{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T19:42:43Z","timestamp":1792266163232,"version":"4.4.0"},"reference-count":29,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:00:00Z","timestamp":1785888000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Lymphatic Research and Biology"],"published-print":{"date-parts":[[2026,12,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Ultrasonographic subcutaneous tissue parameters have previously been used as outcome measures in the evaluation of breast cancer\u2013related lymphedema (BCRL). However, their ability to detect clinically meaningful changes\u2014referred to as responsiveness\u2014has not yet been examined. This study aimed to investigate the responsiveness of ultrasonographic subcutaneous tissue thickness measurements, subcutaneous echogenicity (SEG), and subcutaneous echo-free space (SEFS) changes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and Results:<\/jats:title>\n                    <jats:p>\n                      Forty patients with International Society of Lymphology Stage 2\u20133 unilateral lymphedema underwent phase 1 complex decongestive therapy three times weekly for 4 weeks. Ultrasonographic subcutaneous tissue thickness, SEG, and SEFS, alongside circumferential measurements, limb volume, and visual analog scale scores for pain, heaviness, and tightness, were evaluated pre- and posttreatment. Significant symptomatic improvement was observed (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.0001). Edema volume and percentage decreased significantly (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.012 and\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      = 0.006). Subcutaneous tissue thickness significantly decreased at the upper arm medial, medial epicondyle, and wrist (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      &lt; 0.02), demonstrating the highest responsiveness (effect size = 1.74). In contrast, changes in SEG and SEFS were statistically significant only at limited sites and showed small to negligible responsiveness overall; however, SEFS showed comparatively higher responsiveness at the wrist, the site with the greatest baseline free-fluid accumulation. Circumferential and volumetric measures showed low responsiveness.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Subcutaneous tissue thickness was the most sensitive ultrasonographic marker in BCRL, followed by symptom scores. SEG and SEFS showed limited overall responsiveness, although SEFS remained meaningful at the wrist. Edema volume and percentage showed greater responsiveness than overall limb volume and circumferential measurements. Integrating subcutaneous thickness with edema-specific and symptom assessment may enhance monitoring of therapeutic outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/15578585261473403","type":"journal-article","created":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T07:10:31Z","timestamp":1785913831000},"page":"257-265","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Responsiveness of Ultrasonographic Subcutaneous Tissue Parameters to Complex Decongestive Therapy in Breast Cancer\u2013Related Lymphedema"],"prefix":"10.1177","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3895-4486","authenticated-orcid":false,"given":"Esra","family":"Giray","sequence":"first","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, Fatih Sultan Mehmet Training and Research Hospital, University of Health Sciences, Istanbul, Turkey."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esra Nur","family":"T\u00fcrkmen","sequence":"additional","affiliation":[{"name":"Department of Therapy and Rehabilitation, Physiotherapy Program, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u0130lker","family":"Ya\u011fc\u0131","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, Marmara University School of Medicine, Istanbul, Turkey."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G\u00fclseren","family":"Aky\u00fcz","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, Marmara University School of Medicine, Istanbul, Turkey."},{"name":"Lifemed Medical Center, Istanbul, Turkey."