Spatial and Temporal Variability of Upper Extremity Edema Measures After Breast Cancer Surgery

Abstract

Background: Tissue dielectric constant (TDC), as an index of local tissue water, and girth measurements are quantitative methods to measure and characterize lymphedema. Objective: To describe the spatial and temporal variability in arm girth and TDC values in women surgically treated for breast cancer and to describe the relationship between these measures. Methods and Results: This was a prospective longitudinal study that observed 36 women for 78 weeks after breast cancer surgery with lymph node removal. Arm circumferences and TDC values, as indices of local tissue water, were measured on both arms at multiple sites at postsurgery weeks 2, 4, 12, and 78 in women undergoing surgical breast cancer treatment with one or more axillary lymph nodes removed. TDC and girth values remained relatively uniform from visit-to-visit for both at-risk and contralateral control arms with no overall statistically significant difference in values ( p > 0.05). There was a strong inverse correlation between arm girth and the TDC value in both the at-risk and control arms ( p < 0.001). Overall, there was no statistically significant difference in TDC interarm ratios among visits or anatomical sites. TDC values for at-risk and control arms tended to significantly decrease with increasing distance from the wrist ( p < 0.001). Conclusion: TDC arm values and girth measures remained relatively uniform in women after breast cancer surgery. The fact that TDC values are higher distally than proximally provides new information from which TDC measurements may be interpreted and also provides a better understanding of arm spatial variability in relation to girth measures.

Heat‐related changes in skin tissue dielectric constant (TDC)

“…Prior reports have indicated that tissue dielectric constant (TDC) measurements, the values of which are highly dependent on local tissue fluid content (Aimoto & Matsumoto, ; Gabriel et al , ; Alanen et al , ; Nuutinen et al , ), are useful to detect (Mayrovitz, ; Mayrovitz et al , ; Mayrovitz et al , ), assess (Mayrovitz et al , ; Mayrovitz, ; Mayrovitz & Davey, ) and characterize (Mayrovitz et al , ; Koehler & Mayrovitz, ; Mayrovitz & Weingrad, ) breast cancer treatment‐related lymphoedema (BCRL) that is manifest in upper limbs, breast and chest wall. TDC measurements have also proved useful to evaluate oedema and lymphoedema of lower limbs (Jensen et al , ; Birkballe et al , ; Mayrovitz et al , ).…”

Noninvasive Measurements of Breast Cancer-Related Lymphedema

“…Increased fat with increasing depth tends to lower the TDC value due to the low water content of fat [42]. Variations in TDC values are also expected based on sex, age, body habitus, and at different anatomical sites along the arm [40,[42][43][44]. These normal biological variations do not importantly impact TDC use as a lymphedema assessment method because of various normalization processes.…”

Diagnostic workup of lymphedema

“…It takes no more than 10 s for each measurement point. TDC ratio (TDC affected/TDC unaffected) > 1.26 is considered suggestive of lymphedema by some [26] . It can be applied in virtually any areas, midline body regions included, for post-treatment monitoring and early detection.…”