The impact of monitoring techniques on progression to chronic breast cancer-related lymphedema: a meta-analysis comparing bioimpedance spectroscopy versus circumferential measurements

Abstract

Background Chronic breast cancer-related lymphedema (BCRL) is a potentially serious complication following treatment. Monitoring for progression to BCRL may allow for earlier detection and intervention, reducing the rate of progression to chronic BCRL. Therefore, the purpose of this meta-analysis is to evaluate the impact of monitoring techniques on the incidence of chronic BCRL among patients monitored by bioimpedance spectroscopy (BIS) and circumference as compared to background rates. Methods Eligible peer-reviewed studies from PubMed, CINHAL, or Google Scholar that were published in English from 2013 onward and conducted in North America, Europe, or Oceania. Incidence rates abstracted from studies were classified by BCRL monitoring method: background (no standardized BIS or circumference assessments), BIS or circumference. A random-effects model was used to calculate a pooled annualized estimate of BCRL incidence while accounting for clinical and methodological heterogeneity. Subgroup analyses examined differences in duration of follow-up as well as breast and axillary surgery. Results 50 studies were included, representing over 67,000 women. The annualized incidence of BCRL was 4.9% (95% CI: 4.3–5.5) for background studies (n = 35), 1.5% (95% CI: 0.6–2.4) for BIS-monitored studies (n = 7), and 7.7% (95% CI: 5.6–9.8) for circumference-monitored studies (n = 11). The cumulative BCRL incidence rate in BIS-monitored patients was 3.1% as compared to 12.9% with background monitoring (69% reduction) and 17.0% with circumference-monitored patients (81% reduction). Conclusions Evidence suggests that monitoring with BIS allowing for early intervention significantly reduces the relative risk of chronic BCRL with a 69% and 81% reduction compared to background and circumference, respectively. Circumference monitoring did not appear to provide a benefit with respect to chronic BCRL incidence. Based on these results, BIS should be considered for BCRL screening in order to detect subclinical BCRL and reduce rates of chronic BCRL, particularly in high-risk patients.

A Randomized Clinical Trial of Bioimpedance Spectroscopy or Tape Measure Triggered Compression Intervention in Chronic Breast Cancer Lymphedema Prevention

“…Our findings are consistent with previous prospective studies which found that use of BIS as part of prospective surveillance resulted in a persistent C-BCRL rate of only 6%. 26 The final results of the study, confirm the significantly lower rates of trigger with BIS as compared to TM (20.7% vs 27.5%, P=.011) as seen at the interim analysis. 28,29,30 Critical knowledge to inform the optimal method of prospective surveillance was also generated in this study.…”

“…12,25 This is supported by a metaanalysis of more than 67,000 women and 50 studies that found that use of BIS reduced annualized and cumulative incidence of C-BCRL as compared to TM or background studies, though not controlling for intervention protocols as the current study did. 26 These consistent significant findings are likely related to the ability of BIS to detect an increase in extracellular fluid, as opposed to TM's ability to only detect an increase in whole arm volume. Thus, BIS serves as a better screening method to determine who will best benefit from a prevention intervention and achieve reversal of the S-BCRL process that can lead to C-BCRL.…”

Prospective Surveillance for Breast Cancer–Related Arm Lymphedema: A Systematic Review and Meta-Analysis

“…This stands in contrast to findings from a recent systematic review supporting the use of BIS (81% reduction in risk of chronic BCRaL compared with surveillance programs using circumference measurements). 53 However, this review had considerable methodologic limitations, and conclusions were not supported by the data presented. 54,55 Conversely, our results do not lend support for the superiority of BIS over other measurement methods but instead highlight the need for consensus on BCRaL assessment and associated criteria.…”

“…BIS was the most frequently used measurement method and is considered to be well suited for early diagnosis of BCRaL. 53 However, six different diagnostic criteria for triggering intervention were applied. The general notion is that a lower criterion (eg, increase of two SD instead of three SD) is preferred as it provides better sensitivity to detect BCRaL.…”

Novel Wireless Bioimpedance Device for Segmental Lymphedema Analysis Post Dual-Site Free Vascularized Lymph Node Transfer: A Prospective Cohort Study

“…The accuracy of bioimpedance remains contentious in the screening of lymphedema [12,14,[28][29][30][31][32][33][34][35]. Previous studies demonstrated a low sensitivity (7.5-64%) of BIS in diagnosing breast cancer-related lymphedema [12,14,34,35], which was associated with 61-71% of positive predictive value and 67-70% of negative predictive value [35].…”