Subclinical Breast Cancer-related Lymphedema Research Articles

Abstract P1-05-16: Bioimpedance Spectroscopy Monitoring Reduces Long-term Clinical Lymphedema Risk

Abstract Background: A prospective surveillance model (PSM) of care can reduce the risk of breast cancer related lymphedema (BCRL). Bioimpedance spectroscopy (BIS) devices can identify sub-clinical BCRL (sBCRL). A recent randomized controlled trial (RCT) demonstrated the benefit of a PSM model of care using BIS over tape measure (TM) but it did not look at the long-term risk following intervention. This work reports the actuarial risk of clinical lymphedema for those who have triggered an intervention for sBCRL by either BIS or TM. Materials and Methods: 879 women with breast cancer were randomized to lymphedema screening with either BIS (n=442) or TM (n=437). Following consent, patients underwent baseline pre-surgical measurements with BIS (L-Dex U400, ImpediMed) and volume (circumference) measurements (Gulick II tape) and randomized after surgery. Both the TM and BIS arms underwent planned post-operative assessments at 3, 6, 12, 18, 24, 30, and 36 months as well at the end of any intervention. Patients with a BIS change from baseline of ≥ 6.5 L-Dex units or TM volume change ≥ 5 and < 10% above pre-surgical baselines "triggered" for sBCRL form the basis of this study. Triggered patients underwent 4-weeks of wearing a class two (23–32 mmHg) compression sleeve and gauntlet for 12 hours per day. TM volume change ≥ 10% was considered clinical BCRL (cBCRL) for all patients who triggered by either BIS or TM. The cumulative incidence of cBCRL was calculated via the Kaplan-Meier method and compared by the Log-rank test. Results: 209 (23.8%) women triggered an intervention and completed treatment for sBCRL (BIS: 89 (20.1%), TM: 120 (27.5%)). The median follow up for the women who triggered was 32.2 months (IQR 17.0 – 33.9) with 30 women (14.4%) women developing cBCRL (BIS: 7 (7.9%), TM: 23 (19.2%)). There was a significant difference in risk between the groups over the follow up interval (log rank test p = 0.021) with the cumulative risk in the BIS group being lower compared to the TM group (Hazard Ratio = 0.38, 95%CI 0.19 – 0.79). The 2- year actuarial risk of cBCRL for triggered patients undergoing lymphedema screening by BIS was 5.0% versus 15.7% for TM screening (p = 0.021, HR = 0.30). The corresponding 3-year rates of cBCRL were 10.3% and 21.2%, (p = 0.031, HR = 0.40) respectively. Conclusions: BIS monitoring for sBCRL with subsequent intervention provides significantly lower risks of cBCRL. The lower triggering rates with BIS highlight its better discrimination of true sBCRL compared to TM and support its use for post-treatment surveillance to detect sBCRL and initiate early intervention. These data suggest that monitoring for sBCRL with BIS and subsequent intervention does not just delay the inevitable progression to cBCRL, but rather prevents it over the duration of the study. Citation Format: John Boyages, Frank Vicini, Chirag Shah. Bioimpedance Spectroscopy Monitoring Reduces Long-term Clinical Lymphedema Risk [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P1-05-16.

Current Diagnostic Tools for Breast Cancer-Related Lymphedema.

Breast cancer-related lymphedema (BCRL) can have a significant impact on breast cancer survivors quality of life. The purpose of this review is to evaluate diagnostic tools for the assessment of BCRL. Multiple BCRL diagnostic tools are available, though older diagnostic tools have low sensitivity, limiting the ability for sub-clinical BCRL diagnosis while BIS and perometry have increased sensitivity and theability to diagnose BCRL sub-clinically. Prospective studies have demonstrated such an approach coupled to early intervention is associated with low rates of chronic BCRLwhile a recently published randomized trial demonstrated that prospective surveillance with BIS coupled with early intervention reduced rates of chronic BCRL as compared to circumference measurements with compression garments. Prospective and randomized data support the use of prospective surveillance for BCRL. The strongest data available comes from the PREVENT trial and supports prospective BCRL surveillance with bioimpedance spectroscopy coupled to early intervention with a compression sleeve.