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,5]]},"reference":[{"key":"e_1_3_2_2_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijms25073907"},{"key":"e_1_3_2_3_1","doi-asserted-by":"publisher","DOI":"10.5535\/arm.2013.37.5.683"},{"key":"e_1_3_2_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10549-023-06947-7"},{"issue":"2","key":"e_1_3_2_5_1","first-page":"84","article-title":"Is ultrasonography a useful method to evaluate the effectiveness of complex decongestive therapy in breast cancer-related lymphedema","volume":"50","author":"Sezgin Ozcan D","year":"2017","unstructured":"4.Sezgin Ozcan D, , Oken O, , Dalyan Aras M, et al. Is ultrasonography a useful method to evaluate the effectiveness of complex decongestive therapy in breast cancer-related lymphedema? Lymphology 2017;50(2):84\u201394.","journal-title":"Lymphology"},{"key":"e_1_3_2_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/ecc.13376"},{"key":"e_1_3_2_7_1","first-page":"113","article-title":"The diagnosis and treatment of peripheral lymphedema","volume":"28","author":"Committee ISoLE","year":"1995","unstructured":"6.Committee ISoLE. The diagnosis and treatment of peripheral lymphedema. Lymphology 1995;28:113\u2013117.","journal-title":"Lymphology"},{"key":"e_1_3_2_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD003475.pub2"},{"issue":"6","key":"e_1_3_2_9_1","first-page":"272","article-title":"Assessment of limb volume by manual and automated methods in patients with limb edema or lymphedema","volume":"13","author":"Mayrovitz HN","year":"2000","unstructured":"8.Mayrovitz HN, , Sims N, , Macdonald J. Assessment of limb volume by manual and automated methods in patients with limb edema or lymphedema. Adv Skin Wound Care 2000;13(6):272\u2013276.","journal-title":"Adv Skin Wound Care"},{"key":"e_1_3_2_10_1","doi-asserted-by":"publisher","DOI":"10.3400\/avd.oa.16-00086"},{"key":"e_1_3_2_11_1","doi-asserted-by":"publisher","DOI":"10.5455\/annalsmedres.2019.05.288"},{"key":"e_1_3_2_12_1","doi-asserted-by":"publisher","DOI":"10.1590\/1677-5449.202201441"},{"key":"e_1_3_2_13_1","doi-asserted-by":"publisher","DOI":"10.1089\/lrb.2018.0053"},{"key":"e_1_3_2_14_1","doi-asserted-by":"publisher","DOI":"10.2458\/lymph.4619"},{"key":"e_1_3_2_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvsv.2015.02.001"},{"key":"e_1_3_2_16_1","doi-asserted-by":"publisher","DOI":"10.1089\/lrb.2016.28999.sgr"},{"key":"e_1_3_2_17_1","doi-asserted-by":"publisher","DOI":"10.1089\/lrb.2015.0021"},{"issue":"1","key":"e_1_3_2_18_1","first-page":"101","article-title":"Usefulness of ultrasound examination in evaluation of breast cancer-related lymphedema","volume":"35","author":"Han N","year":"2011","unstructured":"17.Han N, , Cho Y, , Hwang J, et al. Usefulness of ultrasound examination in evaluation of breast cancer-related lymphedema. Ann Rehabil Med 2011;35(1):101\u2013109.","journal-title":"Ann Rehabil Med"},{"key":"e_1_3_2_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-015-2633-9"},{"key":"e_1_3_2_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.breast.2012.12.018"},{"key":"e_1_3_2_21_1","doi-asserted-by":"publisher","DOI":"10.5152\/ejbh.2019.4385"},{"key":"e_1_3_2_22_1","doi-asserted-by":"publisher","DOI":"10.23736\/s1973-9087.21.06853-2"},{"key":"e_1_3_2_23_1","doi-asserted-by":"publisher","DOI":"10.1089\/lrb.2020.0068"},{"key":"e_1_3_2_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/0021-9681(87)90069-5"},{"key":"e_1_3_2_25_1","doi-asserted-by":"publisher","DOI":"10.4324\/9780203771587"},{"key":"e_1_3_2_26_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.23883"},{"key":"e_1_3_2_27_1","doi-asserted-by":"publisher","DOI":"10.1089\/lrb.2018.0022"},{"key":"e_1_3_2_28_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12955-014-0158-4"},{"key":"e_1_3_2_29_1","doi-asserted-by":"publisher","DOI":"10.1089\/lrb.2017.0090"},{"key":"e_1_3_2_30_1","doi-asserted-by":"publisher","DOI":"10.1097\/SAP.0000000000003494"}],"container-title":["Lymphatic Research and Biology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/15578585261473403","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/15578585261473403","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/15578585261473403","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T18:47:11Z","timestamp":1792262831000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/15578585261473403"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,5]]},"references-count":29,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,12,1]]}},"alternative-id":["10.1177\/15578585261473403"],"URL":"https:\/\/doi.org\/10.1177\/15578585261473403","relation":{},"ISSN":["1539-6851","1557-8585"],"issn-type":[{"value":"1539-6851","type":"print"},{"value":"1557-8585","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,5]]}}}