Assessment of local tissue water in the arms and trunk of breast cancer survivors with and without upper extremity lymphoedema

Melissa Mazor1, Betty J. Smoot2, Judy Mastick1, Grace Mausisa1, Steven M. Paul1, Kord M. Kober1, Charles Elboim3, Komal Singh1, Yvette P. Conley4, Gabby Mickevicius2, Jennifer Field2, Heather Hutchison2 and Christine Miaskowski1. Clin Physiol Funct Imaging (2018)

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Assessment of local tissue water in the arms and trunk of breast cancer survivors with and without upper extremity lymphoedema

Melissa Mazor1, Betty J. Smoot2, Judy Mastick1, Grace Mausisa1, Steven M. Paul1, Kord M. Kober1, Charles Elboim3, Komal Singh1, Yvette P. Conley4, Gabby Mickevicius2, Jennifer Field2, Heather Hutchison2 and Christine Miaskowski1. Clin Physiol Funct Imaging (2018)

Given the paucity of information on local tissue water (LTW) in the upper extremity and trunk of women after breast cancer surgery, the purpose of this study was to compare tissue dielectric constant (TDC) values between the affected and unaffected sides of breast cancer survivors with and without upper extremity lymphoedema (LE). Differences in LTW were assessed using the TDC method for three sites in the upper limbs, three sites in the lateral thorax and two sites on the back. Additional measures included demographic and clinical characteristics, arm circumference and bioimpedance analysis. For the 112 survivors without LE, no differences in TDC values were found between the affected and unaffected sides for the first dorsal web space, ventral forearm and upper arm, and upper and lower back. Compared to the unaffected side, TDC values were significantly higher on the affected side for the upper, mid and lower lateral thorax. For the 78 survivors with LE, compared to the unaffected side, TDC was significantly higher on the affected side for all of the sites evaluated except the hand web space. Our findings support the use of the TDC method to detect differences in upper extremity and truncal oedema in survivors with LE following breast cancer treatment. Measurement of LTW may provide a useful method to determine truncal as well as extremity LE. The ability to detect early signs of truncal oedema may lead to pre-emptive interventions in breast cancer survivors.

Main findings

  • This study is part of a larger, ongoing study that is evaluating phenotypic and genomic risk factors for LE in women who underwent breast cancer surgery.
  • TDC measurement sites. The ‘Protocol for Measurement of Breast, Flank, Upper Back, and Arm Using Delfin MoisturemeterD.
  • Bilateral assessments were done for the upper limbs and thorax. Three locations were evaluated in the upper limbs, namely the first dorsal web space, 6 cm distal to the antecubital fossa crease on the ventromedial arm, and 8 cm proximal to the antecubital fossa crease on the ventromedial surface. Three sites were evaluated bilaterally in the lateral thorax using templates based on length of thorax. Two sites were evaluated bilaterally on the back using the template based on thorax length and girth.
  • In the survivors with LE, no differences in TDC values were found between the affected and unaffected sides for hand web space. Compared to the unaffected side, TDC values were significantly higher on the affected side for ventral forearm and upper arm; upper, mid and lower lateral thorax (all, P<0.001); and upper and lower back (both, P<0.05). The TDC ratios of the affected/unaffected side ranged from 102 (007) in the upper and lower back to 1.29 (+/-0.36) in the ventral forearm.
  • This study is the first to report TDC and LTW findings from multiple sites in the upper limbs and trunk in women with and without upper extremity LE following breast cancer surgery.
  • Mayrovitz et al 2014 suggested that a ratio of ≥1.2 could be used as a threshold to detect preclinical LE, based on a change of three standard deviations from mean dominant/non-dominant TDC ratio of their non lymphoedematous participants. Of note, in this study, the mean TDC ratio for the ventral forearm was above this threshold in the LE group (1.29 +/- 0.36), but not in the non-LE group (1.00 +/- 0.09).