Comparison of relative versus absolute arm size change as criteria for quantifying breast cancer-related lymphedema: the flaws in current studies and need for universal methodology.
Identifieur interne : 002076 ( PubMed/Curation ); précédent : 002075; suivant : 002077Comparison of relative versus absolute arm size change as criteria for quantifying breast cancer-related lymphedema: the flaws in current studies and need for universal methodology.
Auteurs : Marek Ancukiewicz [États-Unis] ; Cynthia L. Miller ; Melissa N. Skolny ; Jean O'Toole ; Laura E. Warren ; Lauren S. Jammallo ; Michelle C. Specht ; Alphonse G. TaghianSource :
- Breast cancer research and treatment [ 1573-7217 ] ; 2012.
Descripteurs français
- KwdFr :
- MESH :
- anatomopathologie : Bras, Lymphoedème.
- étiologie : Lymphoedème.
- Complications postopératoires, Femelle, Humains, Indice de masse corporelle, Qualité de vie, Tumeurs du sein.
English descriptors
- KwdEn :
- MESH :
- etiology : Lymphedema.
- pathology : Arm, Lymphedema.
- surgery : Breast Neoplasms.
- Body Mass Index, Female, Humans, Postoperative Complications, Quality of Life.
Abstract
The purpose of this article is to evaluate arm measurements of breast cancer patients to critically assess absolute change in arm size compared to relative arm volume change as criteria for quantifying breast cancer-related lymphedema (BCRL). We used pre-operative measurements of 677 patients screened for BCRL before and following treatment of unilateral breast cancer at Massachusetts General Hospital between 2005 and 2008 to model the effect of an absolute change in arm size of 200 mL or 2 cm compared to relative arm volume change. We also used sequential measurements to analyze temporal variation in unaffected arm volume. Pre-operative arm volumes ranged from 1,270 to 6,873 mL and correlated strongly (Kendall's τ = 0.55) with body mass index (BMI). An absolute arm volume change of 200 mL corresponded to relative arm volume changes ranging from 2.9 to 15.7 %. In a subset of 45 patients, modeling of a 2-cm change in arm circumference predicted relative arm volume changes ranging from 6.0 to 9.8 %. Sequential measurements of 124 patients with >6 measurements demonstrated remarkable temporal variation in unaffected arm volume (median within-patient change 10.5 %). The magnitude of such fluctuations correlated (τ = 0.36, P < 0.0001) with pre-operative arm volume, patient weight, and BMI when quantified as absolute volume change, but was independent of these variables when quantified as relative arm volume change (P > .05). Absolute changes in arm size used as criteria for BCRL are correlated with pre-operative and temporal changes in body size. Therefore, utilization of absolute volume or circumference change in clinical trials is flawed because specificity depends strongly on patient body size. Relative arm volume change is independent of body size and should thus be used as the standard criterion for diagnosis of BCRL.
DOI: 10.1007/s10549-012-2111-8
PubMed: 22710706
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Miller</name></author><author><name sortKey="Skolny, Melissa N" sort="Skolny, Melissa N" uniqKey="Skolny M" first="Melissa N" last="Skolny">Melissa N. Skolny</name></author><author><name sortKey="O Toole, Jean" sort="O Toole, Jean" uniqKey="O Toole J" first="Jean" last="O'Toole">Jean O'Toole</name></author><author><name sortKey="Warren, Laura E" sort="Warren, Laura E" uniqKey="Warren L" first="Laura E" last="Warren">Laura E. Warren</name></author><author><name sortKey="Jammallo, Lauren S" sort="Jammallo, Lauren S" uniqKey="Jammallo L" first="Lauren S" last="Jammallo">Lauren S. Jammallo</name></author><author><name sortKey="Specht, Michelle C" sort="Specht, Michelle C" uniqKey="Specht M" first="Michelle C" last="Specht">Michelle C. Specht</name></author><author><name sortKey="Taghian, Alphonse G" sort="Taghian, Alphonse G" uniqKey="Taghian A" first="Alphonse G" last="Taghian">Alphonse G. 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Miller</name></author><author><name sortKey="Skolny, Melissa N" sort="Skolny, Melissa N" uniqKey="Skolny M" first="Melissa N" last="Skolny">Melissa N. Skolny</name></author><author><name sortKey="O Toole, Jean" sort="O Toole, Jean" uniqKey="O Toole J" first="Jean" last="O'Toole">Jean O'Toole</name></author><author><name sortKey="Warren, Laura E" sort="Warren, Laura E" uniqKey="Warren L" first="Laura E" last="Warren">Laura E. Warren</name></author><author><name sortKey="Jammallo, Lauren S" sort="Jammallo, Lauren S" uniqKey="Jammallo L" first="Lauren S" last="Jammallo">Lauren S. Jammallo</name></author><author><name sortKey="Specht, Michelle C" sort="Specht, Michelle C" uniqKey="Specht M" first="Michelle C" last="Specht">Michelle C. Specht</name></author><author><name sortKey="Taghian, Alphonse G" sort="Taghian, Alphonse G" uniqKey="Taghian A" first="Alphonse G" last="Taghian">Alphonse G. Taghian</name></author></analytic><series><title level="j">Breast cancer research and