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Redefining the Diagnostic Threshold for Breast Cancer-related Lymphedema.

Redefining the Diagnostic Threshold for Breast Cancer-related Lymphedema. Annals of surgery Wagner, B. D., Barrio, A. V., Coriddi, M. R., Rubin, J., Boe, L. A., Shammas, R. L., Levy, J., Hespe, G. E., Yoshimatsu, H., Rockson, S. G., Mehrara, B. J. 2025

Abstract

To empirically determine a normative, distribution-based threshold for diagnosing breast cancer-related lymphedema (BCRL) and compare its diagnostic accuracy with the conventional 10% interlimb volume difference criterion.BCRL is a common and morbid sequela of breast cancer treatment; however, diagnostic thresholds remain inconsistent and inadequately validated. The widely used threshold of =10% interlimb volume difference may miss clinically relevant cases.This prospective cohort study analyzed preoperative bilateral limb measurements in 858 female breast cancer patients undergoing axillary surgery to derive a normative, distribution-based interlimb volume difference threshold. A threshold corresponding to 2 standard deviations (SD) above the mean (7.5%) was identified. Diagnostic performance of this proposed threshold was then compared with the conventional 10% cutoff in a subgroup of 167 patients who underwent axillary lymph node dissection (ALND) with up to 36 months of postoperative follow-up.Among 858 patients (median [IQR] age, 48 [40-56] years; median BMI, 25.5 [22.3-30.0] kg/m²), preoperative interlimb volume differences were normally distributed (mean, 0.24%; SD, 3.74%), supporting a proposed diagnostic threshold of 7.5%. In the 167 patients who underwent ALND, 72 (43.1%) met the =7.5% threshold versus 53 (31.7%) meeting the 10% threshold, yielding 19 additional diagnoses (+11.4%; P<0.001). Of those meeting the 7.5% threshold, 94.4% (68/72) reported symptoms and/or used compression garments.A normative, distribution-based threshold of 7.5% interlimb volume difference improves the identification of clinically meaningful BCRL compared with the traditional 10% cutoff. Adopting this empirically validated threshold may enhance early detection, intervention, and patient outcomes.

View details for DOI 10.1097/SLA.0000000000006983

View details for PubMedID 41220050