International journal of radiation oncology, biology, physics · 2026
Dosimetric and Mammographic Predictors of Breast Lymphedema After Breast-Conserving Therapy.
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Lasko Isaac, Hasnain Layla, Saetern Lonnie, Gomez Kayeromi, Gupte Trisha, Kang Hyejoo, Weiss Jennifer, Bhakta Priya, Ganesh K Rajiv, Reyna Chantal, Small William, Refaat Tamer
Аннотация
PURPOSE: Breast lymphedema (BL) is a complication after breast-conserving therapy (BCT) in breast cancer. There is a paucity of data on the risk factors and diagnostic criteria for BL. The purpose of this study was to assess which factors predict for clinical BL, and whether changes in mammographic skin thickness can be used to detect BL.
METHODS: This IRB-approved study analyzed consecutive patients who underwent BCT with whole breast radiation (WBRT) at our institution. The following data were collected: patient and tumor characteristics, all treatments administered, dosimetry to breast and breast skin, skin thickness at baseline and subsequent mammography, and incidence of BL. Univariable and multivariable logistic regression, linear mixed-effects model (LMM), and Receiver-Operator Characteristic (ROC) analysis were performed.
RESULTS: 116 patients were included, median age 63 (range 36-86) and mean BMI of 29.7, of whom 24.1% (n=28) developed clinical BL. Median stage was T1cN0, with median (IQR) tumor size 1.6 cm (1.1-2.8). 16.4% (n=19) were node positive. 78% (n=90) had sentinel lymph node biopsy and 4.3% (n=5) had axillary dissection. 35% (n=41) had surgery with oncoplastic technique. 81% (n=94) had lumpectomy bed boost with median total dose of 52.56 Gy (range 26-66) in 21 fractions (range 5-33). 19% (22) had regional nodal irradiation (RNI). On multivariable logistic regression, skin V40 >90 cc (OR 3.91, p=0.026) and increasing age (OR 1.05/year, p=0.032) were independently predictive of BL. Mammographic skin thickness over time was significantly different between the treated vs contralateral breast in patients with vs without BL (LMM, p=1.29×10⁻⁶). On ROC analysis, ∆ in mammographic skin thickness from baseline to 6-months post-op had AUC of 0.774 (95% CI: 0.686-0.869, 93% sensitivity and 62% specificity) for the detection of BL.
CONCLUSIONS: Skin V40 Gy greater than 90cc is a predictor for breast lymphedema. Mammographic skin thickness can be used as an objective diagnostic criterion for breast lymphedema.
METHODS: This IRB-approved study analyzed consecutive patients who underwent BCT with whole breast radiation (WBRT) at our institution. The following data were collected: patient and tumor characteristics, all treatments administered, dosimetry to breast and breast skin, skin thickness at baseline and subsequent mammography, and incidence of BL. Univariable and multivariable logistic regression, linear mixed-effects model (LMM), and Receiver-Operator Characteristic (ROC) analysis were performed.
RESULTS: 116 patients were included, median age 63 (range 36-86) and mean BMI of 29.7, of whom 24.1% (n=28) developed clinical BL. Median stage was T1cN0, with median (IQR) tumor size 1.6 cm (1.1-2.8). 16.4% (n=19) were node positive. 78% (n=90) had sentinel lymph node biopsy and 4.3% (n=5) had axillary dissection. 35% (n=41) had surgery with oncoplastic technique. 81% (n=94) had lumpectomy bed boost with median total dose of 52.56 Gy (range 26-66) in 21 fractions (range 5-33). 19% (22) had regional nodal irradiation (RNI). On multivariable logistic regression, skin V40 >90 cc (OR 3.91, p=0.026) and increasing age (OR 1.05/year, p=0.032) were independently predictive of BL. Mammographic skin thickness over time was significantly different between the treated vs contralateral breast in patients with vs without BL (LMM, p=1.29×10⁻⁶). On ROC analysis, ∆ in mammographic skin thickness from baseline to 6-months post-op had AUC of 0.774 (95% CI: 0.686-0.869, 93% sensitivity and 62% specificity) for the detection of BL.
CONCLUSIONS: Skin V40 Gy greater than 90cc is a predictor for breast lymphedema. Mammographic skin thickness can be used as an objective diagnostic criterion for breast lymphedema.