A Prospective Study of L-Dex Values in Breast Cancer Patients Pretreatment and Through 12 Months Postoperatively

Sheila H. Ridner, PhD, RN, FAAN, 1 Mary S. Dietrich, PhD,1,2 Kandace Spotanski, MMHC, 1 Jennifer K. Doersam, MS, 1 Michael S. Cowher, MD, 3 Bret Taback, MD, 4 Sarah McLaughlin, MD, 5 Nicolas Ajkay, MD, 6 John Boyages, MD, PhD, 7 Louise Koelmeyer, BAppSc(OT), 7 Sarah DeSnyder, MD, 8 Chirag Shah, MD, 9 and Frank Vicini, MD10. LYMPHATIC RESEARCH AND BIOLOGY 2018

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A Prospective Study of L-Dex Values in Breast Cancer Patients Pretreatment and Through 12 Months Postoperatively

Sheila H. Ridner, PhD, RN, FAAN, 1 Mary S. Dietrich, PhD,1,2 Kandace Spotanski, MMHC, 1 Jennifer K. Doersam, MS, 1 Michael S. Cowher, MD, 3 Bret Taback, MD, 4 Sarah McLaughlin, MD, 5 Nicolas Ajkay, MD, 6 John Boyages, MD, PhD, 7 Louise Koelmeyer, BAppSc(OT), 7 Sarah DeSnyder, MD, 8 Chirag Shah, MD, 9 and Frank Vicini, MD10. LYMPHATIC RESEARCH AND BIOLOGY 2018

Background: Data regarding pretreatment, bioimpedance spectroscopy (BIS) L-Dexvalues for patients newly diagnosed with breast cancer, and longitudinal data 12 months postoperatively are lacking. This study describes L-Dex values at the time of breast cancer diagnosis and maximum L-Dex change within 12 months of surgery.

Methods and Results: Patients were enrolled in a parent, clinical trial that compares the effectiveness of BIS for early detection of breast cancer-related lymphedema to tape measurement. A total of 280 women with a pretreatment and at least one post operativeL-Dex measurement (within 12 months of surgery) were included. Pretreatment L-Dex readings were compared with population norms and maximum L-Dex changes within 12 months were examined. An L-Dex U400 device was used to obtain BIS measurements. The documented normative me an value using this device is 0.00, which is at the 49th percentile for this sample. Approximately 6% of patients had a pretreatment L-Dex value of‡7.0; 1.8% had an L-Dex value ‡10.0. For 12 months, 17.1% (n=48) of patients had a maximum change in L-Dex value from pretreatment of ‡7.0L-Dex units, suggestive of clinical lymphedema.

Conclusions: At the time of breast cancer diagnosis, L-Dex values are similar to normative values. Identified maximum changes in L-Dex values 12 months postoperatively suggest that frequent L-Dex measurements during that time frame are of potential clinical benefit. Our findings are consistent with research supporting an L-Dex value of ‡7 as indicative of clinical lymphedema with subclinical lymphedema logically occurring at somewhat lower likely, near ‡6.5.

Main findings

  • This study provides information regarding absolute L-Dex values present in women newly diagnosed with breast cancer. Findings from the baseline pretreatment data in this study demonstrate a variability that is only slightly larger (4units as compared to 3 units) than the previously documented absolute normative L-Dexvalues,yet due to skewness,only 6% of women within this population can be expected to have an absolute L-Dex value of ‡7.0. Thus, based on absolute L-Dex values, our findings do not support pre-existing lymphedema as a common occurrence in women newly diagnosed with breast cancer.
  • Given consistent data that demonstrate that early detection of lymphedema improves patient outcomes, aggressive measurement with L-Dex at a frequency greater than every 6 months,that is, every 3 months, especially during the first 6-12 months post surgery, is recommended to facilitate identification of subclinical lymphedema and support early diagnosis of clinical lymphedema
  • This study recommends that an L-Dex change from baseline approximating +/- 6.5, rather than +/-10, be considered to best capture subclinical lymphedema in those with a history of breast cancer. Although future studies may more precisely define the subclinical threshold, use of this recommended lower threshold may enhance the potential success of prevention interventions in the breast cancer population at risk for developing lymphedema.