High-Frequency Ultrasonography Imaging: Anatomical Measuring Site as Potential Clinical Marker for Early Identification of Breast Cancer-Related Lymphedema

<b>Background/Objectives</b>: Accurate diagnosis of breast cancer-related lymphedema remains a clinical challenge. This study evaluated the diagnostic utility of ultrasound in detecting early lymphedema compared to conventional criteria, including the International Society of Lymphology...

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Main Authors: Ivana Klarić-Kukuz, Danijela Budimir Mršić, Antonela Matana, Blaž Barun, Jure Aljinović, Maja Marinović-Guić, Ana Poljičanin
Format: Article
Language:English
Published: MDPI AG 2025-06-01
Series:Biomedicines
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Online Access:https://www.mdpi.com/2227-9059/13/6/1396
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author Ivana Klarić-Kukuz
Danijela Budimir Mršić
Antonela Matana
Blaž Barun
Jure Aljinović
Maja Marinović-Guić
Ana Poljičanin
author_facet Ivana Klarić-Kukuz
Danijela Budimir Mršić
Antonela Matana
Blaž Barun
Jure Aljinović
Maja Marinović-Guić
Ana Poljičanin
author_sort Ivana Klarić-Kukuz
collection DOAJ
description <b>Background/Objectives</b>: Accurate diagnosis of breast cancer-related lymphedema remains a clinical challenge. This study evaluated the diagnostic utility of ultrasound in detecting early lymphedema compared to conventional criteria, including the International Society of Lymphology staging and limb volume measurements. <b>Methods</b>: In this retrospective cross-sectional study, 68 female participants with unilateral breast cancer, who had completed cancer treatment at least six months before study enrolment, underwent both ultrasonographic assessment and standard limb circumference measurements. Ultrasound was performed bilaterally at five standardized anatomical sites. Sonographic parameters included assessment of cutaneous and subcutaneous thickness and echogenicity. Clinical staging and symptom profiles were assessed using ISL criteria and a structured questionnaire. Volume status was determined by relative volume change (RVC). <b>Results</b>: Among 68 participants, 36 were classified as ISL stage 0 and 32 as ISL stage II, 30 had RVC < 5%, while 38 had RVC ≥ 5%. Advanced stages were associated with older age. Multivariate analysis identified increased skin thickness at the medial upper arm cutis as significantly correlated with RVC ≥ 5% (OR 1.49, 95% CI: 1.01–2.21, <i>p</i> = 0.047). A similar trend was observed at the medial forearm (OR 1.3 (95% CI: (0.99, 1.71))). <b>Conclusions</b>: This study highlights ultrasound’s potential for early breast cancer-related lymphedema detection, especially in patients with minimal volume changes where conventional methods fall short. Increased cutaneous thickness in the medial upper arm emerged as a sensitive marker of early disease, while subcutaneous thickness and echogenicity may reflect in advanced stages. This distinction underscores the clinical value of cutaneous thickness as a potential clinical key marker for early lymphedema detection, emphasizing the need for standardized protocols and defined thresholds to guide timely interventions.
