Reliable prediction of postmastectomy lymphedema: The Risk Assessment Tool Evaluating Lymphedema
Section snippets
Study design
An Institutional Review Board approved (#818797) retrospective chart review was performed to identify all women diagnosed with breast cancer who underwent mastectomy at our institution from January 1, 2000 to July 1, 2013. Patients were initially identified by querying electronic medical records for the inclusion criteria of breast cancer diagnosis and mastectomy (Appendix A). Specific operations for oncologic resection and any subsequent reconstructions were classified according to the
Patient and operative characteristics
Of the 4,647 eligible patients identified (Appendix B), a total of 3,136 patients met inclusion criteria and were included with an average age of 52.8 ± 11.6 years (Table 1). Patients were excluded from analysis based on the following: no mastectomy within study time frame (n = 557), incomplete dataset (n = 719), pre-existing upper extremity lymphedema diagnosis (n = 22), and follow-up less than 12 months or mortality within 12 months of mastectomy (n = 213). Thirty percent of patients were
Comments
This study reviews the clinical course of 3,136 women undergoing mastectomy for breast cancer to develop an effective and simple predictive tool for postmastectomy lymphedema. Factors most influential in determining risk included invasive cancer diagnosis, chemoradiation treatment, axillary dissection, and obesity. Approximately 10% of patients suffered BCRL overall—application of the RATE-L resulted in a risk discrimination ranging from a low of 6.2% to a high of 36.4%. Several findings merit
Conclusions
This study demonstrated a 10.4% cumulative incidence of postmastectomy lymphedema in a cohort of 3,136 women treated within one health system. The most significant modulators of risk included invasive cancer diagnosis, chemoradiation, and extent of axillary intervention. We propose a simple risk assessment tool for lymphedema (the RATE-L) that offers significant discrimination of lymphedema risk ranging from 6.2% to 36.4%. Patient outcomes and delivery of cost-effective healthcare are likely to
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Financial Support: Funded by the Center for Human Appearance, the Department of Surgery at the Hospital of the University of Pennsylvania and the Perelman School of Medicine at the University of Pennsylvania.
This study was reviewed and approved by the Institutional Review Board at the Hospital of the University of Pennsylvania.
The authors declare no conflicts of interest.