Risk factors for breast cancer-related lymphedema in patients undergoing 3 years of prospective surveillance with intervention.

BackgroundTo evaluate risk factors (treatment‐related, comorbidities, and lifestyle) for breast cancer–related lymphedema (BCRL) within the context of a Prospective Surveillance and Early Intervention (PSEI) model of care for subclinical BCRL.MethodsThe parent randomized clinical trial assigned patients newly diagnosed with breast cancer to PSEI with either bioimpedance spectroscopy (BIS) or tape measurement (TM). Surgical, systemic and radiation treatments, comorbidities, and lifestyle factors were recorded. Detection of subclinical BCRL (change from baseline of either BIS L‐Dex ≥6.5 or tape volume ≥ 5% and < 10%) triggered an intervention with compression therapy. Volume change from baseline ≥10% indicated progression to chronic lymphedema and need for complex decongestive physiotherapy. In this secondary analysis, multinomial logistic regressions including main and interaction effects of the study group and risk factors were used to test for factor associations with outcomes (no lymphedema, subclinical lymphedema, progression to chronic lymphedema after intervention, progression to chronic lymphedema without intervention). Post hoc tests of significant interaction effects were conducted using Bonferroni‐corrected alphas of .008; otherwise, an alpha of .05 was used for statistical significance.ResultsThe sample (n = 918; TM = 457; BIS = 461) was female with a median age of 58.4 years. Factors associated with BCRL risk included axillary lymph node dissection (ALND) (p < .001), taxane‐based chemotherapy (p < .001), regional nodal irradiation (RNI) (p ≤ .001), body mass index >30 (p = .002), and rurality (p = .037). Mastectomy, age, hypertension, diabetes, seroma, smoking, and air travel were not associated with BCRL risk.ConclusionsWithin the context of 3 years of PSEI for subclinical lymphedema, variables of ALND, taxane‐based chemotherapy, RNI, body mass index >30, and rurality increased risk.

Abstract PS9-34: Initial experience using the SOZO bio-impedance device over a 2 year surveillance period for identifying subclinical breast cancer related lymphedema (BCRL) in patients attending a multidisciplinary breast clinic

Abstract Lymphedema is a leading posttreatment complication for many cancer patients. Roughly 1 of 3 women treated for breast cancer with surgery, radiation, or taxane based chemotherapy will develop chronic lymphedema. Lymphedema is characterized by buildup of lymphatic fluid that causes painful and debilitating tightness and swelling of the extremity with decreased range of motion and increased risk of infection. Unfortunately, it is rarely diagnosed until it has become symptomatic due to fibrotic changes and lipid deposition caused by protein rich extracellular fluid stasis. If the condition is diagnosed when it is preclinical, stage 0, it is reversible with outpatient intervention. Traditional screening methods for lymphedema include limb measurements with a tape measure or by volume displacement however, these techniques can be inaccurate and require significant volume change in the affected limb for detection. The SOZO is a relatively new device that uses noninvasive bioimpedance spectroscopy (BIS) which can detect fluid changes as small as 36 cc. This allows detection of lymphedema at the preclinical stage allowing early intervention with decompressive therapy and compression garments which can reduce the progression of lymphedema by 95%. We reviewed our initial 2-year experience using the SOZO device for lymphedema screening in our multidisciplinary breast clinic. Of the 239 patients who were seen in the multidisciplinary breast clinic, 160 patients had a baseline measurement prior to intervention and 128 of those patients had posttreatment measurements. Of those patients, 35 (27%) were referred for lymphedema therapy. Of those patients referred, 62% were stage 0, 28% were stage I, and 6% were stage II. One patient with stage 0 lymphedema at the initial postoperative measurement progressed to stage I but returned to baseline after treatment. None of the remaining stage 0 patients developed disease progression. Of the 10 patients that had developed stage I lymphedema at the time of their initial postoperative measurement, 6 were down staged to stage 0 after appropriate treatment, 2 continue to receive lymphedema therapy but have not progressed beyond stage I, and 2 were lost to follow-up. It is important to note that 30 of the 35 patients referred for lymphedema therapy were also referred to physical therapy or occupational therapy for functional impairments including decreased range of motion, axillary cording, and scar restriction. These early results showed that a surveillance program using the SOZO bioimpedance technology with pretreatment and posttreatment measurements allows early detection of breast cancer related lymphedema in the preclinical and early clinical stages when therapeutic intervention is most effective. Early stage lymphedema was also found to be associated with an increased incidence of functional impairment including decreased range of motion, axillary cording, and scar contracture. Evaluation for those impairments should be considered in all patients who develop lymphedema. Citation Format: Denise Pfeiffer, Meagan Lord, Caroline Lamb, Kristi Damrill, Katrina Stewart, David T Rock. Initial experience using the SOZO bio-impedance device over a 2 year surveillance period for identifying subclinical breast cancer related lymphedema (BCRL) in patients attending a multidisciplinary breast clinic [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS9-34.

