Ultrasonography.  2024 Jul;43(4):284-293. 10.14366/usg.24059.

Ultrasonographic features of the skin and subcutis: correlations with the severity of breast cancer–related lymphedema

• Park JY
• Jeon JY
• Cha S

• KMID: 2556695
• DOI: http://doi.org/10.14366/usg.24059

Abstract

Purpose
Assessing the severity of breast cancer-related lymphedema (BCRL) requires various clinical tools, yet no standardized methodology is available. Ultrasonography shows promise for diagnosing lymphedema and evaluating its severity. This study explored the clinical utility of ultrasonography in patients with BCRL.
Methods
In this retrospective cross-sectional study, patients with unilateral BCRL were examined. The analyzed data included demographics, lymphedema location, International Society of Lymphology (ISL) stage, surgical history, treatment regimens, and arm circumference. Skin, subcutis, and muscle thicknesses were assessed ultrasonographically at predetermined sites, and the percentage of excess thickness was calculated. Multivariate logistic regression analysis was employed to identify associations between ultrasonographic measurements and advanced lymphedema (ISL 2 or 3). The Lymphedema Quality of Life arm questionnaire was used to evaluate patient-reported outcomes regarding lymphedema and their correlations with ultrasonographic findings.
Results
Among 118 patients, 71 were classified as ISL 0-1 and 47 as ISL 2-3. Patients with advanced lymphedema were older, had higher nodal stages, underwent more axillary lymph node dissections, and had higher rates of dominant-arm lymphedema. Multivariate logistic regression revealed significant associations of greater skin thickness (adjusted odds ratio [OR], 4.634; 95% confidence interval [CI], 1.233 to 17.419), subcutis thickness (adjusted OR, 7.741; 95% CI, 1.649 to 36.347), and subcutis echogenicity (adjusted OR, 4.860; 95% CI, 1.517 to 15.566) with advanced lymphedema. Furthermore, greater skin thickness (P=0.016) and subcutis echogenicity (P=0.023) were correlated with appearance-related discomfort.
Conclusion
Ultrasonographic measurements were significantly associated with advanced lymphedema in BCRL. Ultrasonography represents a valuable diagnostic and severity assessment tool for lymphedema.

Keyword

Lymphedema; Ultrasonography; Breast neoplasm; Lymphatic system

Figure

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  Fig. 1. Study flowchart.

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  Fig. 2. Case of a 64-year-old woman with left lymphedema.A, B. Images display measurements of skin and subcutaneous thickness, obtained without pressure, resulting in a convex appearance of the skin. C, D. Images present measurements of muscle thickness, taken with minimal pressure. Compared to the opposite side, the affected side exhibited increased skin and subcutaneous tissue thickness, with no significant difference in muscle thickness observed.

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Reference

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