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Background <p>Chronic inflammatory responses initiated by lymphatic injury play a key role in the pathophysiology of secondary lymphedema; however, it is unknown if these responses vary by race/ethnicity. We assessed whether baseline differences in inflammation, characterized by crown-like structures of the breast (CLS-B), contributed to lymphedema risk in a diverse cohort of patients treated with axillary lymph node dissection (ALND).</p> Methods <p>Between 11/2016-03/2020, patients undergoing ALND were enrolled in a prospective lymphedema screening study. Race/ethnicity were self-reported. BMI and volumetric arm measurements were performed at baseline and biannually. Breast tissue was assessed for CLS-B utilizing a CD-68 IHC stain in non-tumor tissue. Lymphedema incidence was assessed using competing-risk analysis and compared between patients with and without CLS-B.</p> Results <p>Of 281 patients included, 11% self-identified as Asian, 20% Black, 8% Hispanic, 58% White, and 3% unknown. Median BMI was 26.3kg/m<sup>2</sup>; median follow-up was 2.99 years. Overall, 54% had CLS-B; prevalence varied by BMI (36% [BMI &lt; 25], 63% [BMI 25-30], 70% [BMI &gt; 30], <i>p</i> &lt; 0.001) and by race/ethnicity (68% Black/64% Hispanic vs. 59% Asian/46% White, <i>p</i> = 0.02). The 2-year lymphedema rate was higher among Black and Hispanic women (32% Black/27% Hispanic versus 15% Asian/17% White, <i>p</i> = .012), and among women with CLS-B (27% vs. 12% [no CLS-B], <i>p</i> = 0.03). On multivariable analysis, Black race (<i>p</i> = 0.009), neoadjuvant chemotherapy receipt (<i>p</i> = 0.024), and older age (<i>p</i> = 0.002) were independently associated with lymphedema development, while CLS-B was not (<i>p</i> = 0.3).</p> Conclusion <p>The higher CLS-B prevalence observed in Black women suggests an increased propensity for inflammation, although its role in lymphedema development remains uncertain.</p>

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Racial and Ethnic Differences in Breast Inflammation and Its Association with Lymphedema Risk After Axillary Lymph Node Dissection

  • 期刊论文

  • 发表日期：

    2025年2月19日

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  • Arielle Roberts,
  • Adana-Christine Campbell,
  • Bracha L. Pollack,
  • Giacomo Montagna,
  • Varadan Sevilimedu,
  • Bayley Axelrod,
  • Ethan A Gomez,
  • Dilip Giri,
  • Monica Morrow,
  • Babak J. Mehrara,
  • Andrea V. Barrio

摘要

Background

Chronic inflammatory responses initiated by lymphatic injury play a key role in the pathophysiology of secondary lymphedema; however, it is unknown if these responses vary by race/ethnicity. We assessed whether baseline differences in inflammation, characterized by crown-like structures of the breast (CLS-B), contributed to lymphedema risk in a diverse cohort of patients treated with axillary lymph node dissection (ALND).

Methods

Between 11/2016-03/2020, patients undergoing ALND were enrolled in a prospective lymphedema screening study. Race/ethnicity were self-reported. BMI and volumetric arm measurements were performed at baseline and biannually. Breast tissue was assessed for CLS-B utilizing a CD-68 IHC stain in non-tumor tissue. Lymphedema incidence was assessed using competing-risk analysis and compared between patients with and without CLS-B.

Results

Of 281 patients included, 11% self-identified as Asian, 20% Black, 8% Hispanic, 58% White, and 3% unknown. Median BMI was 26.3kg/m2; median follow-up was 2.99 years. Overall, 54% had CLS-B; prevalence varied by BMI (36% [BMI < 25], 63% [BMI 25-30], 70% [BMI > 30], p < 0.001) and by race/ethnicity (68% Black/64% Hispanic vs. 59% Asian/46% White, p = 0.02). The 2-year lymphedema rate was higher among Black and Hispanic women (32% Black/27% Hispanic versus 15% Asian/17% White, p = .012), and among women with CLS-B (27% vs. 12% [no CLS-B], p = 0.03). On multivariable analysis, Black race (p = 0.009), neoadjuvant chemotherapy receipt (p = 0.024), and older age (p = 0.002) were independently associated with lymphedema development, while CLS-B was not (p = 0.3).

Conclusion

The higher CLS-B prevalence observed in Black women suggests an increased propensity for inflammation, although its role in lymphedema development remains uncertain.