Lymphedema in survivors of breast cancer.

The tremendous improvement of survival in patients with breast cancer can be attributed to several treatment strategies, but these strategies also lead to the occurrence of breast cancer-related lymphedema (BCRL). BRCL is regularly associated with factors such as axillary lymph node dissection and local lymph node radiotherapy and manifests as an increase of >10% in the volume of affected limbs. Being overweight or having obesity (body mass index ≥25 kg/m2), an excessive number of positive lymph nodes (>8) and capsular invasion by a tumor are additional risk factors for lymphedema. It is worth assessing the risk before surgery as this can prevent the occurrence of BCRL at the initial stage of breast cancer management. The clinical utility of many diagnostic tools and lymphedema surveillance allows early stage and even subclinical BCRL to be diagnosed, and allows real-time monitoring of the disease. The early diagnosis of BRCL allows treatment at an early stage, which is beneficial to the reduction of excess limb volume and the improvement of quality of life. At present, the major therapeutic methods of BCRL include complex decongestive therapy, pneumatic compression devices, participating in exercise, microsurgery and liposuction, each of which alleviates lymphedema effectively. No medications for treatment of BRCL have yet been developed. However, the recent findings on the success of molecular therapy in animal models may remedy this deficiency. Furthermore, the volume reduction of swollen limbs without swelling rebound by transplanting autologous stem cells has been successfully reported in some pilot studies, which may provide a new technique for treating BCRL. This review aimed to discuss the pathogenesis, clinical manifestation, risk factors, advantages and disadvantages of diagnostic tools, lymphedema surveillance and the characteristics of traditional and newly emerging BCRL treatments.

Abstract P6-12-03: Utilization of bioimpedance spectroscopy in the prevention of chronic breast cancer related lymphedema

Abstract Background: With improved breast cancer outcomes, an increasing focus on sequelae of treatment as part of survivorship has emerged. Breast cancer related lymphedema (BCRL) represents one such sequelae. Increasing data and recent NCCN guidelines support the use of prospective BCRL surveillance to allow for early detection and intervention as a method to reduce chronic, irreversible BCRL. Therefore, this study was performed to evaluate the impact early detection and treatment of BCRL in breast cancer patients undergoing prospective surveillance with bioimpedance spectroscopy (BIS). Methods: From 8/2010 through 12/2016, 206 patients were evaluated with BIS as part of a prospective surveillance program.The protocol included pre-operative assessment with BIS as well as post-operative assessments with BIS at regular intervals. Patients with L-Dex readings increasing by more than 10 from baseline were considered to have subclinical BCRL and treated with a compression sleeve for 4 weeks. For the purpose of this analysis, high-risk was defined as receipt of ALND, regional nodal irradiation, or taxane chemotherapy. Chronic BCRL was defined as the need for complex decongestive physiotherapy. Results: A total of 206 patients were analyzed, with a mean age of 61 years old and a median follow up of 25.9 months. Overall, 17% of patients had least one high-risk feature, 8% had two factors, and 7% had all three factors. A total of 21 patients (9.8%) were diagnosed with subclinical BCRL. Increased rates of subclinical BCRL were seen in patients undergoing ALND (23% vs. 7%, p=0.01) with ALND and receipt of RNI associated with development of subclinical BCRL. At last follow-up, no patients had persistent, chronic BCRL following early, conservative intervention measures. Conclusions: The results of this study support prospective surveillance and early treatment utilizing BIS. Intervention triggered by subclinical BCRL detection with an elevated L-Dex score was associated with a very low rate of chronic BCRL. Citation Format: Kaufman D, Shah C, Vicini F. Utilization of bioimpedance spectroscopy in the prevention of chronic breast cancer related lymphedema [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-12-03.