treatment</title><idno type="eISSN">1573-7217</idno><imprint><date when="2012" type="published">2012</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Arm (pathology)</term><term>Body Mass Index</term><term>Breast Neoplasms (surgery)</term><term>Female</term><term>Humans</term><term>Lymphedema (etiology)</term><term>Lymphedema (pathology)</term><term>Postoperative Complications</term><term>Quality of Life</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Bras (anatomopathologie)</term><term>Complications postopératoires</term><term>Femelle</term><term>Humains</term><term>Indice de masse corporelle</term><term>Lymphoedème (anatomopathologie)</term><term>Lymphoedème (étiologie)</term><term>Qualité de vie</term><term>Tumeurs du sein ()</term></keywords><keywords scheme="MESH" qualifier="anatomopathologie" xml:lang="fr"><term>Bras</term><term>Lymphoedème</term></keywords><keywords scheme="MESH" qualifier="etiology" xml:lang="en"><term>Lymphedema</term></keywords><keywords scheme="MESH" qualifier="pathology" xml:lang="en"><term>Arm</term><term>Lymphedema</term></keywords><keywords scheme="MESH" qualifier="surgery" xml:lang="en"><term>Breast Neoplasms</term></keywords><keywords scheme="MESH" qualifier="étiologie" xml:lang="fr"><term>Lymphoedème</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Body Mass Index</term><term>Female</term><term>Humans</term><term>Postoperative Complications</term><term>Quality of Life</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Complications postopératoires</term><term>Femelle</term><term>Humains</term><term>Indice de masse corporelle</term><term>Qualité de vie</term><term>Tumeurs du sein</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">The purpose of this article is to evaluate arm measurements of breast cancer patients to critically assess absolute change in arm size compared to relative arm volume change as criteria for quantifying breast cancer-related lymphedema (BCRL). We used pre-operative measurements of 677 patients screened for BCRL before and following treatment of unilateral breast cancer at Massachusetts General Hospital between 2005 and 2008 to model the effect of an absolute change in arm size of 200 mL or 2 cm compared to relative arm volume change. We also used sequential measurements to analyze temporal variation in unaffected arm volume. Pre-operative arm volumes ranged from 1,270 to 6,873 mL and correlated strongly (Kendall's τ = 0.55) with body mass index (BMI). An absolute arm volume change of 200 mL corresponded to relative arm volume changes ranging from 2.9 to 15.7 %. In a subset of 45 patients, modeling of a 2-cm change in arm circumference predicted relative arm volume changes ranging from 6.0 to 9.8 %. Sequential measurements of 124 patients with >6 measurements demonstrated remarkable temporal variation in unaffected arm volume (median within-patient change 10.5 %). The magnitude of such fluctuations correlated (τ = 0.36, P < 0.0001) with pre-operative arm volume, patient weight, and BMI when quantified as absolute volume change, but was independent of these variables when quantified as relative arm volume change (P > .05). Absolute changes in arm size used as criteria for BCRL are correlated with pre-operative and temporal changes in body size. Therefore, utilization of absolute volume or circumference change in clinical trials is flawed because specificity depends strongly on patient body size. Relative arm volume change is independent of body size and should thus be used as the standard criterion for diagnosis of BCRL.</div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">22710706</PMID><DateCreated><Year>2012</Year><Month>08</Month><Day>08</Day></DateCreated><DateCompleted><Year>2013</Year><Month>01</Month><Day>24</Day></DateCompleted><DateRevised><Year>2017</Year><Month>02</Month><Day>20</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1573-7217</ISSN><JournalIssue CitedMedium="Internet"><Volume>135</Volume><Issue>1</Issue><PubDate><Year>2012</Year><Month>Aug</Month></PubDate></JournalIssue><Title>Breast cancer research and treatment</Title><ISOAbbreviation>Breast Cancer Res. Treat.</ISOAbbreviation></Journal><ArticleTitle>Comparison of relative versus absolute arm size change as criteria for quantifying breast cancer-related lymphedema: the flaws in current studies and need for universal methodology.