Reducing chronic breast cancer related lymphedema utilizing a program of prospective surveillance with bioimpedance spectroscopy (BIS).

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 10117-10117 ◽  
Author(s):  
Pat W. Whitworth ◽  
Chirag Shah ◽  
Frank Vicini ◽  
Andrea Cooper
Keyword(s):  
Breast Cancer ◽  
Axillary Lymph ◽  
Bioimpedance Spectroscopy ◽  
Prospective Surveillance ◽  
Over The Counter ◽  
Breast Cancer Related Lymphedema ◽  
Clinically Significant ◽  
Prospective Monitoring

10117 Background: Breast cancer related lymphedema (BCRL) represents a major side effect that can significantly impact quality of life. Current guidelines support prospective surveillance to allow for early diagnosis and treatment of BCRL at a subclinical, reversible stage. This current large, single institution experience evaluated the use of bioimpedance spectroscopy (BIS) to monitor patients for the development and treatment of BCRL. Methods: From April 2010 through Nov 2016, 596 patients (79.6% with high-risk features) were evaluated with BIS.Patients received a pre-operative baseline L-Dex measurement and post-operatively at regular intervals. Elevated L-Dex scores were defined as an increase of ≥10 points above baseline (considered subclinical BCRL). Intervention then consisted of applying an over the counter (OTC) sleeve for 4 weeks followed by re-evaluation. The need for complete decongestive physiotherapy (CDP) represented a surrogate for the development of clinically significant, chronic BCRL. Results: Median follow-up for all patients was 17 months. Seventy-three patients (12%) developed an elevated L-Dex score with axillary lymph node dissection (ALND) (p < 0.001), taxanes (p = 0.008), and (regional nodal irradiation (RNI) (p < 0.001) associated. At last follow-up, only 18 patients (3%) had unresolved clinically significant BCRL requiring CDP. Mastectomy (p = 0.02), ALND (p < 0.001), taxanes (p = 0.05), and RNI (p < 0.001) were associated with requiring CDP. Conclusions: Our results demonstrate that prospective monitoring using BIS, with intervention (using a simple OTC sleeve for 4 weeks) triggered by a ≥10-point L-Dex elevation, resulted in only a 3% rate of chronic, clinically significant BCRL. These results are lower than reported in contemporary studies and validate recent guidelines supporting prospective screening and intervention for BCRL.

scholarly journals Quantifying the Impact of Axillary Surgery and Nodal Irradiation on Breast Cancer–Related Lymphedema and Local Tumor Control: Long-Term Results From a Prospective Screening Trial

2020 ◽  
Vol 38 (29) ◽  
pp. 3430-3438 ◽  
Author(s):  
George E. Naoum ◽  
Sacha Roberts ◽  
Cheryl L. Brunelle ◽  
Amy M. Shui ◽  
Laura Salama ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Locoregional Control ◽  
Long Term Results ◽  
Axillary Lymph ◽  
Axillary Surgery ◽  
Breast Cancer Related Lymphedema ◽  
The Impact ◽  
Screening Trial

PURPOSE To independently evaluate the impact of axillary surgery type and regional lymph node radiation (RLNR) on breast cancer–related lymphedema (BCRL) rates in patients with breast cancer. PATIENTS AND METHODS From 2005 to 2018, 1,815 patients with invasive breast cancer were enrolled in a lymphedema screening trial. Patients were divided into the following 4 groups according to axillary surgery approach: sentinel lymph node biopsy (SLNB) alone, SLNB+RLNR, axillary lymph node dissection (ALND) alone, and ALND+RLNR. A perometer was used to objectively assess limb volume. All patients received baseline preoperative and follow-up measurements after treatment. Lymphedema was defined as a ≥ 10% relative increase in arm volume arising > 3 months postoperatively. The primary end point was the BCRL rate across the groups. Secondary end points were 5-year locoregional control and disease-free-survival. RESULTS The cohort included 1,340 patients with SLNB alone, 121 with SLNB+RLNR, 91 with ALND alone, and 263 with ALND+RLNR. The overall median follow-up time after diagnosis was 52.7 months for the entire cohort. The 5-year cumulative incidence rates of BCRL were 30.1%, 24.9%, 10.7%, and 8.0% for ALND+RLNR, ALND alone, SLNB+RLNR, and SLNB alone, respectively. Multivariable Cox models adjusted for age, body mass index, surgery, and reconstruction type showed that the ALND-alone group had a significantly higher BCRL risk (hazard ratio [HR], 2.66; P = .02) compared with the SLNB+RLNR group. There was no significant difference in BCRL risk between the ALND+RLNR and ALND-alone groups (HR, 1.20; P = .49) and between the SLNB-alone and SLNB+RLNR groups (HR, 1.33; P = .44). The 5-year locoregional control rates were similar for the ALND+RLNR, ALND-alone, SLNB+RLNR, and SLNB-alone groups (2.8%, 3.8%, 0%, and 2.3%, respectively). CONCLUSION Although RLNR adds to the risk of lymphedema, the main risk factor is the type of axillary surgery used.

