Skin thickness measurement helps diagnose breast lymphedema

SAN ANTONIO (Reuters Health) - Ultrasonic measurement of breast skin thickness may be a good tool for diagnosing breast lymphedema in women who have undergone non-mastectomy procedures for breast cancer, investigators report.

"While roughly 10 to 15% of breast cancer patients develop breast lymphedema, there is presently no standard method for establishing the diagnosis," Dr. Amy Degnim, associate professor of surgery at the Mayo Clinic in Rochester, Minnesota, told Reuters Health at the 2008 San Antonio Breast Cancer Symposium (SABCS).

In fact, in the absence of objective measures of diagnosis, the condition is usually diagnosed on the basis of clinical impression, she added. Since the clinical features of breast lymphedema are similar to infectious cellulitis, this condition is often mistaken for infection, which may lead to excessive courses of antibiotic therapy.

To investigate the utility of skin thickness determinations, Dr. Degnim and colleagues enrolled 85 women preoperatively who were scheduled for unilateral non-mastectomy procedures and who were evaluated postoperatively for signs and symptoms of lymphedema in the operated breast. Twelve patients with established breast lymphedema were also included in the analysis.

Breast lymphedema was diagnosed in participants using a graded physical exam targeting the hallmark clinical signs of chronic diffuse edema and mild erythema. Skin thickness was measured with ultrasound at the 6 o' clock position of both breasts. Differences in skin thickness were assessed by the ratio of skin thickness in the operated and nonoperated contralateral breasts.

At a median follow-up of eight months, the mean measured skin thickness was 2.3 mm in unaffected breasts and 3.2 mm in operated breasts. Women with breast lymphedema had significantly greater skin thickness in the operated breast compared to the contralateral breast, with a mean skin thickness ratio of 1.83 in patients with breast lymphedema compared to 1.18 among those without breast lymphedema (p<0.0001).

Dr. Degnim said that the results show that sonographically measuring breast skin thickness -- either a s a single reading or as a ratio to the unaffected breast -- may assist in the diagnosis of breast lymphedema.

Her group is now working to develop an easy- to-use set of criteria for screening and diagnosis of breast lymphedema.

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