Early Diagnosis of Lymphedema in Postsurgery Breast Cancer Patients

Abstract

Lymphedema is an accumulation of lymph fluid in the limb resulting from an insufficiency of the lymphatic system. It is commonly associated with surgical or radiotherapy treatment for breast cancer. As with many progressively debilitating disorders, the effectiveness of treatment is significantly improved by earlier intervention. Multiple frequency bioelectrical impedance analysis (MFBIA) previously was shown to provide accurate relative measures of lymphedema in the upper limb in patients after treatment for breast cancer. This presentation reports progress to date on a three‐year prospective study to evaluate the efficacy of MFBIA to predict the early onset of lymphedema in breast cancer patients following treatment. Bioelectrical impedance measurements of each upper limb were recorded in a group of healthy control subjects (n= 50) to determine the ratio of extracellular limb‐fluid volumes. From this population, the expected normal range of asymmetry (99.7% confidence) between the limbs was determined. Patients undergoing surgery to treat breast cancer were recruited into the study, and MFBIA measurements were recorded presurgery, at one month and three months after surgery, and then at two‐month intervals for up to 24 months postsurgery. When patients had an MFBIA measure outside the 99.7% range of the control group, they were referred to their physician for clinical assessment. Results to date: Over 100 patients were recruited into the study over the past two years; at present, 19 have developed lymphedema and, of these, 12 are receiving treatment. In each of these 19 cases, MFBIA predicted the onset of the condition up to four months before it could be clinically diagnosed. The false‐negative rate currently is zero. The study will continue to monitor patients over the remaining year to accurately ascertain estimates of specificity and sensitivity of the procedure.

Segmental measurement of breast cancer-related arm lymphoedema using perometry and bioimpedance spectroscopy

“…Across segments for both devices, there was a significant linear component to the change in inter-limb segment ratios (F (1, 28) =11.97, p=0.002) and a significant quadratic component (F (1,28) =10.50, p=0.003). This supports visual inspection of the data in Fig.…”

Improving the physical status and quality of life of women treated for breast cancer: A pilot study of a structured exercise intervention

“…The difference in the SOC was determined by taking the SOC of the untreated side from the SOC of the treated side. The use of multifrequency bioelectrical impedance (MF-BIA) was considered the primary measure for the presence of lymphoedema as it has been shown to have an initial false-positive rate of zero [20,21]. This method calculates the ratio of the resistance provided to different frequencies of an electrical current by the extracellular and intracellular fluid of the treated arm and untreated arm.…”

Early Diagnosis of Lymphedema after Breast Cancer Treatment: Bio-Impedance Spectroscopy

“…BIS offers the advantage of identifying lymphedema as early as 4 months in advance as it provides more precise and standardized measurements as compared to conventional measurement methods (7,10). This way, it may become possible to reduce long-term morbidity related to lymphedema.…”

“…Only this can make it possible to keep lymphedema under control before it results in sequelae, fibrosis and limitation (7,10). From an economic point of view, the treatments and preventive services provided when lymphedema is at earlier stages (bandage, massage, exercise) are both more cost-efficient and promising in terms of treatment efficacy as compared to the treatment methods applied when advanced lymphedema develops (pumps applying pressurized massage, surgical procedures) (5, 9, 10).…”

“…For that reason, it is of critical importance to recognize the group of patients that may develop lymphedema in advance. The method of bio-impedance spectroscopy (BIS) developed by Cornish et al (7) in recent years enables precise measurement of any changes in the extracellular fluid and numerical assessment of the difference between the arms through a direct measurement of the electrical resistance of the extracellular fluid in the soft tissue of the arm, thereby making it possible to make a diagnosis of lymphedema before clinical signs occur, which are expressed as Stage 0. It has been reported that objective comparison can be made at follow-ups and the patients' clinical progress can be monitored by performing regular measurements and analyzing the numerical values obtained (7)(8)(9)(10)(11).…”