Prospective surveillance using l-dex monitoring results in significant reductions in the chronic rate of breast cancer related-lymphedema (BCRL) in high-risk breast cancer patients.

2017 ◽  
Vol 35 (5_suppl) ◽  
pp. 118-118
Author(s):  
Alison L. Laidley ◽  
Beth V. Anglin
Keyword(s):  
Breast Cancer ◽  
High Risk ◽  
Clinical Stage ◽  
Breast Cancer Patients ◽  
Prospective Surveillance ◽  
Complete Decongestive Therapy ◽  
Risk Patients ◽  
Breast Cancer Related Lymphedema ◽  
Stage 1

118 Background: Survivorship represents an increasing focus in the management of breast cancer with chronic toxicities including breast cancer-related lymphedema (BCRL). This study looked at prospective surveillance using bioimpedance spectroscopy (BIS) to reduce risks of chronic BCRL requiring referral for complete decongestive therapy (CDT). Methods: 132 patients at high-risk for the development of BCRL were prospectively followed using BIS with serial monitoring. This included a pre-operative baseline assessment and a minimum of two post-operative follow up assessments. Interventions were initiated when the L-Dex score increased by greater than 10 units from baseline and consisted of conservative treatment with a compression sleeve for four weeks. Patients were also clinically monitored for the development of BCRL. Results: Median follow-up was 19.3 months (range 4-54 mos). Of the 132 patients evaluated, 24 (18.1%) were subsequently diagnosed with elevated L-Dex scores and underwent intervention. Of the 24 that underwent treatment, 14 (58%) had resolution of their elevated L-Dex scores following four weeks of therapy with 10 having persistent elevations and clinical BCRL which necessitated referral to physical therapy for CDT. A further 7 subjects were diagnosed and not treated for elevated L-Dex scores, but had complete resolution (return to baseline) at last visit. At last follow-up, only 10 patients (7.6 %) had unresolved, clinical stage 1, BCRL. Conclusions: The use of L-Dex to prospectively follow our high-risk patients and prescribe intervention with a compression sleeve for 4 weeks when scores are elevated resulted in only a 7.6 % rate of stage 1, chronic BCRL. This rate of BCRL has been reported as 15-20%, suggesting that a prospective program of screening and intervention using L-Dex does result in clinically meaningful reductions in this long-term sequelae of treatment.

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

2020 ◽  
Author(s):  
Chirag Shah ◽  
April Zambelli-Weiner ◽  
Nicole Delgado ◽  
Ashley Sier ◽  
Robert Bauserman ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Meta Analysis ◽  
Incidence Rates ◽  
Bioimpedance Spectroscopy ◽  
Monitoring Method ◽  
Monitoring Techniques ◽  
Risk Patients ◽  
Breast Cancer Related Lymphedema ◽  
The Impact

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.

