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New tool may help predict breast-cancer-associated lymphedema
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ASCO 2011 Breast Cancer Symposium
SAN FRANCISCO — A set of statistical models have demonstrated more than 70% accuracy for predicting the 5-year risk for developing lymphedema after lymph node removal during breast cancer surgery.
Jose Bevilacqua, MD, PhD, a surgical oncologist at the Hospital Sirio Libanes in Sao Paulo, Brazil, and colleagues studied 1,054 women with breast cancer who underwent axillary dissection in 2001 and 2002. They used clinical factors such as age, BMI, ipsilateral arm chemotherapy infusions, level of axillary dissection and others to develop three models and nomograms to predict the risk for developing lymphedema.
The first model predicted lymphedema in advance of surgery and considered age, BMI and number of chemotherapy cycles before surgery. The concordance index for this model was 0.706. The second model used the same predictors within 6 months surgery, as well as the extent of axillary dissection and the location of the radiotherapy field. The concordance index for this model was 0.729. The third model predicted lymphedema 6 months or more after surgery. It considered the same predictors, as well as the development of fluid buildup and swelling. The concordance index for this model was 0.736.
“The statistical models and the corresponding nomograms use readily available clinical factors and allow for quick and easy estimation of individual risks of developing lymphedema after axillary lymph node surgery in women with breast cancer,” Bevilacqua said. “For the sake of comparison, these modeling tools are as accurate for predicting a woman’s risk of developing lymphedema as mammography is for the detection of breast cancer.”
Disclosure: The researchers report no relevant financial disclosures.
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This data comes at a time of transition in the management of the axilla. We certainly are living in the sentinel lymph node biopsy era where, fortunately, fewer women today need to undergo full axillary lymph node dissection than did decades ago. This has resulted in a decline in the overall rate of lymphedema. However, certainly for patients with extensive axillary involvement, there remains a need for axillary lymph node dissection. The ability to preoperatively or postoperatively identify those patients who are at particularly high risk for lymphedema is an important step forward. It allows us to identify patients who then can be appropriately triaged for early intervention and perhaps for clinical trials aimed at preventing what many consider inevitable, which is the development of lymphedema.
– Andrew D. Seidman, MD
Attending
Physician, Memorial Sloan-Kettering Cancer Center
Earn CME this spring at the HemOnc Today Breast Cancer Review & Perspective meeting to be held March 23-24, 2012 at the Hilton San Diego Bayfront. See details at HemOncTodayBreastCancer.com.
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