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Updated: Sep 28, 2025
Ultrasonographic Evaluation of Breast Cancer-related Lymphedema
Published on: January 12, 2017
Manual Lymphatic Drainage for Breast Cancer-related Lymphedema: A Systematic Review and Meta-analysis of Randomized
Yan Lin1, Yan Yang1, Xiaoyu Zhang1
1Department of Aesthetic and Reconstructive Breast Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
Insights
Manual lymphatic drainage (MLD) significantly reduces pain in breast cancer-related lymphedema (BCRL) patients. However, current evidence does not support MLD for improving limb volume or quality of life in BCRL.
Area of Science:
- Oncology
- Rehabilitation Medicine
- Evidence-Based Practice
Background:
- Breast cancer-related lymphedema (BCRL) is a common and debilitating side effect of cancer treatment.
- Manual lymphatic drainage (MLD) is a conservative treatment option for lymphedema.
- The effectiveness of MLD for BCRL requires robust scientific evaluation.
Purpose of the Study:
- To systematically review and meta-analyze the efficacy of MLD in managing BCRL.
- To evaluate the impact of MLD on key outcomes including lymphedema incidence, volume, pain, and quality of life.
Main Methods:
- A comprehensive search of major databases (Cochrane Library, PubMed, EMBASE, Web of Science, ClinicalTrials.gov) was conducted.
- Randomized controlled trials (RCTs) comparing MLD to control groups for women with BCRL were included.
- Statistical analysis was performed using Review Manager 5.3.
Main Results:
- Eleven RCTs with 1564 patients were identified; 10 were included in the meta-analysis.
- MLD demonstrated a statistically significant reduction in the incidence of lymphedema (RR=0.58, P=.02).
- MLD also significantly improved pain intensity (SMD=-0.72, P=.02), but showed no significant effects on volumetric changes or quality of life.
Conclusions:
- MLD provides significant pain relief for patients with BCRL.
- Current evidence does not support the use of MLD for improving limb volume or quality of life in BCRL.
- Further research into the preventative role of MLD for BCRL is warranted.
Background:
The purpose of this systematic review was to meta-analyze the effectiveness of manual lymphatic drainage (MLD) in breast cancer-related lymphedema (BCRL) patients.
Methods:
The following databases: the Cochrane Library, the Cochrane Central Register of Controlled Trials, PubMed, EMBASE, Web of Science, ClinicalTrials.gov were systematically searched. All English publications before April 2021 have been retrieved without any restrictions of countries, time, or article type. We included randomized controlled trials (RCTs) examining the effectiveness of MLD versus control group without MLD of women with BCRL. The outcomes were (1) the incidence of lymphedema, (2) volumetric changes of lymphedema, (3) pain, (4) quality of life. Review Manager 5.3 was used to perform statistical analysis.
Results:
In total, 11 RCTs involving 1564 patients were included, in which 10 trials were deemed viable for inclusion in the meta-analysis. Due to the effects of MLD for BCRL, statistically significant improvements were found on the incidence of lymphedema (RR = 0.58, 95% CI [0.37, 0.93], P =.02) and pain intensity (SMD = -0.72, 95% CI [-1.34, -0.09], P = .02). Besides, the meta-analysis carried out implied that the effects that MLD had on volumetric changes of lymphedema and quality of life, were not statistically significant.
Conclusion:
The current evidence based on the RCTs shows that pain of BCRL patients undergoing MLD is significantly improved, while our findings do not support the use of MLD in improving volumetric of lymphedema and quality of life. Note that the effect of MLD for preventing BCRL is worthy of discussion.
