Background. Lymphoedema of the operated and irradiated breast is a common complication following early breast cancer treatment. There is no consensus on objective diagnostic criteria and standard measurement tools. This study investigates the use of ultrasound elastography as an objective quantitative measurement tool for the diagnosis of parenchymal breast oedema.
Patients and methods. The elasticity ratio of the subcutis, measured with ultrasound elastography, was compared with high-frequency ultrasound parameters and subjective symptoms in twenty patients, bilaterally, prior to and following breast conserving surgery and breast irradiation.
Results. Elasticity ratio of the subcutis of the operated breast following radiation therapy increased in 88.9% of patients, was significantly higher than prior to surgery, unlike the non operated breast and significantly higher than the non operated breast, unlike preoperative results. These results were significantly correlated with visibility of the echogenic line, measured with high-frequency ultrasound. Big preoperative bra cup size was a significant risk factor for the development of breast oedema.
Conclusions. Ultrasound elastography is an objective quantitative measurement tool for the diagnosis of parenchymal breast oedema, in combination with other objective diagnostic criteria. Further research with longer follow-up and more patients is necessary to confirm our findings.
If the inline PDF is not rendering correctly, you can download the PDF file here.
1. Olivotto IA Weir LM Kim-Sing C Bajdik CD Trevisan CH Doll CM et al. Late cosmetic results of short fractionation for breast conservation. Radiother Oncol 1996; 41: 7-13.
2. Aryana K Gholizadeh M Momennezhad M Naji M Aliakbarian M Forghani MN et al. Efficacy of high-energy collimator for sentinel node lymphoscintigraphy of early breast cancer patients. Radiol Oncol 2012; 46: 75-80.
3. Kelemen G Varga Z Lázár G Thurzó L Kahán Z. Cosmetic outcome 1-5 years after breast conservative surgery irradiation and systemic therapy. Pathol Oncol Res 2012; 18: 421-7.
4. Feng-yan L Zhen-yu H Ming X Li-xin C San-gang W Xun-xing G. Feasibility and acute toxicity of 3-dimensional conformal external-beam accelerated partial-breast irradiation for early-stage breast cancer after breast-conserving surgery in Chinese female patients. Chin Med J 2011; 124: 1305-9.
5. Monticciolo DL Biggs K Gist AK Sincleair ST Hajdik RL Nipper ML et al. Breast conserving therapy with accelerated partial breast versus external beam whole breast irradiation: comparison of imaging sequela and complications in a matched population. Breast J 2011; 17: 187-90.
6. Wratten C Kilmurray J Wright S O’Brien PC Back M Hamilton CS et al. Pilot study of High-Frequency Ultrasound to assess cutaneous oedema in the conservatively managed breast. Int J Cancer 2000; 90: 295-301.
7. Meek AG. Breast radiotherapy and lymphoedema. Cancer 1998; 83: 2788-97.
8. Rucigaj TP; Leskovec NK; Zunter VT. Lymphedema following cancer therapy in Slovenia: a frequently overlooked condition? Radiol Oncol 2010; 44: 244-8.
9. Goffman TE Laronga C Wilson L Elkins D. Lymphoedema of the arm and breast in irradiated breast cancer patients: risks in an era of dramatically changing axillary surgery. Breast J 2004; 10: 405-11.
10. Pezner RD Patterson MF Hill LR Desai KR Vora N Lipsett JA. Breast oedema in patients treated conservatively for stage I and II breast cancer. Int J Radiat Oncol Biol Phys 1985; 11: 1765-8.
11. Rönkä RH Pamilo MS von Smitten KAJ Leidenius MHK. Breast lymphoedema after breast conserving treatment. Acta Oncol 2004; 43: 551-7.
12. Delay E Gosset J Toussoun G Delaporte T Delbaere M. Post-treatment sequelae after breast cancer conservative surgery. Ann Chir Plast Esth 2008; 53: 135-52.
13. Trog D Garbe S Lutterbey G Lütter C Barwig P Boldt I et al. Volumetric changes of the breast during radiotherapy. Is a replanning necessary for the electron boost? Strahlenther Onkol 2005; 181: 255-9.
14. Wratten CR O’Brien PC Hamilton CS ill D Kilmurray J Denham JW. Breast oedema in patients undergoing breast-conserving treatment for breast cancer: assessment via High Frequency Ultrasound. Breast J 2007; 13: 266-73.
15. Lievens P Pastouret F Leduc A Leduc O Bougeois P. The short time effect of radiation therapy on the newly formed lymphvessels. The European Journal of Lymphology 2008; 19: 25-6.
