Pat W. Whitworth, Andrea Cooper. Breast Journal. 2018;24:62-65

Main findings

• Patient n = 596. Of those with elevated BMI, 61 underwent ALND, 311 SLNB, and 9 had an unknown axillary procedure, one-third of patients had more than one risk factor.
• Median follow-up for all patients was 17 months (range 0.2-80.4) and the median number of follow-up visits was 4 (range: 2-19).
• Overall, 73 patients (12% of all patients) had an abnormal L-Dex score at some point during surveillance. Of these 73 patients, the L-Dex score returned back to baseline in 55 patients (75%). In the remaining 18 patients (3% of total), the L-Dex score did not return to baseline and/or they had clinically apparent/significant BCRL requiring CDP.
• All patients that went on to CDP were initially identified with elevated L-Dex readings (no false negatives). Patients undergoing ALND were more likely to develop an abnormal L-Dex score (31% vs 8%, P < .001) and to have unresolved BCRL (11% vs 1%, P < .001).
• Median time to first elevated L-Dex score was 4.5 months (range: 0-193) with median time to resolution of 3.8 months from diagnosis (range: 0.1-51.7).
• Those developing subclinical BCRL were less likely to undergo SLNB and more likely to have received adjuvant systemic therapy, taxane based therapy, and/or RNI.
• Those developing irreversible, chronic BCRL were less likely to undergo SLNB and more likely to have undergone mastectomy, received adjuvant systemic therapy, taxane based therapy, high tangents, or RNI.
• The results of the current analysis support the concept that prospective surveillance using BIS can detect subclinical BCRL in patients (79.6% of whom were considered high risk), facilitating simple preemptive intervention and resulting in very low rates of chronic BCRL.
• Overall lymphedema rate of 3% (persistent L-Dex elevation or clinical BCRL following an OTC sleeve) is lower than reported in modern studies of low-risk patients; the lymphedema rate in over 5000 patients in the ACOSOG Z0010 trial (sentinel node biopsy in T1-2N0 breast cancers) was 7% at only 6 months.
• In the vast majority of patients with elevated L-Dex scores, BCRL was reversible with a simple OTC compression sleeve applied for 4 weeks.
• In those that did not respond to this conservative management, it might be that BCRL needs to be detected even sooner in order to prevent progression to its chronic form. Recent data have demonstrated higher sensitivity and specificity of L-Dex when using a 2 standard deviation (SD) trigger, or an L-Dex increase of >6.5 from presurgical baseline rather than the current criterion of 3 SD (L-Dex increase of >10).