patients who underwent axillary lymph node dissection (ALND).

Summary Background Data:

The pathophysiology of BCRL is poorly understood. It has been assumed that one of the factors predisposing to the development of BCRL is nodal positivity, although retrospective series have produced contradictory findings. As these studies have included treatment regimens known to cause BCRL, such as axillary radiotherapy, any relationship between nodal positivity and the development of BCRL remains speculative.

Methods:

A total of 212 patients who had undergone ALND for invasive breast cancer had arm volume measurements preoperatively, and at intervals postoperatively. No patient received axillary radiotherapy. Arm volumes were obtained by measuring serial arm circumferences every 4 cm up the arm and then calculated by using the formula for the volume of a truncated cone. Robust regression techniques were used to analyze the effects of node positivity, age, preoperative body mass index, and wound infection on arm volume excess.

Results:

In all, 64 of 212 (30%) patients were node positive. Contrary to previous assumptions, positive node status was significantly inversely associated with arm volume after adjusting for tumor size, time since operation, and allowing for correlated observations within subjects. Furthermore, the number of positive nodes also correlated inversely with arm volume.

Conclusion:

These results are counterintuitive to the conventional understanding of the pathophysiology of BCRL. A possible explanation is that patients who develop disease in axillary lymph nodes and subsequently undergo ALND have more time and ability to develop lymphatic collaterals, which may provide adequate lymphatic drainage following surgery, thereby reducing the risk of developing BCRL.

Url:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1899199

DOI: 10.1097/01.sla.0000259390.51203.7b
PubMed: 17592289
PubMed Central: 1899199

Affiliations:

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PMC:1899199

Le document en format XML

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<author><name sortKey="Purushotham, Anand D" sort="Purushotham, Anand D" uniqKey="Purushotham A" first="Anand D." last="Purushotham">Anand D. Purushotham</name>
<affiliation><nlm:aff id="N0x9447d60N0x9d50ec8"></nlm:aff>
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</author>
<author><name sortKey="Britton, Thomas M Bennett" sort="Britton, Thomas M Bennett" uniqKey="Britton T" first="Thomas M. Bennett" last="Britton">Thomas M. Bennett Britton</name>
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Lymph Node Status and Breast Cancer-related Lymphedema</title>
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<author><name sortKey="Klevesath, Manfred B" sort="Klevesath, Manfred B" uniqKey="Klevesath M" first="Manfred B." last="Klevesath">Manfred B. Klevesath</name>
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<author><name sortKey="Chou, Patrick" sort="Chou, Patrick" uniqKey="Chou P" first="Patrick" last="Chou">Patrick Chou</name>
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<author><name sortKey="Agbaje, Olorunsola F" sort="Agbaje, Olorunsola F" uniqKey="Agbaje O" first="Olorunsola F." last="Agbaje">Olorunsola F. Agbaje</name>
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<author><name sortKey="Duffy, Stephen W" sort="Duffy, Stephen W" uniqKey="Duffy S" first="Stephen W." last="Duffy">Stephen W. Duffy</name>
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<series><title level="j">Annals of Surgery</title>
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<front><div type="abstract" xml:lang="en"><sec><title>Objective:</title>
<p>This study examines the association between nodal positivity and risk of developing breast cancer-related lymphedema (BCRL) in patients who underwent axillary lymph node dissection (ALND).</p>
</sec>
<sec><title>Summary Background Data:</title>
<p>The pathophysiology of BCRL is poorly understood. It has been assumed that one of the factors predisposing to the development of BCRL is nodal positivity, although retrospective series have produced contradictory findings. As these studies have included treatment regimens known to cause BCRL, such as axillary radiotherapy, any relationship between nodal positivity and the development of BCRL remains speculative.</p>
</sec>
<sec><title>Methods:</title>
<p>A total of 212 patients who had undergone ALND for invasive breast cancer had arm volume measurements preoperatively, and at intervals postoperatively. No patient received axillary radiotherapy. Arm volumes were obtained by measuring serial arm circumferences every 4 cm up the arm and then calculated by using the formula for the volume of a truncated cone. Robust regression techniques were used to analyze the effects of node positivity, age, preoperative body mass index, and wound infection on arm volume excess.</p>
</sec>
<sec><title>Results:</title>
<p>In all, 64 of 212 (30%) patients were node positive. Contrary to previous assumptions, positive node status was significantly inversely associated with arm volume after adjusting for tumor size, time since operation, and allowing for correlated observations within subjects. Furthermore, the number of positive nodes also correlated inversely with arm volume.</p>
</sec>
<sec><title>Conclusion:</title>
<p>These results are counterintuitive to the conventional understanding of the pathophysiology of BCRL. A possible explanation is that patients who develop disease in axillary lymph nodes and subsequently undergo ALND have more time and ability to develop lymphatic collaterals, which may provide adequate lymphatic drainage following surgery, thereby reducing the risk of developing BCRL.</p>
</sec>
</div>
</front>
</TEI>
<pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
  <front><journal-meta><journal-id journal-id-type="nlm-ta">Ann Surg</journal-id>
<journal-id journal-id-type="publisher-id">Annals of Surgery</journal-id>
<journal-title>Annals of Surgery</journal-title>
<issn pub-type="ppub">0003-4932</issn>
<issn pub-type="epub">1528-1140</issn>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">17592289</article-id>
<article-id pub-id-type="pmc">1899199</article-id>
<article-id pub-id-type="publisher-id">0000658-200707000-00008</article-id>
<article-id pub-id-type="doi">10.1097/01.sla.0000259390.51203.7b</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Original Articles</subject>
</subj-group>
</article-categories>
<title-group><article-title>Lymph Node Status and Breast Cancer-related Lymphedema</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Purushotham</surname>
<given-names>Anand D.</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="N0x9447d60N0x9d50ec8">*</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Britton</surname>
<given-names>Thomas M. Bennett</given-names>
</name>
<degrees>MBBS</degrees>
<xref ref-type="aff" rid="N0x9447d60N0x9d50ec8">*</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Klevesath</surname>
<given-names>Manfred B.</given-names>
</name>
<degrees>MD</degrees>
<xref ref-type="aff" rid="N0x9447d60N0x9d50ec8">†</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Chou</surname>
<given-names>Patrick</given-names>
</name>
<degrees>MSc</degrees>
<xref ref-type="aff" rid="N0x9447d60N0x9d50ec8">‡</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Agbaje</surname>
<given-names>Olorunsola F.</given-names>
</name>
<degrees>PhD</degrees>
<xref ref-type="aff" rid="N0x9447d60N0x9d50ec8">‡</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Duffy</surname>
<given-names>Stephen W.</given-names>
</name>
<degrees>PhD</degrees>
<xref ref-type="aff" rid="N0x9447d60N0x9d50ec8">‡</xref>
</contrib>
</contrib-group>
<aff id="N0x9447d60N0x9d50ec8">From *King’s College London and Guy’s and St. Thomas’ NHS Foundation Trust; †Department of Surgery, Ipswich Hospital NHS Trust; and ‡Centre for Epidemiology, Mathematics and Statistics, Cancer Research, London, United Kingdom.<break></break>
</aff>
<pub-date pub-type="ppub"><month>7</month>
<year>2007</year>
</pub-date>
<volume>246</volume>
<issue>1</issue>
<fpage>42</fpage>
<lpage>45</lpage>
<copyright-statement>© 2007 Lippincott Williams & Wilkins, Inc.</copyright-statement>
<abstract><sec><title>Objective:</title>
<p>This study examines the association between nodal positivity and risk of developing breast cancer-related lymphedema (BCRL) in patients who underwent axillary lymph node dissection (ALND).</p>
</sec>
<sec><title>Summary Background Data:</title>
<p>The pathophysiology of BCRL is poorly understood. It has been assumed that one of the factors predisposing to the development of BCRL is nodal positivity, although retrospective series have produced contradictory findings. As these studies have included treatment regimens known to cause BCRL, such as axillary radiotherapy, any relationship between nodal positivity and the development of BCRL remains speculative.</p>
</sec>
<sec><title>Methods:</title>
<p>A total of 212 patients who had undergone ALND for invasive breast cancer had arm volume measurements preoperatively, and at intervals postoperatively. No patient received axillary radiotherapy. Arm volumes were obtained by measuring serial arm circumferences every 4 cm up the arm and then calculated by using the formula for the volume of a truncated cone. Robust regression techniques were used to analyze the effects of node positivity, age, preoperative body mass index, and wound infection on arm volume excess.</p>
</sec>
<sec><title>Results:</title>
<p>In all, 64 of 212 (30%) patients were node positive. Contrary to previous assumptions, positive node status was significantly inversely associated with arm volume after adjusting for tumor size, time since operation, and allowing for correlated observations within subjects. Furthermore, the number of positive nodes also correlated inversely with arm volume.</p>
</sec>
<sec><title>Conclusion:</title>
<p>These results are counterintuitive to the conventional understanding of the pathophysiology of BCRL. A possible explanation is that patients who develop disease in axillary lymph nodes and subsequently undergo ALND have more time and ability to develop lymphatic collaterals, which may provide adequate lymphatic drainage following surgery, thereby reducing the risk of developing BCRL.</p>
</sec>
</abstract>
<abstract abstract-type="toc"><p>This study examines the association between nodal positivity and the risk of developing breast cancer-related lymphedema in patients who underwent axillary lymph node dissection. Positive node status and number of positive nodes were significantly inversely associated with arm volume excess.</p>
</abstract>
</article-meta>
</front>
</pmc>
<affiliations><list></list>
<tree><noCountry><name sortKey="Agbaje, Olorunsola F" sort="Agbaje, Olorunsola F" uniqKey="Agbaje O" first="Olorunsola F." last="Agbaje">Olorunsola F. Agbaje</name>
<name sortKey="Britton, Thomas M Bennett" sort="Britton, Thomas M Bennett" uniqKey="Britton T" first="Thomas M. Bennett" last="Britton">Thomas M. Bennett Britton</name>
<name sortKey="Chou, Patrick" sort="Chou, Patrick" uniqKey="Chou P" first="Patrick" last="Chou">Patrick Chou</name>
<name sortKey="Duffy, Stephen W" sort="Duffy, Stephen W" uniqKey="Duffy S" first="Stephen W." last="Duffy">Stephen W. Duffy</name>
<name sortKey="Klevesath, Manfred B" sort="Klevesath, Manfred B" uniqKey="Klevesath M" first="Manfred B." last="Klevesath">Manfred B. Klevesath</name>
<name sortKey="Purushotham, Anand D" sort="Purushotham, Anand D" uniqKey="Purushotham A" first="Anand D." last="Purushotham">Anand D. Purushotham</name>
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</record>

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Lymph Node Status and Breast Cancer-related Lymphedema

Lymph Node Status and Breast Cancer-related Lymphedema

Source :

Abstract

Links toward previous steps (curation, corpus...)

Links to Exploration step

Le document en format XML

Pour manipuler ce document sous Unix (Dilib)

Pour mettre un lien sur cette page dans le réseau Wicri

Pour générer des pages wiki