目的 观察臂围(AC)测量和上肢体积(ULV)测量评估乳腺癌相关淋巴水肿(BCRL)的相关性。 方法 2013年11月至2015年2月,连续收集女性单侧乳腺癌术后放疗患者281例。以肘关节鹰突中心水平下5 cm和上10 cm处臂围测量值的均值为AC;以上肢浸没水面至鹰突中心上15 cm处的排水体积为ULV。对AC和ULV进行单因素和多因素线形回归,计算Kappa系数。 结果 放疗前后,两侧AC与In(ULV)的Pearson和Spearman相关系数均> 0.959 (P < 0.001)。线性回归方程R2 > 0.90。两者对BCRL诊断一致率> 90% (Kappa系数> 0.492, P < 0.001)。 结论 AC和In(ULV)线性关系显著。单独利用AC诊断和评估术后放疗BCRL可靠实用。
Objective To compare arm circumference (AC) and upper limb volume (ULV) in assessment of breast cancer related lymphedema (BCRL). Methods From November, 2013 to February, 2015, 281 women with one-sided breast cancer accepting radiotherapy were consecutively enrolled. AC was measured as the means of circumference 10 cm above and 5 cm below the most eminent midpoint of olecranon. ULV was measured as the water displacement volume when the water surface reached at 15 cm above the midpoint of olecranon. Univariate and multivariable linear regressions were used between AC and ULV. Results All the correlated coefficients between AC and In(ULV) were above 0.959 (P < 0.001). For linear equations, the R2 > 0.90. The consistency of diagnoses of BCRL with AC and ULV were above 90% (Kappa > 0.492, P < 0.001). Conclusions AC and ULV are consistent in measurement of BCRL. AC is reliable and easier.
1 GillespieT C, SayeghH E, BrunelleC L, et al. Breast cancer-related lymphedema: risk factors, precautionary measures, and treatments [J]. Gland Surg, 2018, 7(4): 379-403.
2 PintoM, GimiglianoF, TatangeloF, et al. Upper limb function and quality of life in breast cancer related lymphedema: a cross-sectional study [J]. Eur J Phys Rehabil Med, 2013, 49(5): 665-673.
3 ShigakiC L, MadsenR, WanchaiA, et al. Upper extremity lymphedema: presence and effect on functioning five years after breast cancer treatment [J]. Rehabil Psychol, 2013, 58(4): 342-349.
4 NguyenT T, HoskinT L, HabermannE B, et al. Breast cancer-related lymphedema risk is related to multidisciplinary treatment and not surgery alone: results from a large cohort study [J]. Ann Surg Oncol, 2017, 24(10): 2972-2980.
5 GrossJ P, SachdevS, HelenowskiI B, et al. Radiation therapy field design and lymphedema risk after regional nodal irradiation for breast cancer [J]. Int J Radiat Oncol Biol Phys, 2018, 102(1): 71-78.
6 McLaughlinS A, StaleyA C, ViciniF, et al. Considerations for clinicians in the diagnosis, prevention, and treatment of breast cancer-related lymphedema: recommendations from a multidisciplinary expert ASBrS panel: Part 1: definitions, assessments, education, and future directions [J]. Ann Surg Oncol, 2017, 24(10): 2818-2826.
7 McLaughlinS A, de SnyderS M, KlimbergS, et al. Considerations for clinicians in the diagnosis, prevention, and treatment of breast cancer-related lymphedema, recommendations from an expert panel: Part 2: preventive and therapeutic options [J]. Ann Surg Oncol, 2017, 24(10): 2827-2835.
8 SewardC, SkolnyM, BrunelleC, et al. A comprehensive review of bioimpedance spectroscopy as a diagnostic tool for the detection and measurement of breast cancer-related lymphedema [J]. J Surg Oncol, 2016, 114(5): 537-542.
9 ShahC, ArthurD W, WazerD, et al. The impact of early detection and intervention of breast cancer-related lymphedema: a systematic review [J]. Cancer Med, 2016, 5(6): 1154-1162.
10 赵赛,孟繁洁. 乳腺癌术后上肢淋巴水肿的测量和评估研究现状[J]. 中华护理杂志, 2013, 48(6): 558-560.
11 AdriaenssensN, BuylR, LievensP, et al. Comparative study between mobile infrared optoelectronic volumetry with a Perometer and two commonly used methods for the evaluation of arm volume in patients with breast cancer related lymphedema of the arm [J]. Lymphology, 2013, 46(3): 132-143.
12 RidnerS H, MontgomeryL D, HepworthJ T, et al. Comparison of upper limb volume measurement techniques and arm symptoms between healthy volunteers and individuals with known lymphedema [J]. Lymphology, 2007, 40(1): 35-46.
13 CzerniecS A, WardL C, RefshaugeK M, et al. Assessment of breast cancer-related arm lymphedema-comparison of physical measurement methods and self-report [J]. Cancer Invest, 2010, 28(1): 54-62.
14 Lopez PenhaT R, SlangenJ J, HeutsE M, et al. Prevalence of lymphoedema more than five years after breast cancer treatment [J]. Eur J Surg Oncol, 2011, 37(12): 1059-1063.