Quantification of breast lymphoedema following conservative breast cancer treatment: a systematic review

Nicola Fearn; Catalina Llanos; Elizabeth Dylke; Kirsty Stuart; Sharon Kilbreath

doi:10.1007/s11764-022-01278-w

Quantification of breast lymphoedema following conservative breast cancer treatment: a systematic review

J Cancer Surviv. 2023 Dec;17(6):1669-1687. doi: 10.1007/s11764-022-01278-w. Epub 2022 Oct 27.

Authors

Nicola Fearn¹, Catalina Llanos², Elizabeth Dylke¹, Kirsty Stuart^{2

3

4}, Sharon Kilbreath⁵

Affiliations

¹ Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Susan Wakil Health Sciences Building, Western Avenue, Camperdown, NSW, Australia.
² Westmead Breast Cancer Institute, Westmead Hospital, Sydney, NSW, Australia.
³ Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.
⁴ Department of Radiation Oncology, Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, NSW, Australia.
⁵ Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Susan Wakil Health Sciences Building, Western Avenue, Camperdown, NSW, Australia. sharon.kilbreath@sydney.edu.au.

Abstract

Purpose: Breast lymphoedema is a possible side effect of breast conserving surgery, but it is poorly understood. This is due, in part, to difficulty assessing the breast. This systematic review described outcome measures that quantify breast lymphoedema signs and symptoms and evaluated the measurement properties for these outcome measures.

Method: Seven databases were searched using terms in four categories: breast cancer, lymphoedema and oedema, clinician reported (ClinROM) and patient reported outcome measures (PROM) and psychometric and measurement properties. Two reviewers independently reviewed studies and completed quality assessments. The Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) methodology was used for studies including measurement property evidence.

Results: Fifty-six papers were included with thirteen questionnaires, eight patient-reported rating scales, seven physical measures, seven clinician-rating scales and four imaging techniques used to quantify breast lymphoedema. Based on COSMIN methodology, one ClinROM had sufficient reliability, ultrasound measuring dermal thickness. Tissue dielectric constant (TDC) measuring local tissue water had promising reliability. Four questionnaires had sufficient content validity (BLYSS, BLSQ, BrEQ and LYMQOL-Breast).

Conclusions: Ultrasound is recommended to reliably assess breast lymphoedema signs. No PROM can be recommended with confidence, but BLYSS, BLSQ, BrEQ and LYMQOL-Breast are promising. Further research is recommended to improve evidence of measurement properties for outcome measures.

Implications for cancer survivors: There are many approaches to assess breast lymphoedema, but currently, only ultrasound can be recommended for use, with others, such as TDC and questionnaires, showing promise. Further research is required for all approaches to improve evidence of measurement properties.

Keywords: Assessment; Breast cancer; Breast conserving surgery; Breast lymphoedema; COSMIN; Measurement properties.

Publication types

Systematic Review
Review
Research Support, Non-U.S. Gov't

MeSH terms

Breast Neoplasms* / surgery
Cancer Survivors*
Female
Humans
Lymphedema* / diagnosis
Lymphedema* / etiology
Patient Reported Outcome Measures
Psychometrics / methods
Reproducibility of Results