Diagnosing breast cancer-related lymphoedema in the arm

Research Assistant; Russell Mellor is Research Assistant; Peter Mortimer is Professor of Dermatological Medicine, Division of Cardiac and Vascular Sciences (Dermatology); Rodney Levick is Professor of Physiology, Division of Basic Medical Sciences (Physiology) all at St George’s, University of London *These authors contributed equally to this work Lymphoedema of the arm is acknowledged as a serious complication of breast cancer treatment. With the introduction of treatments that conserve the axilla such as axillary sampling and particularly sentinel lymph node biopsy (SLNB), there is a view that breast cancer-related lymphoedema (BCRL) is now much less of a problem. It has even been suggested that dedicated lymphoedema clinics are a waste of time (Rampaul et al, 2003). Several reports conclude that SLNB poses less of a risk of BCRL than lymph node dissection or clearance (Blanchard et al, 2003; Mansel et al, 2006). The disparity in the reported incidence of BCRL following SLNB in these studies has several possible explanations, including differing times since axillary surgery when the patient is assessed, inaccurate reporting in questionnaires, use of different anatomical sites at which to measure circumference (with often only two sites being measured), and use of different circumference or volume thresholds.