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The Pittsburgh Trunk Lymphedema Staging System (PTLSS) - a validated staging system for the description of breast cancer associated trunk lymphedema
Fishman JE, Moroni EA, DeLaCruz C
University of Pittsburgh Medical Center
2021-01-27
Presenter: Elizabeth Moroni
Affidavit:
All work is original work of the resident.
Director Name: Vu T. Nguyen
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Background: Neither anatomic nor functional descriptions exist of trunk/breast lymphedema following breast cancer treatment. ICG-lymphangiography has been shown to characterize lymph channel dysfunction seen in lymphedema. We propose using ICG-lymphangiography to evaluate trunk and breast lymphedema following breast cancer surgery to characterize the regions affected via a novel, validated staging system.
Methods: Patients undergoing revisional breast surgery with suspicion of upper extremity lymphedema between 12/2014 and 3/2020 were offered lymphangiography. The breast and lateral/anterior trunks were visualized and blindly evaluated using Koshima's patterns of dermal backflow. Patients were then staged. A linear-weighted Cohen's Kappa statistic was calculated comparing each rated area and stage assignment.
Results: 52 sides (29 patients) were included. 8 sides underwent no treatment and were considered controls. No lymphedema was identified within this cohort. 1 patient (2 sides) had no transit of ICG. 76% of the non-controls had dermal backflow. This was seen in 67% of anterior trunks, 50% of lateral trunks, 50% of IMFs, 43% of inferior breasts, and 5% of superior breasts. Cohen's Kappa for area agreement was 0.4117 ± 0.0535. Stage 0 was seen in 31(±7)% of sides; stage 1: 21(±1)%; stage 2: 22(±5)%; stage 3: 18(±4)%; stage 4: 1(±1)%; and stage 5: 9(±3). The Cohen's Kappa for staging was 0.8109 ± 0.0868.
Conclusion: Following breast cancer surgery, lymphedema occurs throughout the trunk and breast. Severe dysfunction appears to be located around the inferior-lateral aspect of the breast and chest wall. Furthermore, the PTLSS is a validated measure of trunk and breast lymphedema.
