Abstract P3-09-06: Development and validation of a questionnaire for axillary web syndrome self-assessment
Authors: Nevola Teixeira LF , Sandrin F , Rietjens M , Veronesi P , Lohsiriwat V , Casales Schorr M , Simoncini MC , Gandini S , Zanatta Sarian LO , Luini A 
Published: August 2014

INTRODUCTION: Despite the great strides made in medical knowledge and technology, surgery still remains a necessary part of the breast cancer treatment protocol. Even with the employment of less aggressive techniques, surgical procedures still lead to post surgical sequelae and complications. The axillary web syndrome (AWS) is one such sequela which can lead to disability, reduced arm mobility and compromised quality of life. Currently, there is no diagnostic tool such as a self-validated questionnaire to detect AWS which may help the patient to seek the opportunity for immediate treatment. To improve diagnosis and patient education, the ST-AWS questionnaire was drafted and applied at the European Institute of Oncology (IEO).

MATERIALS AND METHOD: We prospectively recruited patients from October 2012 to December 2012. Groups of patients who underwent ipsilateral sentinel lymph node biopsy and/or axillary dissection with or without plastic reconstruction procedures were registered. The complete physical examination by physiotherapist was set as a gold standard to evaluate the validity and reliability of ST-AWS.

Axillary Web Syndrome general table  AWS EVALUATION CATEGORIESYES 32 (%)NO 56 (%)p-value §AGE*&lt; 5119 (59)24 (43)0.14 ≥ 5113 (41)32 (57) SCHOOLINGHigh28 (88)42 (75)0.16 Low4 (12)14 (25) BMI≤ 18,55 (16)0 (0)0.006 18,5 - 25,022 (68)32 (57)  &gt; 255 (16)24 (43) TIME OF SURGERY (min)*≤ 11912 (37)33 (59)0.05 &gt; 11920 (63)23 (41) PLASTIC RECONSTRUCTIONYes25 (78)29 (52)0.02 No7 (22)27 (48) BREAST SURGERYMastectomy25 (78)34 (61)0.10 Quadrantectomy7 (22)22 (39) AXILLARY SURGERYAxillary Dissection20 (63)29 (52)0.33 Sentinel Lymph Node Biopsy12 (37)27 (48) N STAGE09 (28)25 (45)0.07 115 (47)16 (28)  22 (6)10 (18)  36 (19)5 (9) SENSIBILITY LOSSYes15 (47)9 (16)0.002 No17 (53)47 (84) * median values were used as cut off points § Chi-square, Fisher exact and Mantel-Haenszel Chi-Square tests

RESULTS: 88 patients completed the questionnaire and the physical examinations and were included in the study. 32 patients had axillary web syndrome diagnosed, thus a 36% incidence. Median age was 51 years (range 22-78 years).

The questionnaire achieved a sensitivity of 94%, a specificity of 91%, a positive prevalence value (PPV) of 86%, a negative prevalence value (NPV) of 96% and an accuracy of 92%.

Comparing Gold Standard physical Evaluation and ST-AWS Questionnaire results PHYSICAL EVALUATION (GOLD STANDARD)  NEGATIVEPOSITIVETOTALQUESTIONNAIRE   NEGATIVE51253POSITIVE53035TOTAL563288Sensibility: 94%, Specificity: 91%, Accuracy:92%, PPV:86%, NPV:96%

CONCLUSION: Our questionnaire achieves high sensitivity and predictive values, and we would recommend it as a screening-tool for auto-diagnosis of the axillary web syndrome. Nevertheless, the results of the ST-AWS should be confirmed by a physiotherapy examination.

The main objective of the questionnaire is to enhance patient and therapist awareness of the problem, and prompt management in order to shorten the effects of this disability. Moreover, it may offer a tool to enhance body image acceptance after surgery.

Further studies whereby the efficacy of the questionnaire is investigated in a larger, heterogeneous group and in different situations are warranted.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-09-06.