Andrea V Barrio1,2, Anne Eaton3, Thomas G Frazier4. 1. Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA. barrioa@mskcc.org. 2. Department of Surgery, The Bryn Mawr Hospital, Bryn Mawr, PA, USA. barrioa@mskcc.org. 3. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA. 4. Department of Surgery, The Bryn Mawr Hospital, Bryn Mawr, PA, USA.
Abstract
BACKGROUND: Although volume displacement (VD) is considered the gold standard for diagnosing breast cancer-related lymphedema, it is inconvenient. We compared bioimpedance (L-Dex) and VD measurements in a prospective cohort of breast cancer patients at risk for lymphedema. METHODS: Between 2010 and 2014, a total of 223 breast cancer patients were enrolled. Following exclusions (n = 37), 186 received baseline VD and L-Dex; follow-up measurements were performed at 3-6 months intervals for 3 years. At each visit, patients fitted into one of three categories: normal (normal VD and L-Dex); abnormal L-Dex (L-Dex > 10 or increase in 10 from baseline and normal VD); or lymphedema (relative arm volume difference of >10 % by VD ± abnormal L-Dex). Change in L-Dex was plotted against change in VD; correlation was assessed using the Pearson correlation. RESULTS: At a median follow-up of 18.2 months, 152 patients were normal, 25 had an abnormal L-Dex, and 9 developed lymphedema without a prior L-Dex abnormality. Of the 25 abnormal L-Dex patients, 4 progressed to lymphedema, for a total of 13 patients with lymphedema. Evaluating all time points, 186 patients had 829 follow-up measurements. Sensitivity and specificity of L-Dex compared with VD were 75 and 93 %, respectively. There was no correlation between change in VD and change in L-Dex at 3 months (r = 0.31) or 6 months (r = 0.21). CONCLUSIONS: VD and bioimpedance demonstrated poor correlation with inconsistent overlap of measurements considered abnormal. Of patients with an abnormal L-Dex, few progressed to lymphedema; most patients with lymphedema did not have a prior L-Dex abnormality. Further studies are needed to understand the clinical significance of bioimpedance.
BACKGROUND: Although volume displacement (VD) is considered the gold standard for diagnosing breast cancer-related lymphedema, it is inconvenient. We compared bioimpedance (L-Dex) and VD measurements in a prospective cohort of breast cancerpatients at risk for lymphedema. METHODS: Between 2010 and 2014, a total of 223 breast cancerpatients were enrolled. Following exclusions (n = 37), 186 received baseline VD and L-Dex; follow-up measurements were performed at 3-6 months intervals for 3 years. At each visit, patients fitted into one of three categories: normal (normal VD and L-Dex); abnormal L-Dex (L-Dex > 10 or increase in 10 from baseline and normal VD); or lymphedema (relative arm volume difference of >10 % by VD ± abnormal L-Dex). Change in L-Dex was plotted against change in VD; correlation was assessed using the Pearson correlation. RESULTS: At a median follow-up of 18.2 months, 152 patients were normal, 25 had an abnormal L-Dex, and 9 developed lymphedema without a prior L-Dex abnormality. Of the 25 abnormal L-Dexpatients, 4 progressed to lymphedema, for a total of 13 patients with lymphedema. Evaluating all time points, 186 patients had 829 follow-up measurements. Sensitivity and specificity of L-Dex compared with VD were 75 and 93 %, respectively. There was no correlation between change in VD and change in L-Dex at 3 months (r = 0.31) or 6 months (r = 0.21). CONCLUSIONS: VD and bioimpedance demonstrated poor correlation with inconsistent overlap of measurements considered abnormal. Of patients with an abnormal L-Dex, few progressed to lymphedema; most patients with lymphedema did not have a prior L-Dex abnormality. Further studies are needed to understand the clinical significance of bioimpedance.
