Reducing chronic breast cancer related lymphedema utilizing a program of prospective surveillance with bioimpedance spectroscopy (BIS).

Abstract

10117 Background: Breast cancer related lymphedema (BCRL) represents a major side effect that can significantly impact quality of life. Current guidelines support prospective surveillance to allow for early diagnosis and treatment of BCRL at a subclinical, reversible stage. This current large, single institution experience evaluated the use of bioimpedance spectroscopy (BIS) to monitor patients for the development and treatment of BCRL. Methods: From April 2010 through Nov 2016, 596 patients (79.6% with high-risk features) were evaluated with BIS.Patients received a pre-operative baseline L-Dex measurement and post-operatively at regular intervals. Elevated L-Dex scores were defined as an increase of ≥10 points above baseline (considered subclinical BCRL). Intervention then consisted of applying an over the counter (OTC) sleeve for 4 weeks followed by re-evaluation. The need for complete decongestive physiotherapy (CDP) represented a surrogate for the development of clinically significant, chronic BCRL. Results: Median follow-up for all patients was 17 months. Seventy-three patients (12%) developed an elevated L-Dex score with axillary lymph node dissection (ALND) (p < 0.001), taxanes (p = 0.008), and (regional nodal irradiation (RNI) (p < 0.001) associated. At last follow-up, only 18 patients (3%) had unresolved clinically significant BCRL requiring CDP. Mastectomy (p = 0.02), ALND (p < 0.001), taxanes (p = 0.05), and RNI (p < 0.001) were associated with requiring CDP. Conclusions: Our results demonstrate that prospective monitoring using BIS, with intervention (using a simple OTC sleeve for 4 weeks) triggered by a ≥10-point L-Dex elevation, resulted in only a 3% rate of chronic, clinically significant BCRL. These results are lower than reported in contemporary studies and validate recent guidelines supporting prospective screening and intervention for BCRL.