Lymphoedema: a current real world prospective evaluation

Introduction: Breast-cancer-related-lymphoedema (BCRL) remains problematic clinically. A recent meta-analysis showed a pooled incidence of 21.9 %. Greater lymph node dissection increases BCRL incidence with a pooled average of 5.9 % for sentinel lymph node biopsy (SLNB) versus 23.6 % for axillary lymph node dissection (ALND). The primary aim was to assess the BCRL incidence in symptomatic breast cancer patients undergoing axillary surgery. Methods: A prospective, single centre study was carried out whereby included patients had limb volumes assessed pre-operatively and at 1 and 2 years post-operatively between January 2016 and July 2019. Assessment involved two standardised methods; arm circumference measurement and water displacement. Results: 147 patients, mean age 56.4 years (±sd 14.0, range 28–86) were included. 97/147(66 %) of patients underwent SLNB, with 50/147(34 %) undergoing ALND. 70/97(72.2 %) of the SLNB group had a wide local excision versus 24/50(48.0 %) in the ALND group (p = 0.004). Mean lymph nodes excised was 8.0(±sd 7.4, range 1–30) for all patients, 3.3(±sd 2.2, range 1–11) for SLNB and 17.1(±sd 5.1, range 9–30) for ALND (p < 0.001). Overall incidence of BCRL was 6.1 %(9/147) using arm circumference measurement and 15.7 %(23/147) with water displacement at 2 year follow-up. BCRL incidence determined using arm circumference measurement was found to be 4.3 % (4/94), 33.3 % (1/33), 11.5 % (3/26) and 4.2 % (1/24) for SLNB alone, SLNB + RLNR, ALND alone and ALND + RLNR respectively. Using water displacement, BCRL incidence in the SLNB alone, SLNB + RLNR, ALND alone and ALND + RLNR groups was 10.6 % (10/94), 33.3 % (1/3), 15.4 % (4/26), and 33.3 % (8/24) respectively. Conclusion: This study gives a real world perspective on the diagnosis, incidence and subsequent management of BCRL whilst showing that the incidence of BCRL is low at our institution by international standards.