Abstract P3-14-09: Low rates of chronic breast cancer related lymphedema (BCRL) in a cohort of high-Risk patients undergoing prospective surveillance with bioimpedance spectroscopy (BIS)

Abstract Background: We report outcomes using prospective BIS surveillance in a high-risk cohort of patients who all underwent axillary lymph node dissection (ALND). Methods: From 8/2010 through 12/2016, 206 consecutive patients were evaluated with BIS as part of a prospective surveillance program. 30 underwent ALND and constitute the study population. The program included pre-operative BIS measurement as well as post-operative assessments at regular intervals. Patients with L-Dex readings increasing by more than 10 from baseline were considered to have subclinical BCRL and treated with an over-the-counter (OTC) compression sleeve for 4 weeks. For the purpose of this analysis, additional high-risk features were defined as receipt of axillary radiation, a high body mass index (BMI) or the use of taxane based chemotherapy. Chronic BCRL was defined as the need for complex decongestive physiotherapy (CDP). Results: Median follow-up was 36 months (range: 4.8-122.1 months). The median number of nodes removed was 18 (range: 5-32) and the median number of positive nodes was two. The median age for the cohort was 57.5 years old with 70% of patients undergoing mastectomy and the remainder breast conserving therapy. With respect to additional high-risk features, 77% also received taxane-based chemotherapy, 62% axillary irradiation, and 48% had an elevated BMI. Overall, 86% of patients had at least one additional high-risk feature, 70% at least two, and 23% had all three additional high-risk features. Seven patients (23%) had an elevated L-Dex score at some point during follow-up and underwent intervention with an OTC sleeve for 4 weeks. To date, no patients have required CDP at any time. Conclusions: Prospective surveillance with BIS in a high-risk cohort of patients all undergoing ALND (plus additional high-risk features) led to no patients requiring CDP. These excellent findings are consistent with growing data supporting the use of BIS in prospective BCRL surveillance programs. Citation Format: Kaufman D, Shah C, Vicini F. Low rates of chronic breast cancer related lymphedema (BCRL) in a cohort of high-Risk patients undergoing prospective surveillance with bioimpedance spectroscopy (BIS) [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-14-09.

Abstract P3-14-08: The impact of a structured surveillance protocol using bioimpedance spectroscopy (BIS) on preventing breast cancer related lymphedema (BCRL) in high-Risk patients

Abstract Background: We evaluated the impact of structured surveillance using bioimpedance spectroscopy (BIS) to prevent clinical BCRL in a group of high-risk (axillary lymph node dissection) patients. Methods: From April 2010 through November 2016, 93 patients who were treated with axillary lymph node dissection (ALND) were prospectively monitored with BIS using L-Dex (Impedimed). Patients received a pre-operative baseline L-Dex measurement followed by post-operative assessments at regular intervals. An elevated L-Dex score was defined as an increase of ≥10 points above baseline (considered subclinical BCRL). Intervention 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 was 24 months (range: 0.3-206.4 months). The median number of nodes removed was 19 (range: 5-41) and the median number of positive nodes was 3. Median age was 53 years old. Eighty five percent of patients underwent mastectomy and the remainder breast conserving therapy. 55% of patients received taxane based chemotherapy, 24% received some form of axillary RT (15% high tangents and 9% comprehensive regional nodal RT) and 74% had an elevated body mass index (BMI, &amp;gt; 25). Overall, 75% of these patients had at least one additional high-risk feature, 48% had at least two, and 6% had 3 (either taxane chemotherapy, axillary RT or elevated BMI). Thirty-three patients (35.4%) developed an elevated L-Dex score at some point during follow up. Overall, 10 patients (11%) required CDP at any point after treatment. Conclusions: The results of this analysis support previously published data on the efficacy of prospective BCRL surveillance and early intervention using BIS. Of the 93 high-risk patients prospectively followed and managed in this structured BCRL protocol, 11% required CDP. These results compare favorably to all contemporary studies reporting BCRL rates in high-risk patients. Citation Format: Whitworth P, Cooper A, Shah C, Vicini F. The impact of a structured surveillance protocol using bioimpedance spectroscopy (BIS) on preventing breast cancer related lymphedema (BCRL) in high-Risk patients [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-14-08.