</ArticleTitle><Pagination><MedlinePgn>145-52</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1007/s10549-012-2111-8</ELocationID><Abstract><AbstractText>The purpose of this article is to evaluate arm measurements of breast cancer patients to critically assess absolute change in arm size compared to relative arm volume change as criteria for quantifying breast cancer-related lymphedema (BCRL). We used pre-operative measurements of 677 patients screened for BCRL before and following treatment of unilateral breast cancer at Massachusetts General Hospital between 2005 and 2008 to model the effect of an absolute change in arm size of 200 mL or 2 cm compared to relative arm volume change. We also used sequential measurements to analyze temporal variation in unaffected arm volume. Pre-operative arm volumes ranged from 1,270 to 6,873 mL and correlated strongly (Kendall's τ = 0.55) with body mass index (BMI). An absolute arm volume change of 200 mL corresponded to relative arm volume changes ranging from 2.9 to 15.7 %. In a subset of 45 patients, modeling of a 2-cm change in arm circumference predicted relative arm volume changes ranging from 6.0 to 9.8 %. Sequential measurements of 124 patients with >6 measurements demonstrated remarkable temporal variation in unaffected arm volume (median within-patient change 10.5 %). The magnitude of such fluctuations correlated (τ = 0.36, P < 0.0001) with pre-operative arm volume, patient weight, and BMI when quantified as absolute volume change, but was independent of these variables when quantified as relative arm volume change (P > .05). Absolute changes in arm size used as criteria for BCRL are correlated with pre-operative and temporal changes in body size. Therefore, utilization of absolute volume or circumference change in clinical trials is flawed because specificity depends strongly on patient body size. Relative arm volume change is independent of body size and should thus be used as the standard criterion for diagnosis of BCRL.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Ancukiewicz</LastName><ForeName>Marek</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>Department of Radiation Oncology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Miller</LastName><ForeName>Cynthia L</ForeName><Initials>CL</Initials></Author><Author ValidYN="Y"><LastName>Skolny</LastName><ForeName>Melissa N</ForeName><Initials>MN</Initials></Author><Author ValidYN="Y"><LastName>O'Toole</LastName><ForeName>Jean</ForeName><Initials>J</Initials></Author><Author ValidYN="Y"><LastName>Warren</LastName><ForeName>Laura E</ForeName><Initials>LE</Initials></Author><Author ValidYN="Y"><LastName>Jammallo</LastName><ForeName>Lauren S</ForeName><Initials>LS</Initials></Author><Author ValidYN="Y"><LastName>Specht</LastName><ForeName>Michelle C</ForeName><Initials>MC</Initials></Author><Author ValidYN="Y"><LastName>Taghian</LastName><ForeName>Alphonse G</ForeName><Initials>AG</Initials></Author></AuthorList><Language>eng</Language><GrantList CompleteYN="Y"><Grant><GrantID>P50 CA089393</GrantID><Acronym>CA</Acronym><Agency>NCI NIH HHS</Agency><Country>United States</Country></Grant><Grant><GrantID>R01 CA139118</GrantID><Acronym>CA</Acronym><Agency>NCI NIH HHS</Agency><Country>United States</Country></Grant><Grant><GrantID>P50CA089393</GrantID><Acronym>CA</Acronym><Agency>NCI NIH HHS</Agency><Country>United States</Country></Grant><Grant><GrantID>R01CA139118</GrantID><Acronym>CA</Acronym><Agency>NCI NIH HHS</Agency><Country>United States</Country></Grant></GrantList><PublicationTypeList><PublicationType UI="D003160">Comparative Study</PublicationType><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D052061">Research Support, N.I.H., Extramural</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2012</Year><Month>06</Month><Day>19</Day></ArticleDate></Article><MedlineJournalInfo><Country>Netherlands</Country><MedlineTA>Breast Cancer Res Treat</MedlineTA><NlmUniqueID>8111104</NlmUniqueID><ISSNLinking>0167-6806</ISSNLinking></MedlineJournalInfo><CitationSubset>IM</CitationSubset><CommentsCorrectionsList><CommentsCorrections RefType="ErratumIn"><RefSource>Breast Cancer Res Treat. 2012 Nov;136(2):623</RefSource></CommentsCorrections><CommentsCorrections RefType="Cites"><RefSource>Lymphat Res Biol. 2009;7(2):81-5</RefSource><PMID Version="1">19522677</PMID></CommentsCorrections><CommentsCorrections RefType="Cites"><RefSource>Lymphology. 2009 Dec;42(4):161-75</RefSource><PMID Version="1">20218084</PMID></CommentsCorrections><CommentsCorrections RefType="Cites"><RefSource>J Clin Oncol. 2008 Nov 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Version="1">19218505</PMID></CommentsCorrections><CommentsCorrections RefType="Cites"><RefSource>J Surg Oncol. 2010 Aug 1;102(2):111-8</RefSource><PMID Version="1">20648579</PMID></CommentsCorrections><CommentsCorrections RefType="Cites"><RefSource>J Lymphoedema. 2009 Apr 1;4(1):14-18</RefSource><PMID Version="1">20182653</PMID></CommentsCorrections><CommentsCorrections RefType="Cites"><RefSource>Ann Surg Oncol. 2009 Jul;16(7):1959-72</RefSource><PMID Version="1">19365624</PMID></CommentsCorrections><CommentsCorrections RefType="Cites"><RefSource>Lymphology. 2010 Jun;43(2):85-94</RefSource><PMID Version="1">20848996</PMID></CommentsCorrections></CommentsCorrectionsList><MeshHeadingList><MeshHeading><DescriptorName UI="D001132" MajorTopicYN="N">Arm</DescriptorName><QualifierName UI="Q000473" MajorTopicYN="Y">pathology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D015992" MajorTopicYN="N">Body Mass Index</DescriptorName></MeshHeading><MeshHeading><DescriptorName 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