Tissue Dielectric Constant Measures in Women With and Without Clinical Trunk Lymphedema Following Breast Cancer Surgery: A 78-Week Longitudinal Study

Abstract

Objective Following breast cancer surgery with lymph node removal, women are at risk of developing lymphedema in the upper extremity or trunk. Currently, trunk lymphedema diagnosis relies on a clinical assessment because no quantifiable standard method exists. Tissue dielectric constant (TDC) values are quantifiable measures of localized skin tissue water and may be able to detect trunk lymphedema. The goal of this study was to (1) compare parameters derived from TDC measurements with those derived from clinically accepted criteria for trunk lymphedema in women following breast cancer surgery and (2) explore the potential utility of TDC to detect trunk lymphedema early in its progression. Methods This prospective longitudinal study, a secondary analysis from a larger study, observed women with and without clinically determined truncal lymphedema following breast cancer surgery. TDC was measured on the lateral trunk wall at post-surgery weeks 2, 4, 12, and 78 in women who had surgical breast cancer treatment with lymph node removal. Clinical assessment for trunk lymphedema was determined at 78 weeks by a lymphedema expert. Comparison of TDC measurements in women with and without clinical trunk lymphedema was analyzed. Results Clinical assessment identified trunk lymphedema in 15 out of 32 women at 78 weeks. These women had TDC ratios statistically higher than women without truncal lymphedema. Conclusion The overall findings indicate that TDC has the ability to quantify trunk lymphedema and might be valuable in early detection. Impact TDC may be a beneficial tool in the early detection of breast cancer related trunk lymphedema which could trigger intervention.

Measuring Breast Cancer-Related Lymphedema

“…To assess edema or lymphedema, it's use is based on the fact that its value strongly depends on tissue water content (86)(87)(88). In contrast to lymphedema assessment methods useful only for limbs, TDC measurements are localized and usable to measure skin water or skin-to-fat water at most anatomical sites including breast (20,89) and trunk (9,90). Tissue dielectric properties are dependent on their water content and use of the Debye relationship can describe frequency dependence of tissue dielectric properties (91,92).…”

“…These normal biological variations do not importantly impact TDC use as a lymphedema assessment method because of various normalization processes. For unilateral BCRL, inter-arm (107,108) or inter-trunk (9,10) or inter-breast (20,109) ratios are used with the added advantage that specific localized targets can be tracked. The method permits assessing head-and-neck-related lymphedema (110) and lower extremity lymphedema (111,112) based on individualized inter-site normalizations.…”

Biology of Lymphedema

“…As described above, the main aim and, therefore, outcome parameter of CDT is the reduction of overall volume and circumference of the affected part of the body, accompanied by improvements of functionality and quality of life. Several studies compare volume and circumference changes before and after different forms of therapy [ 114 , 123 ], with different durations reaching from six days intensive therapy [ 124 ] up to several months of treatment [ 70 , 125 , 126 ]. Water displacement [ 127 ], perometry [ 128 ], and tape measurement of the limb circumference [ 129 ] are the standard methods for these assessments.…”

Breast edema, from diagnosis to treatment: state of the art

“…A more technical assessment that can be performed is the assessment of TDC. TDC ratios have been demonstrated as prognostic in the presence of edema [ 32 , 53 , 54 ]. In patients with bilateral edema, no TDC ratios can be calculated.…”