Utilization of bioimpedance spectroscopy in the prevention of chronic breast cancer-related lymphedema

BackgroundThis analysis was performed to assess the impact of early intervention following prospective surveillance using bioimpedance spectroscopy (BIS) to detect and manage breast cancer-related lymphedema (BCRL).MethodsFrom 8/2010 to 12/2016, 206 consecutive patients were evaluated with BIS. The protocol included pre-operative assessment with L-Dex as well as post-operative assessments at regular intervals. Patients with L-Dex scores >10 from baseline were considered to have subclinical BCRL and were treated with over-the-counter (OTC) compression sleeve for 4 weeks. High-risk patients were defined as undergoing axillary lymph node dissection (ALND), receiving regional nodal irradiation (RNI), or taxane chemotherapy. Chronic BCRL was defined as the need for complex decongestive physiotherapy (CDP).ResultsMedian follow-up was 25.9 months. Overall, 17% of patients had one high-risk feature, 8% two, and 7% had three. 9.8% of patients were diagnosed with subclinical BCRL with highest rates seen following ALND (23 vs. 7%, p = 0.01). Development of subclinical BCRL was associated with ALND and receipt of RNI. At last follow-up, no patients (0%) developed chronic, clinically detectable, BCRL. Subset analysis was performed of the 30 patients undergoing ALND. Median number of nodes removed was 18 and median number of positive nodes was 2. 77% received taxane chemotherapy, 62% axillary RT, and 48% had elevated BMI. Overall, 86% of patients had at least one additional high-risk feature, 70% at least two, and 23% had all three. Seven patients (23%) had abnormally elevated L-Dex scores at some point during follow-up. To date, none has required CDP.ConclusionsThe results of this study support prospective surveillance utilizing BIS initiated pre-operatively with subsequent post-operative follow-up measurements for the detection of subclinical BCRL. Intervention triggered by subclinical BCRL detection with an elevated L-Dex score was associated with no cases progressing to chronic, clinically detectable BCRL even in very high-risk patients.

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

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 &lt; 0.001), taxanes (p = 0.008), and (regional nodal irradiation (RNI) (p &lt; 0.001) associated. At last follow-up, only 18 patients (3%) had unresolved clinically significant BCRL requiring CDP. Mastectomy (p = 0.02), ALND (p &lt; 0.001), taxanes (p = 0.05), and RNI (p &lt; 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.

The Impact of L-Dex® Measurements in Assessing Breast Cancer-Related Lymphedema as Part of Routine Clinical Practice

With improved survivorship, the prevalence of breast cancer-related lymphedema (BCRL) continues to increase, leading to impairment of a patients' quality of life. While traditional diagnostic methods are limited by an inability to detect BCRL until clinically apparent, bioimpedance spectroscopy (BIS) has been shown to detect subclinical BCRL. The purpose of this study is to evaluate the role of BIS in the early detection of BCRL, as well as assessment of response to BCRL treatment. A retrospective review of 1,133 patients treated between November 2008 and July 2013 at two surgical practices was performed. Eligible patients (n = 326) underwent preoperative and postoperative L-Dex measurements. Patients were identified as having subclinical lymphedema if they were asymptomatic and the L-Dex score increased >10 U above baseline and were monitored following treatment. Patients were stratified by lymph node dissection technique [sentinel lymph node biopsy (SLNB) vs. axillary lymph node dissection (ALND)] and receipt of BCRL treatment. The average age of the cohort was 56.2 years old, and mean follow-up was 21.7 months. Of the 326 patients, 210 underwent SLNB and 116 underwent ALND. BCRL was identified by L-Dex in 40 patients (12.3%). The cumulative incidence rate of subclinical lymphedema was 4.3% for SLNB (n = 9) and 26.7% for ALND (n = 31). Of those diagnosed with BCRL, 50% resolved following treatment, 27.5% underwent treatment without resolution, and 22.5% had resolution without treatment. The prevalence of persistent, clinical BCRL was 0.5% for SLNB and 8.6% for ALND. This study demonstrates both the feasibility and clinical utility of implementing L-Dex measurements in routine breast cancer care. L-Dex identified patients with possible subclinical BCRL and allowed for assessment of response to therapy.

