Kocaeli Med J. 2025; 14(1): 62-68 | DOI: 10.5505/ktd.2025.88123

Ultrasonographic Evaluation of Biceps Muscle thickness and Cutaneous Stiffness in Breast Cancer Related Lymphedema

Zeliha Ünlü¹, Ilhan Celil Özbek², Emir Onað^1
1Department Of Physical Medicine And Rehabilitation, Celal Bayar University, Faculty Of Medicine, Manisa, Turkey
²Department of Physical Medicine and Rehabilitation, University of Health Science, Derince Training and Research Hospital, Kocaeli, Türkiye

INTRODUCTION: This study aims to evaluate biceps muscle thickness and cutaneous stiffness using ultrasound in cases of secondary lymphedema in the arm following breast cancer and to investigate their relationship with clinical findings.
METHODS: Thirty patients, with an average age of 52 years, were assessed comparing the unaffected and lymphedematous arms. Arm volumes and edema ratios were calculated from circumferential measurements. Ultrasonography was used to assess lymphedema, measuring skin-subcutaneous tissue thickness, compliance ratio with and without compression, echogenicity, echo-free space, and shear wave elastography. Biceps muscle thickness was also measured. Clinically, the Lymphedema Quality of Life Scale was applied.
RESULTS: Most cases had stage 1 (63.3%) and stage 2 (33.3%) lymphedema. A statistically significant difference was found in the volumes of the unaffected and lymphedematous arms (p<0.001), with an edema ratio of 0.23±0.22. No significant difference was found between the two arms in skin-subcutaneous elastography and compliance ratio (p>0.05). The lymphedematous arm had significantly thinner biceps muscle thickness compared to the unaffected arm (p=0.025).
DISCUSSION AND CONCLUSION: The similarity in skin-subcutaneous elastography and compliance ratio values suggests that advanced-stage lymphedema-fibrosis has not developed, supporting the clinical staging of lymphedema in these cases. The significant decrease in biceps muscle thickness indicates sarcopenia, which may occur even without advanced-stage lymphedema. This underscores the importance of regular exercise, especially strength training, from the early postoperative period in breast cancer patients to prevent potential lymphedema. Further research on sarcopenia and exercise therapy in lymphedema cases is needed.

Keywords: lymphedema, ultrasonography, sarcopenia, elasticity imaging techniques, breast cancer

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Meme Kanserý̇ne Baðlý Lenfödemde Bý̇seps Kas Kalýnlýðý ve Kutanöz Sertlý̇ðý̇n Ultrasonografý̇k Deðerlendý̇rý̇lmesý̇

Zeliha Ünlü¹, Ilhan Celil Özbek², Emir Onað^1
1Celal Bayar Üniversitesi, Týp Fakültesi, Fiziksel Týp Ve Rehabilitasyon Ana Bilim Dalý, Manisa, Türkiye
²Saðlýk Bilimleri Üniversitesi, Kocaeli Derince Eðitim ve Araþtýrma Hastanesi, Fiziksel Týp ve Rehabilitasyon Kliniði Kocaeli, Türkiye

GÝRÝÞ ve AMAÇ: Bu çalýþmada meme kanseri sonrasý kolda sekonder lenfödem geliþen olgularda biseps kas kalýnlýðý ve kutanöz sertliðin ultrasonografi ile deðerlendirilmesi ve klinik bulgularla iliþkisinin araþtýrýlmasý amaçlandý.
YÖNTEM ve GEREÇLER: Yaþ ortalamasý 52 olan 30 hasta, etkilenmemiþ ve lenfödemli kollar karþýlaþtýrýlarak deðerlendirildi. Çevresel ölçümlerden kol hacimleri ve ödem oranlarý hesaplandý. Lenfödemi deðerlendirmek için ultrasonografi kullanýldý ve cilt-cilt altý doku kalýnlýðý, kompresyonlu ve kompresyonsuz komplians oraný, ekojenite, ekosuz alan ve kayma dalgasý elastografisi ölçüldü. Biseps kas kalýnlýðý ölçüldü. Klinik olarak Lenfödem Yaþam Kalitesi Ölçeði uygulandý.
BULGULAR: Olgularýn çoðu evre 1 (%63,3) ve evre 2 (%33,3) lenfödeme sahipti. Etkilenmemiþ ve lenfödemli kollarýn hacimlerinde istatistiksel olarak anlamlý bir fark bulundu (p<0,001) ve ödem oraný 0,23±0,22 idi. Ýki kol arasýnda cilt-cilt altý elastografi ve komplians oraný açýsýndan anlamlý bir fark bulunmadý (p>0,05). Lenfödemli kolun biseps kas kalýnlýðý etkilenmemiþ kola kýyasla anlamlý derecede daha inceydi (p=0,025).
TARTIÞMA ve SONUÇ: Deri-cilt altý elastografi ve komplians oraný deðerlerindeki benzerlik, bu olgularda ileri evre lenfödem-fibrozis geliþmediðini düþündürmekte ve lenfödemin klinik evrelemesini desteklemektedir. Biseps kas kalýnlýðýndaki belirgin azalma, ileri evre lenfödem olmadan da ortaya çýkabilen sarkopeniye iþaret etmektedir. Bu durum, meme kanseri hastalarýnda olasý lenfödemi önlemek için ameliyat sonrasý erken dönemden itibaren düzenli egzersizin, özellikle de kuvvet antrenmanýnýn önemini vurgulamaktadýr. Lenfödem vakalarýnda sarkopeni ve egzersiz tedavisi konusunda daha fazla araþtýrmaya ihtiyaç vardýr.

Anahtar Kelimeler: lenfödem, ultrasonografi, sarkopeni, elastisite görüntüleme teknikleri, meme kanseri

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