Breast cancer-related lymphedema (BCRL) of the upper limb is a chronic complication of breast cancer treatment that significantly impairs patient quality of life. Conventional management typically begins only after overt swelling occurs. This reactive approach delays diagnosis, relies on subjective assessment, and prioritizes volume reduction over functional recovery. Consequently, it often misses the optimal window for intervention. Recent advances in objective early-monitoring technologies, such as hyperspectral imaging and bioelectrical impedance analysis, alongside the development of precision functional lymphatic surgery, are now transforming BCRL care. This article details a novel "Precision Collaborative Management" paradigm, which integrates these diagnostic and surgical advances into a synergistic cycle where monitoring informs clinical decisions and surgical outcomes refine subsequent strategies. This paradigm establishes a continuous management pathway encompassing risk screening, early warning, precise intervention, and long-term follow-up across the entire disease continuum. Through sustained exploration in the aforementioned directions, we aim to transform BCRL management from a reactive symptom treatment to a proactive health safeguard, ultimately empowering breast cancer survivors to achieve a comprehensive and high-quality life. The paradigm facilitates a fundamental shift in BCRL clinical practice from delayed symptomatic treatment to early, function-preserving care.

BackgroundSentinel lymph node biopsy (SLNB) has been the standard treatment procedure for clinically node-negative (cN0) breast cancer (BC). Three randomized trials (Z0011, AMAROS and SENOMAC) have shown that patients with low-burden sentinel lymph node metastasis can be safely omitted axillary lymph node dissection who receive adjuvant radiotherapy. However, these published studies have been insufficient to accurately assess the recurrence risk in this patient population, leading to variability in adjuvant radiotherapy volume across different studies.ObjectiveThis study evaluates whether an integrated axillary management strategy combining SLNB with individualized regional nodal irradiation (RNI) based on recurrence risk reduces 2-year lymphedema compared to ALND followed by comprehensive RNI.Materials and MethodsThis trial is a single institute, open-labeled, non-randomized cohort trial. Participants are stratified into two cohorts based on the extent of axillary surgery after enrollment. For SLNB cohort, patients are divided into three groups according to clinical and genomic risk assessment. Clinically high-risk patients are defined as having at least two factors (tumor size≥2cm, percent of positive SLNs>30%, LVI positive and SLN macro-metastases), who have a predicted risk of n-SLN involvement greater than 30%. Clinically high-risk n-SLN involvement patients are further detected by using RecurIndex test. For pathological node positive (pN+) after ALND cohort, patients are treated with WBI/chest wall irradiation combined with comprehensive RNI excluding the dissected axillary region; A total of 205 patients will be enrolled, with 68 patients in SLNB cohort and 137 patients in ALND cohort with a 1:2 ratio assignment. The RNI precision trial uses a clinical-genomic model to accurately stratify the recurrence risk and provides the individualized RNI volume for early-stage BC with low-burden sentinel lymph node metastasis, and we anticipate that our study will provide high-quality data to potentially support individualized RNI in this patient population.

[Purpose] Lymphedema is a chronic, progressive disorder impairing function and quality of life. Although complete decongestive therapy (CDT) is standard, optimal regulation of physical activity during CDT is unclear. This case report evaluated the feasibility of wearable device use during intensive CDT. [Participant and Methods] A 78-year-old woman with bilateral lower limb lymphedema after cervical cancer surgery and radiotherapy underwent a 2-week inpatient CDT program. Assessments included limb circumference, Timed Up and Go test (TUG), skin mechanical properties (Cutometer®), body water distribution (ECW/TBW ratio), and quality of life (LYMQOL-Leg). A Fitbit® device continuously monitored steps, distance, energy expenditure, and sleep. A 7,000-step daily goal was collaboratively set. [Results] After CDT, limb circumference and ECW/TBW ratio decreased, with improvements in skin parameters and mobility (shorter TUG times). LYMQOL-Leg scores improved across function, symptoms, and emotions. Fitbit® data confirmed adherence to the step goal, facilitating shared use of activity information. [Conclusion] Wearable devices can be integrated into CDT, providing objective, continuous activity data to support adherence and collaborative goal setting. Such monitoring may enhance engagement, optimize exercise under compression, and guide individualized rehabilitation for lymphedema.