Authors: Rebecca J Tsai; Leslie K Dennis; Charles F Lynch; Linda G Snetselaar; Gideon K D Zamba; Carol Scott-Conner Journal: Ann Surg Oncol Date: 2009-04-14 Impact factor: 5.344
Authors: Sandra C Hayes; Rebecca M Speck; Elizabeth Reimet; Azadeh Stark; Kathryn H Schmitz Journal: Breast Cancer Res Treat Date: 2011-05-12 Impact factor: 4.872
Authors: M R Fu; C M Cleland; A A Guth; M Kayal; J Haber; F Cartwright; R Kleinman; Y Kang; J Scagliola; D Axelrod Journal: Lymphology Date: 2013-06 Impact factor: 1.286
Authors: Armando E Giuliano; Kelly K Hunt; Karla V Ballman; Peter D Beitsch; Pat W Whitworth; Peter W Blumencranz; A Marilyn Leitch; Sukamal Saha; Linda M McCall; Monica Morrow Journal: JAMA Date: 2011-02-09 Impact factor: 56.272
Authors: Ya-Chen Tina Shih; Ying Xu; Janice N Cormier; Sharon Giordano; Sheila H Ridner; Thomas A Buchholz; George H Perkins; Linda S Elting Journal: J Clin Oncol Date: 2009-03-16 Impact factor: 44.544
Authors: Lynn T Dengel; Kimberly J Van Zee; Tari A King; Michelle Stempel; Hiram S Cody; Mahmoud El-Tamer; Mary L Gemignani; Lisa M Sclafani; Virgilio S Sacchini; Alexandra S Heerdt; George Plitas; Manuela Junqueira; Deborah Capko; Sujata Patil; Monica Morrow Journal: Ann Surg Oncol Date: 2013-08-22 Impact factor: 5.344
Authors: Lauren M Havens; Cheryl L Brunelle; Tessa C Gillespie; Madison Bernstein; Loryn K Bucci; Yara W Kassamani; Alphonse G Taghian Journal: Mhealth Date: 2021-01-20
Authors: Melissa B Aldrich; John C Rasmussen; Sarah M DeSnyder; Wendy A Woodward; Wenyaw Chan; Eva M Sevick-Muraca; Elizabeth A Mittendorf; Benjamin D Smith; Michael C Stauder; Eric A Strom; George H Perkins; Karen E Hoffman; Melissa P Mitchell; Carlos H Barcenas; Lynn E Isales; Simona F Shaitelman Journal: Breast Cancer Res Treat Date: 2022-07-10 Impact factor: 4.624
Authors: Anna Janssen; Candice Donnelly; Judy Kay; Peter Thiem; Aldo Saavedra; Nirmala Pathmanathan; Elisabeth Elder; Phuong Dinh; Masrura Kabir; Kirsten Jackson; Paul Harnett; Tim Shaw Journal: J Med Internet Res Date: 2020-04-21 Impact factor: 5.428
Authors: Sandra Russo; Joan L Walker; Jay W Carlson; Jeanne Carter; Leigh C Ward; Allan Covens; Edward J Tanner; Jane M Armer; Sheila Ridner; Sandi Hayes; Alphonse G Taghian; Cheryl Brunelle; Micael Lopez-Acevedo; Brittany A Davidson; Mark V Schaverien; Sharad A Ghamande; Michael Bernas; Andrea L Cheville; Kathleen J Yost; Kathryn Schmitz; Barbara Coyle; Jeannette Zucker; Danielle Enserro; Stephanie Pugh; Electra D Paskett; Leslie Ford; Worta McCaskill-Stevens Journal: Gynecol Oncol Date: 2020-11-04 Impact factor: 5.482
Authors: Sheila H Ridner; Mary S Dietrich; Michael S Cowher; Bret Taback; Sarah McLaughlin; Nicolas Ajkay; John Boyages; Louise Koelmeyer; Sarah M DeSnyder; Jamie Wagner; Vandana Abramson; Andrew Moore; Chirag Shah Journal: Ann Surg Oncol Date: 2019-05-03 Impact factor: 5.344
Authors: Chirag Shah; April Zambelli-Weiner; Nicole Delgado; Ashley Sier; Robert Bauserman; Jerrod Nelms Journal: Breast Cancer Res Treat Date: 2020-11-27 Impact factor: 4.872