Use of bioimpedance spectroscopy for prospective surveillance and early diagnosis of breast cancer–related lymphedema

2021 ◽  
pp. 1-9
Author(s):  
Antonio J. Forte ◽  
Maria T. Huayllani ◽  
Daniel Boczar ◽  
Francisco R. Avila ◽  
Salam Kassis ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Early Diagnosis ◽  
English Language ◽  
Bioimpedance Analysis ◽  
Bioimpedance Spectroscopy ◽  
Prospective Surveillance ◽  
Cross Sectional ◽  
Ovid Medline ◽  
Language Studies ◽  
Breast Cancer Related Lymphedema

BACKGROUND: Bioimpedance spectroscopy has been suggested as a useful tool for early diagnosis of breast cancer–related lymphedema (BCRL). We aimed to describe the outcomes of published studies that evaluated bioimpedance analysis as a method for prospective surveillance and early diagnosis of BCRL. METHODS: We queried the PubMed, Ovid Medline, and EMBASE databases to identify studies that evaluated use of bioimpedance spectroscopy as a diagnostic tool. We used the keywords “bioimpedance” AND (“lymphedema” OR “lymphoedema”) in the search. Only English-language studies that reported quantitative outcomes for patients with BCRL were included. RESULTS: Of 152, 235 and 116 identified articles in PubMed, Ovid Medline and EMBASE databases, only 22 were included. Use of bioimpedance analysis for prospective surveillance has been shown to prevent chronic BCRL. All the cross-sectional and retrospective studies that evaluated bioimpedance for diagnosis of BCRL reported significantly different L-Dex scores between lymphedema patients and healthy participants; in addition, bioimpedance scores were positively correlated with volume of lymphedema. CONCLUSION: Bioimpedance analysis is a potential tool with demonstrated benefits for prevention of chronic BCRL and may be an economic and great alternative for early diagnosis of BCRL.

Long-term quality of life in patients with breast cancer according to sentinel lymph node biopsy or axillary lymph node dissection: A multicenter cohort study with 6 years follow-up.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 1114-1114 ◽  
Author(s):  
Tienhan Sandrine Dabakuyo ◽  
Emmanuel De Gournay ◽  
Aurelie Guyomard ◽  
Stephanie Boulet ◽  
Patrick Arveux ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Lymph Node Biopsy ◽  
Axillary Lymph ◽  
Node Dissection ◽  
Node Biopsy ◽  
Eortc Qlq

1114 Background: the aim of this study was to assess long term quality of life (QoL) over a period of 6 years in women with a breast cancer (BC) who underwent sentinel lymph node biopsy (SLNB), axillary lymph node dissection (ALND), or SLNB followed by ALND. Methods: The EORTC-QLQ-C30 and the EORTC-QLQ-BR-23 questionnaires were used to assess QoL before surgery, just after surgery, 6, 12 and 72 months later. The Kruskal Wallis test with the Bonferroni correction was used to compare scores. A mixed model analysis of variance for repeated measurements was then applied to assess the longitudinal effect of surgical modalities on QoL. Results: Five hundred and eighteen BC patients were initially included. The median follow-up was 6 years. During the follow-up, 61 patients died. None of the patients of the SLNB group has developed lymphedema during follow-up and the relapse rate was not different between the different groups (p=0.62). Before surgery, global health (GHS) (P = 0.5226) and arm symptoms (BRAS) (P = 0.9902) QoL scores were similar whatever the surgical procedure. BRAS score (p=0.0001) was better in the SNLB group 72 months after surgery. Moreover, compared to ALND patients, patients treated with SLNB had fewer arm symptoms with the follow-up. In addition, body image (P = 0.0005), upset by hair loss (P = 0.0045), systemic therapy side effects (P = 0.0097) and future perspective (P = 0.0375) QoL dimensions remained better 5 to 6 years after diagnosis in patients treated by SLNB. Conclusions: Long term follow-up showed that, SLNB is a safe and acceptable accurate method associated with less morbidity than ALND.

Reducing Breast Cancer-Related Lymphedema (BCRL) Through Prospective Surveillance Monitoring Using Bioimpedance Spectroscopy (BIS) and Patient Directed Self-Interventions

2018 ◽  
Vol 25 (10) ◽  
pp. 2948-2952 ◽  
Author(s):  
Lyndsey J. Kilgore ◽  
Sabrina S. Korentager ◽  
Amanda N. Hangge ◽  
Amanda L. Amin ◽  
Christa R. Balanoff ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Bioimpedance Spectroscopy ◽  
Prospective Surveillance ◽  
Breast Cancer Related Lymphedema
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