Elastographic and Ultrasonographic Evaluation of Patients With Breast Cancer Related Lymphedema
Condition: Lymphedema of Upper Arm; Stiffness of Hand, Not Elsewhere Classified; Evaluations, Diagnostic Self
MeSH terms: Lymphedema; Breast Cancer Lymphedema
Study type: Observational

Summary: 
      The aim of this study is to evaluate the feasibility of shear-wave elastography for the
      diagnosis and staging of breast cancer related lymphedema by assessing the skin and
      subcutaneous tissues of the arm and forearm, which could serve as a reference standard and be
      more easily applicable in daily life; and to investigate the relationship between the
      patients' symptoms and elastographic measurements.
    

Detailed description: 
      Both upper extremities of 72 patients with lymphedema and 72 healthy upper extremities were
      included in the study. The patients' demographic and clinical data were recorded. The
      thickness and echogenicity of the skin and subcutaneous tissues of all extremities were
      evaluated with B-mode ultrasonography, and the stiffness of the skin and subcutaneous tissues
      was evaluated with shear-wave elastography. The lymphedema arm and the healthy arm of the
      patients were compared both with each other and with the data of the control group.
      Interobserver and intraobserver reliability analysis was performed for ultrasonography and
      elastography measurements. The patients' pain, tension, weight, and stiffness symptoms
      associated with lymphedema were questioned using a numerical scale. The patients'
      functionality and participation in daily life activities were evaluated with the Quick DASH
      and Life Impact Index questionnaires. The relationship between these findings and
      elastographic and ultrasonographic parameters was analyzed.
    

Intervention name(s): Shear Wave Elastography and B Mode Ultrasonography; Quick Dash Questionnare; The Lymphedema Life Impact Scale; Questioning lymphedema-related symptoms; Extremity circumference and volume measurement
Intervention type(s): Diagnostic Test; Diagnostic Test; Diagnostic Test; Diagnostic Test; Other
Intervention description(s): We evaluated the both upper extremities of the patient and control group with elastography and B mode ultrasonography. Shear wave elastography evaluates tissue deformation caused by acoustic radiation force. A highly focused ultrasound radiation is produced; The propagation speed of the shear wave depends on the stiffness of the tissue. It is a simple, inexpensive, bedside, widely available, non-invasive technique. B mode USG can be used to assess skin and subcutaneous tissue thickness and echogenicity. Skin and subcutaneous thickness were measured with b mode ultrasound. Skin and subcutaneous tissue stiffness was measured by shear wave ultrasonography; Quick-DASH is an assessment questionnaire that measures activity and participation limitations in all upper extremity disorders. In the questionnaire, the difficulties of the patients during their daily living activities are questioned with 11 questions. Each answer is scored from 1 to 5 on a Likert scale, from best to worst.; The Lymphedema Life Impact Scale is a questionnaire developed to evaluate the physical, functional and psychosocial effects of lymphedema. It consists of 18 questions; It includes 8 physical, 4 psychosocial and 6 functional subgroups. Each question is scored from 1 to 5, with higher scores indicating increased seriousness.; Arm pain and feeling of tension, heaviness and stiffness in the arm were evaluated separately by numerical scale. This scale is a 10 cm ruler that writes no pain, no tension, no heaviness, no stiffness on one side, and unbearable pain, tension and heaviness on the other side. Patients were asked to rate their associated symptoms on this scale between 0 and 10.; For the diagnosis of lymphedema, a detailed physical examination and extremity circumference were measured. This measurement was taken from both wrists to arm height with 4 cm intervals. Those with a circumference difference greater than 2 cm and/or no 10% volume difference were considered preclinical (latent) and those with clinical lymphedema.
Observational model: Case-Control
Time perspective: Cross-Sectional
Sampling method: Non-Probability Sample
Study population: 
        In our study, individuals with breast cancer-related lymphedema diagnosis followed by
        Marmara University Pendik Training and Research Hospital Physical Medicine and
        Rehabilitation Department were included in the patient group, while upper extremity data of
        healthy volunteers without a known lymphedema history were controlled by one-to-one
        matching, considering the dominant and lymphedema sides of the patient group. included in
        the group.