Skin and Subcutaneous Tissue Ultrasonography Features in Breast Cancer-Related Lymphedema

Abstract

Objective: To investigate skin, subepidermal low echogenic band (SELEB), and subcutaneous tissue (SCT) thickness as well as the degree of increase in subcutaneous echogenicity (SEG) and subcutaneous echo-free space (SEFS) in arms with lymphedema (LE). Materials and Methods: The skin and SCT of both arms of 30 patients with unilateral stage II breast cancer-related LE were scanned at five points (medial/lateral upper arm/forearm and dorsum of the hand). SEG and SEFS grades were determined according to severity (range: 0-2). Results: All measured parameters, except the SEFS in the medial upper arm, were significantly higher on the LE side than on the normal (N) side. The parameters differed most remarkably in the medial forearm (MFA; skin: LE 1.7 ± 0.8 mm vs. N 0.8 ± 0.2 mm; SELEB: LE 1.0 ± 0.6 mm vs. N 0.3 ± 0.1 mm; SCT: LE 8.7 ± 3.4 mm vs. N 3.8 ± 2.0 mm; SEG: LE 0.9 ± 0.5 vs. N 0.1 ± 0.3; and SEFS: LE 0.5 ± 0.7 vs. N 0). Conclusion: The differences in the thickness of the skin, SELEB, and SCT and the SEG and SEFS grades between the LE and N arms seemed most evident in the MFA.

Keywords: arm; lymphedema; ultrasonography.

Figures

Fig. 1

(A) The points of scanning and (B) definition of echogenic borders. a: The posterior echogenic border of the epidermal entrance echo, that is, the anterior echogenic border of the SELEB; b: the posterior echogenic border of the SELEB; c: the posterior echogenic border of the papillary dermis, that is, the anterior echogenic border of the SCT; and d: the posterior echogenic border of the SCT, that is, the anterior echogenic border of the deep muscular fascia. (C) Representative ultrasonography images. Ultrasonography images of the medial forearms of a patient with right unilateral arm lymphedema are shown. The rectangles indicate the scan points. On the side with the lymphedema, the skin, SELEB, and SCT are thicker. Note that a large part of the border between the skin and SCT is blurred. SELEB: subepidermal low echogenic band; SEG: subcutaneous echogenicity (grade); SEFS: subcutaneous echo-free space (grade); SCT: subcutaneous tissue

Fig. 2

(A) Difference ratio, (B) Difference in SEG and SEFS grades. *p <.05 between the arm with lymphedema and the normal arm. SELEB: subepidermal low echogenic band; SCT: subcutaneous tissue; MUA: medial upper arm; LUA: lateral upper arm; MFA: medial forearm; LFA: lateral forearm; DH: dorsum of the hand; SEG: subcutaneous echogenicity (grade); SEFS: subcutaneous echo-free space (grade)