Abstract

Assessment of Upper Limb Physiological Features in Patients with Lymphedema After Breast Surgery Using Multiple Instruments

Motohiro Kojima, MD, PhD,1 Chisako Yamauchi, MD, PhD,1,2 Shunsuke Oyamada, MS,3 Takashi Hojo, MD, PhD,2 Satoru Iwase, MD, PhD,4 Atsushi Naito, MS,5 Kazuhiko Yamano, MS,5 Shinichiro Takahashi, MD, PhD,6 and Atsushi Ochiai, MD, PhD1. Lymphatic Research Biology 2019.

Background: Objective assessment of upper limb physiological features may allow for early detection and proper intervention for lymphedema after breast surgery. However, the development of diagnostic instruments and standard measurement procedures are required.

Methods and Results: Four instruments (Venustron, Softmeasure, Myoton Pro, and iBDent), tape measurement, and water volumetry were investigated in this study. Inter-limb differences in physiological data were obtained from 40 patients with lymphedema after breast surgery and 38 control subjects. Four instruments and tape measurements were performed at four points. Inter-limb differences between patients with lymphedema and control subjects were determined. All measurements took <20 minutes with minimal pain reported. Inter-limb differences in water volumetry and tape measurements, especially when measured at 5cm distal to the cubital fossa, were increased in International Society of Lymphology (ISL) stage II cases. All four instruments showed high reproducibility in standard silicon sample measurement. On the other hand, data from human samples were varied, and the utility for assessment of lymphedema was not determined.

Conclusion: Water volumetry and tape measurement at 5cm distal to the cubital fossa were useful to assess lymphedema in ISL stage II cases. Four instruments used in this study were feasible in clinical practice. In addition, inconsistent data from human tissue were not due to sensor limitations, rather, acquisition of accurate data from human tissue seemed to be difficult due to anatomical factors. In addition to high-quality sensor, development of system that produce accurate and reproducible results from human tissue is required.

Main findings

• Instruments included
  • The Venustron system measures elastic modules based on Hooke’s law and Hertz’s contact stress theory.
  • Softmeasure is an indentation tester based on the Hertz’s contact stress theory, and palpation mechanic;
  • The iBDent prototype is a tonometer system, which measures the phase difference caused by the deformation of the arm after compression by air;
  • Myoton Pro measures several biomechanical and viscoelastic features through the oscillation of measurement point
    • Physiological measurements using these instruments were performed at the inner base of the thumb, inner part of the wrist, and at the inner 5cm distal to and 10cm proximal to the elbow
  • Circumference measurements were performed at corresponding locations to the instrument measurements: the plane of the thumb and index finger and ulnar styloid process (corresponding to the inner base of thumb), ulnar and radial styloid processes (corresponding to the wrist), and 5cm distal to and 10cm proximal to the plane of the olecranon and cubital fossa.
  • Water volumetry was performed using a water bath, and the water volume overflowing from the water bath to the saucer was measured when the whole upper limb was inserted into the bath.
  • The usefulness of water volumetry and tape measurement to differentiate patients in ISL stage II. Furthermore, tape measurement showed a high variation across the different measurement locations in patients with lymphedema. The plane 5cm distal to the cubital fossa can be used as a standard location for tape measurement. In addition to the development of high-quality sensors, systems that ensure accurate human tissue measurement are required for the assessment of patients with lymphedema.