16. Liu T Zhou J Yoshida EJ Woodhouse SA Schiff PB Wang TJC. Quantitative Ultrasonic evaluation of Radiation-induced late tissue toxicity: pilot study in breast-cancer radiotherapy. Int J Radiat Oncol Biol Phys 2010; 78: 811-20.
17. Padhani AR Yarnold J Regan J Husband JE. Dynamic MRI of breast hardness following radiation treatment. J Magn Reson Im 2003; 17: 427-34.
18. Thomas A Fischer T Frey H Ohlinger R Grunwald S Blohmer JU et al. Realtime elastography--an advanced method of ultrasound: First results in 108 patients with breast lesions. Ultrasound Obstet Gynecol 2006; 28: 335-40.
19. Das D Gupta M Kaur H Kalucha A. Elastography: the next step. J Oral Sci 2011; 53: 137-41.
20. Lalitha P Reddy MCh Reddy KJ. Musculoskeletal applications of elastography: a pictorial essay of our initial experience. Korean J Radiol 2011; 12: 365-75.
21. Alam F Naito K Horiguchi J Fukuda H Tachikake T Ito K. Accuracy of sonographic elastography in the differential diagnosis of enlarged cervical lymph nodes: comparison with conventional B-mode sonography. AJR Am J Roentgenol 2008; 191: 604-10.
22. Kangelaris GT Kim TB Orloff LA. Role of ultrasound in thyroid disorders. Otolaryngol Clin North Am 2010; 43: 1209-27.
23. Dudea SM Giurgiu CR Dumitriu D Chiorean A Ciurea A Botar-Jid C Coman I. Value of ultrasound elastography in the diagnosis and management of prostate carcinoma. Med Ultrason 2011; 13: 45-53.
24. Carstensen EL Parker KJ Lerner RM. Elastography in the management of liver disease. Ultrasound Med Biol 2008; 34: 1535-46.
25. Voordeckers M Vinh-Hung V Lamote J Bretz A Storme G. Survival benefit with radiation therapy in node-positive breast carcinoma patients. Strahlenther Onkol 2009; 185: 656-62.
26. Reynders T Tournel K De Coninck P Heymann S Vinh-Hung V Van Parijs H et al. Dosimetric assessment of static and helical TomoTherapy in the clinical implementation of breast cancer treatments. Radiat Ther Oncol 2009; 93: 71-9.
27. Qiao Q Zhou G Ling Y. Breast volume measurement in young Chinese women and clinical applications. Aesth Plast Surg 1997; 21: 362-8.
28. Kayar R Civelek S Cobanoglu M Gungor O Catal H Emiroglu M. Five methods of breast volume measurement: a comparative study of measurements of specimen volume in 30 mastectomy cases. Breast Cancer 2011; 5: 43-52.
29. Kovacs L Eder M Hollweck R Zimmermann A Settles M Schneider A et al. Comparison between breast volume measurement using 3D surface imaging and classical techniques. Breast 2007; 16: 137-45.
30. Bulstrode N Bellamy E Shrotria S. Breast volume assessment: comparing five different techniques. Breast 2001; 10: 117-23.
31. Findikcioglu K Findikcioglu F Ozmen S Guclu T. The impact of breast size on the vertebral column: a radiologic study. Aesth Plast Surg 2007; 31: 23-7.
32. Cox JD Stetz J Pajak TF. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys 1995; 31: 1341-6.
33. Wratten C Kilmurray J Wright S O’Brien P Back M Hamilton C et al. A study of high frequency ultrasound to assess cutaneous oedema in conservatively managed breast. Front Radiat Ther Oncol 2002; 37: 121-7.
34. Olivier JB Verhaege JL Butarelli M Marchal F Houvenaeghel G. Functional anatomy of the lymphatic drainage of the breast: contribution of sentinel lymph node biopsy. Ann Chir 2006; 131: 608-15.
35. Estourgie SH Nieweg OE Olmos RA Rutgers EJ Kroon BB. Lymphatic drainage patterns from the breast. Ann Surg 2004; 239: 232-7.
36. Hidden G Arvy L. Remarques sur le drainage lymphatique de la glande mammaire humaine. Bull Assoc Anat 1973; 57: 879-86.
37. Leduc A Caplan I Leduc O. Lymphatic drainage of the upper limb. Substitution lymphatic pathways. The European Journal of Lymphology 1993; 13: 11-8.