【原】早期监测减少乳腺癌相关淋巴水肿

　　众所周知，人体正常组织与水肿组织的电阻不同。生物阻抗谱是一种利用生物组织与器官的电特性及其变化规律提取与人体生理、病理状况相关生物医学信息的检测技术，可以早期发现乳腺癌相关淋巴水肿。

　　2018年12月6日，美国癌症学会《癌症》在线发表澳大利亚麦考瑞大学、新西兰奥克兰理工大学的研究报告，对早期监测模式与传统转诊模式的医疗服务指标和乳腺癌相关淋巴水肿发生率进行了比较。

　　该研究对2007年1月1日～2016年12月31日接受生物阻抗谱测定的753例女性数据进行回顾分析，其中淋巴水肿早期监测组女性188例（术前121例、术后90天内67例）、传统转诊组女性285例（术后超过90天开始监测）。医疗服务指标包括术后超过90天至首次生物阻抗谱测定的时间、中位随访时间、就诊次数。根据生物阻抗谱测量，进行淋巴水肿诊断。

　　结果，早期监测组与传统转诊组的女性相比：

• 淋巴水肿诊治较早

• 每年就诊次数相似

• 临床淋巴水肿较少（14%比39%，P<0.001）

• 严重淋巴水肿较少（4%比24%）

　　因此，该研究结果支持将生物阻抗谱用于早期前瞻监测模式，可有助于乳腺癌相关水肿的及时发现和治疗。

Cancer. 2018 Dec 6. [Epub ahead of print]

Early surveillance is associated with less incidence and severity of breast cancer-related lymphedema compared with a traditional referral model of care.

Louise A. Koelmeyer Robert J. Borotkanics Jessica Alcorso Philip Prah Caleb J. Winch Kristine Nakhel Catherine M. Dean John Boyages.

Macquarie University, Sydney, New South Wales, Australia; Auckland University of Technology, Auckland, New Zealand.

The differences in health service metrics and in the incidence of breast cancer-related lymphedema are evaluated in an early surveillance model of care compared with a traditional referral model of care. The findings support the adoption of an early prospective surveillance model of care using bioimpedance spectroscopy for the early detection and management of breast cancer-related lymphedema.

BACKGROUND: Bioimpedance spectroscopy (BIS) has enabled the early identification of breast cancer-related lymphedema. In this study, differences in health service metrics and in the incidence of breast cancer-related lymphedema are evaluated in an early surveillance model of care compared with a traditional referral model of care.

METHODS: In a retrospective analysis of data from 753 women who underwent BIS measures between January 1, 2007 and December 31, 2016, 188 women were assigned to the "early surveillance" group if they began lymphedema monitoring presurgery (n = 121) or within 90 days postsurgery (n = 67), and 285 women were assigned to the "traditional referral" group if they began monitoring after 90 days postsurgery. Health service metrics were calculated as the time to the first BIS measure after 90 days postsurgery, the median follow-up, and the number of health care visits. Lymphedema was diagnosed based on BIS measures.

RESULTS: Women in the early surveillance group received lymphedema care significantly earlier than those in the traditional referral group. However, there was no difference in the number of visits per year to the clinic between groups. Significantly more women in the traditional referral group were diagnosed with clinical lymphedema (stage I-III, 39 % vs 14%; P < .001) and with greater severity (stage II-III, 24%) compared with those in the early surveillance group (4%).

CONCLUSIONS: The current findings support the adoption of an early prospective surveillance model of care using BIS for the early detection and management of breast cancer-related lymphedema.

DOI: 10.1002/cncr.31873