Reducing chronic breast cancer-related lymphedema utilizing a program of prospective surveillance with bioimpedance spectroscopy

Pat W. Whitworth, Andrea Cooper. Breast J. 2017;1–4

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Reducing chronic breast cancer-related lymphedema utilizing a program of prospective surveillance with bioimpedance spectroscopy

Pat W. Whitworth, Andrea Cooper. Breast J. 2017;1–4

This single-institution experience evaluated the use of bioimpedance spectroscopy to facilitate early detection and treatment of breast cancer-related lymphedema (BCRL) in a cohort of 596 patients (79.6% high risk). Seventy-three patients (12%) developed an elevated L-Dex score with axillary lymph node dissection (P < .001), taxane chemotherapy (P = .008), and regional nodal irradiation (P < .001) associated. At last follow-up, only 18 patients (3%) had unresolved clinically significant BCRL requiring complete decongestive physiotherapy. This rate of BCRL is lower than reported in contemporary studies, supporting recent NCCN guidelines promoting prospective screening, education and intervention for BCRL.

Main findings

  • Patients were considered to have an elevated reading if their L-Dex score increased >10 points from baseline (defined as ‘subclinical BCRL).8 Intervention was then triggered and consisted of applying an over-the-counter (OTC) compression sleeve for 4 weeks followed by a recheck of their L-Dex score.
  • Patients were considered high risk (n = 475) if they had an elevated body mass index (BMI, >25) (n = 379), axillary lymph node dissection (ALND) (n = 93), received regional nodal irradiation (RNI) (n = 17), or received taxane chemotherapy (n = 163).
  • 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).
  • 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.
  • An additional component for designing surveillance programs is the need for efficiency with respect to cost, space, and time. Bioimpedance spectroscopy using L-Dex has a minimal space footprint and has been found to add minimal time in its application.
  • All patients that ultimately required CDP were first identified with an elevated L-Dex measurement. In the vast majority of patients with elevated L-Dex scores, BCRL was reversible with a simple OTC compression sleeve applied for 4 weeks.
  • There was a 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). This may lead to a higher sensitivity to mild-to-moderate volume changes.