Bioimpedance spectroscopy for lymphedema assessment: Clinical practice guidelines.

146 Background: Breast cancer related lymphedema (BCRL) is an increasingly diagnosed complication of breast cancer treatment with incidence rates of 5% with lumpectomy alone to more than 40% with mastectomy, axillary dissection, and radiation therapy. Increasing data supports the role of early detection and treatment with one diagnostic modality being bioimpedance spectroscopy (BIS) with L-Dex measurements. Methods: A systematic review of the National Library of Medicine’s PubMed search was performed for articles applicable to BIS and BCRL. Clinical guidelines were created by the authors based on published data and consensus agreement. Results: At this time, multiple randomized and prospective trials have been performed evaluating early detection for BCRL and have demonstrated reduced rates of BCRL with such an approach. BIS with L-Dex represents a technique with published literature supporting increased sensitivity, ability to detect subclinical BCRL and standardized clinical decision points, an improvement from traditional BCRL diagnostics. BCRL surveillance programs should focus on high-risk patients including those undergoing mastectomy, axillary lymph node dissection, sentinel node biopsy with greater than 6 nodes sampled, regional nodal irradiation, and those requiring taxane based chemotherapy. Patients should undergo assessment prior to locoregional therapy and then every 3 months for the first 3 years with additional measurements made based on clinical assessment. A change in L-Dex of 10 has been utilized has a consistent trigger to initiate BCRL treatment. Conclusions: With increasing data supporting early diagnosis and treatment of BCRL, these guidelines offer clinicians a tool to help develop BCRL surveillance programs as part of routine breast cancer care.

Segmental Limb Volume Change as a Predictor of the Onset of Lymphedema in Women With Early Breast Cancer

To demonstrate that segmental changes along the upper extremity occur before the onset of breast cancer-related lymphedema (BCRL). These changes may be subclinical in nature and may be predictive of the onset of chronic lymphedema. A retrospective subset analysis of a larger prospective cohort trial. PATIENT COHORT: A total of 196 patients provided consent and were enrolled in the prospective study. Subclinical lymphedema developed in 46 of these patients. Limb volume data were available for 45 of these 46 patients from visits before the onset of lymphedema and were used in this analysis. We compared this group with an age-matched control group without BCRL from the same cohort (n = 45). Military hospital outpatient breast care center. Women were enrolled and assessed preoperatively. Baseline measures of limb volume were obtained with the use of optoelectronic perometry, and reassessment was conducted at 1, 3, 6, 9, and 12 months postoperatively. BCRL was identified in 46 of 196 women at an average of 6.9 months postoperatively. A retrospective analysis was conducted in which we examined volume changes over four 10-cm segments of the limb at the visits before the onset of BCRL. By using repeated-measures multivariate analysis of variance, we compared segmental volumes between groups at preoperative baseline, time of diagnosis of BCRL, and time of follow-up after early intervention. Linear regression analysis was performed to determine the strength of the relationship between total limb volume change with segmental volumes at the time of diagnosis of BCRL. We hypothesized that segmental volume changes occur and can be measured in the limb before the onset of lymphedema. At arm segments 10-20 cm (P = .044) and 20-30 cm (P <.001), a significant volume increase was noted before the diagnosis of subclinical BCRL. Segmental volume changes correlated to the total limb volume (TLV) change. At segments 20-30 cm, the coefficient of determination was r(2) = 0.952, and at 10-20 cm it was r(2) = 0.845, suggesting that these segments predicted TLV changes. Serial interval assessment of limb volume segments may be an important clinical tool to detect early-onset lymphedema before TLV changes.