Keratinocytes, once viewed as inert epidermal scaffolds, are now recognized as active participants in the cutaneous immunity. They orchestrate local immune responses by releasing cytokines, chemokines, and alarmins that shape innate and adaptive inflammation. Dysregulated keratinocyte-immune interactions underline chronic inflammatory skin disorders, such as atopic dermatitis, psoriasis, and cutaneous lupus erythematosus. More recently, keratinocytes have been identified as key contributors to secondary lymphedema, a chronic inflammatory and fibrotic condition historically attributed to lymphatic dysfunction. This review revises our understanding of keratinocytes as immunomodulatory cells, while focusing primarily on their emerging role in the pathogenesis of secondary lymphedema. We highlight and appraise recent evidence that lymphatic stasis reprograms keratinocyte differentiation, induces type 2 helper T cells-skewed inflammatory responses, and perpetuates chronic inflammation and fibrosis. Understanding this keratinocyte-immune-lymphatic axis may unveil novel therapeutic targets beyond traditional lymphangiogenic approaches.

Lymphatic disease represents a well-described manifestation of Noonan syndrome (NS), yet the full phenotypic spectrum remains incompletely characterized, especially in asymptomatic individuals. We conducted a cross-sectional study including 10 individuals with NS (four with peripheral lymphedema and six without) and 10 age- and sex-matched cardiovascularly healthy controls. Central lymphatic anatomy was visualized using non-contrast T2-weighted MR-lymphangiography, and peripheral lymphatic morphology and function were assessed with near-infrared fluorescence (NIRF) imaging and strain gauge plethysmography (SGP). Variations in thoracic duct morphology were observed in 89% (8/9) of NS individuals compared to 20% (2/10) of controls. Thoracic lymphatic classifications (Biko/Dori scale) differed significantly in NS individuals, both with and without lymphedema, compared with healthy controls (p < 0.05). Central lymphatic abnormalities were observed in five of nine NS individuals, including three without clinical signs of lymphatic disease. Abnormal peripheral conduction in collective vessels, characterized by retrograde or absent flow, was detected in all four NS individuals with lymphedema (p < 0.05), while normal conduction was observed in asymptomatic NS individuals and controls. Findings from this study indicate that central lymphatic abnormalities may be present in NS regardless of symptom status, with abnormal peripheral conduction developing later in association with clinically manifest lymphedema. Central lymphatic abnormalities extend beyond clinically apparent disease and broaden the recognized phenotype, highlighting the value of lymphatic imaging for diagnosis and monitoring.

Chronic lymphedema is a well-recognized risk factor for recurrent cellulitis. However, deep soft tissue infections in lymphedematous limbs may present without classical cutaneous signs, leading to delayed diagnosis and rapid clinical deterioration. We report a 35-year-old woman with chronic filarial lymphedema and prior recurrent cellulitis who presented with a three-day history of fever, myalgia, and arthralgia without localizing symptoms. Initial examination revealed no evidence of cellulitis. She rapidly developed severe neutropenia, thrombocytopenia, acute kidney injury, severe metabolic acidosis, followed by refractory shock and acute hypoxic respiratory failure. Despite early broad-spectrum antibiotics, vasopressor support, and intensive care management, she deteriorated and died within 24 h of admission. Blood cultures remained negative. Post-mortem examination demonstrated multiorgan failure consistent with septic shock and revealed deep subcutaneous cellulitis without superficial skin inflammation.This case highlights that chronic lymphedema may predispose to clinically occult deep soft tissue infection, which can progress rapidly to fulminant septic shock in the absence of overt cutaneous findings. A high index of suspicion is essential in patients with systemic inflammatory features, and early empiric antimicrobial therapy should be considered even when classical signs of cellulitis are absent.