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spelling doaj-art-e03be7eeb76648ef88ffe7c643f0e0532025-08-20T03:27:18ZengMDPI AGBiomedicines2227-90592025-06-01136139610.3390/biomedicines13061396High-Frequency Ultrasonography Imaging: Anatomical Measuring Site as Potential Clinical Marker for Early Identification of Breast Cancer-Related LymphedemaIvana Klarić-Kukuz0Danijela Budimir Mršić1Antonela Matana2Blaž Barun3Jure Aljinović4Maja Marinović-Guić5Ana Poljičanin6Department of Health Studies, University of Split, 21000 Split, CroatiaDepartment of Health Studies, University of Split, 21000 Split, CroatiaDepartment of Health Studies, University of Split, 21000 Split, CroatiaInstitute of Physical Medicine and Rehabilitation with Rheumatology, University Hospital of Split, 21000 Split, CroatiaDepartment of Health Studies, University of Split, 21000 Split, CroatiaDepartment of Health Studies, University of Split, 21000 Split, CroatiaDepartment of Health Studies, University of Split, 21000 Split, Croatia<b>Background/Objectives</b>: Accurate diagnosis of breast cancer-related lymphedema remains a clinical challenge. This study evaluated the diagnostic utility of ultrasound in detecting early lymphedema compared to conventional criteria, including the International Society of Lymphology staging and limb volume measurements. <b>Methods</b>: In this retrospective cross-sectional study, 68 female participants with unilateral breast cancer, who had completed cancer treatment at least six months before study enrolment, underwent both ultrasonographic assessment and standard limb circumference measurements. Ultrasound was performed bilaterally at five standardized anatomical sites. Sonographic parameters included assessment of cutaneous and subcutaneous thickness and echogenicity. Clinical staging and symptom profiles were assessed using ISL criteria and a structured questionnaire. Volume status was determined by relative volume change (RVC). <b>Results</b>: Among 68 participants, 36 were classified as ISL stage 0 and 32 as ISL stage II, 30 had RVC < 5%, while 38 had RVC ≥ 5%. Advanced stages were associated with older age. Multivariate analysis identified increased skin thickness at the medial upper arm cutis as significantly correlated with RVC ≥ 5% (OR 1.49, 95% CI: 1.01–2.21, <i>p</i> = 0.047). A similar trend was observed at the medial forearm (OR 1.3 (95% CI: (0.99, 1.71))). <b>Conclusions</b>: This study highlights ultrasound’s potential for early breast cancer-related lymphedema detection, especially in patients with minimal volume changes where conventional methods fall short. Increased cutaneous thickness in the medial upper arm emerged as a sensitive marker of early disease, while subcutaneous thickness and echogenicity may reflect in advanced stages. This distinction underscores the clinical value of cutaneous thickness as a potential clinical key marker for early lymphedema detection, emphasizing the need for standardized protocols and defined thresholds to guide timely interventions.https://www.mdpi.com/2227-9059/13/6/1396lymphedemabreast cancerdiagnostic ultrasoundcross-sectional anatomydisease early detection
spellingShingle Ivana Klarić-Kukuz
Danijela Budimir Mršić
Antonela Matana
Blaž Barun
Jure Aljinović
Maja Marinović-Guić
Ana Poljičanin
High-Frequency Ultrasonography Imaging: Anatomical Measuring Site as Potential Clinical Marker for Early Identification of Breast Cancer-Related Lymphedema
Biomedicines
lymphedema
breast cancer
diagnostic ultrasound
cross-sectional anatomy
disease early detection
title High-Frequency Ultrasonography Imaging: Anatomical Measuring Site as Potential Clinical Marker for Early Identification of Breast Cancer-Related Lymphedema
title_full High-Frequency Ultrasonography Imaging: Anatomical Measuring Site as Potential Clinical Marker for Early Identification of Breast Cancer-Related Lymphedema
title_fullStr High-Frequency Ultrasonography Imaging: Anatomical Measuring Site as Potential Clinical Marker for Early Identification of Breast Cancer-Related Lymphedema
title_full_unstemmed High-Frequency Ultrasonography Imaging: Anatomical Measuring Site as Potential Clinical Marker for Early Identification of Breast Cancer-Related Lymphedema
title_short High-Frequency Ultrasonography Imaging: Anatomical Measuring Site as Potential Clinical Marker for Early Identification of Breast Cancer-Related Lymphedema
title_sort high frequency ultrasonography imaging anatomical measuring site as potential clinical marker for early identification of breast cancer related lymphedema
topic lymphedema
breast cancer
diagnostic ultrasound
cross-sectional anatomy
disease early detection
url https://www.mdpi.com/2227-9059/13/6/1396
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