Risk assessment for lymphedema in breast cancer survivors.

Abstract

141 Background: Breast cancer patients are receiving survivorship care plans that describe potential late effects of treatment. The potential for lymphedema ranges from 5% to 53% and is a serious long term problem. In the past, water displacement was the “gold standard” for measuring lymphedema; this involves placing the arm into a large graduated cylinder filled with water to measure displacement compared with the opposite arm. This method is inconvenient for both patient and practitioner and can cause significant anxiety. Methods: In 2010 we began assessing women undergoing unilateral axillary surgery for preclinical and clinical lymphedema using a method that measures bioimpedance, using the L-Dex U400 analyzer. L-Dex uses a mild electrical current to assess fluid levels in the extracellular compartment, earlier than a patient might feel a change in size or weight. One hundred thirty -seven patients were assessed using both volume displacement and L-Dex preoperatively, as a baseline and repeating at 3 to 6 month intervals for three years. Results: Of the patients followed, 83% had sentinel node excision only and 17% had completion axillary dissection. Our study identified an overall lymphedema rate of 7%. Of the patients with full axillary dissection the lymphedema rate was 9% and those with sentinel node excision were found to have no clinical lymphedema (0%). In every case where the patients developed lymphedema the L-Dex bioimpedance measurement identified a change 100% of the time before fluid volume displacement became out of range. Conclusions: Based on our results and the ease of use of the bioimpedance analysis, we have added lymphedema assessment using the L-Dex analyzer to our survivorship process. Patients with invasive cancer undergoing unilateral axillary node surgery are assessed at the same time they receive their sentinel node tracer injection. If there is a sentinel node excision only they are checked once or with any symptom. Patients who have a complete axillary dissection are to be followed for three years. This modest intervention should reduce anxiety surrounding one of the most serious late effects of breast cancer.