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Breast Cancer Research and Treatment

, Volume 151, Issue 1, pp 121–129 | Cite as

Comparison of multi-frequency bioimpedance with perometry for the early detection and intervention of lymphoedema after axillary node clearance for breast cancer

  • Nigel J. BundredEmail author
  • Charlotte Stockton
  • Vaughan Keeley
  • Katie Riches
  • Linda Ashcroft
  • Abigail Evans
  • Anthony Skene
  • Arnie Purushotham
  • Maria Bramley
  • Tracey Hodgkiss
  • The Investigators of BEA/PLACE studies
Clinical Trial

Abstract

The importance of early detection of lymphoedema by arm volume measurements before surgery and repeated measurements after surgery in women undergoing axillary node clearance (ANC) in order to enable early intervention is recognised. A prospective multi-centre study was performed which studied the difference between multi-frequency bioimpedance electrical analysis (BIS) and perometer arm measurement in predicting the development of lymphoedema. Women undergoing ANC underwent pre-operative and regular post-operative measurements of arm volume by both methods. The primary endpoint is the incidence of lymphoedema (≥10 % arm volume increase compared to contralateral arm by perometer) at 2 and 5 years after ANC. The threshold for intervention in lymphoedema was also assessed. Out of 964 patients recruited, 612 had minimum 6 months follow-up data. Using 1-month post-operative measurements as baseline, perometer detected 31 patients with lymphoedema by 6 months (BIS detected 53). By 6 months, 89 % of those with no lymphoedema reported at least one symptom. There was moderate correlation between perometer and BIS at 3 months (r = 0.40) and 6 months (r = 0.60), with a sensitivity of 73 % and specificity of 84 %. Univariate and multivariate analyses revealed a threshold for early intervention of ≥5 to <10 % (p = 0.03). Threshold for early intervention to prevent progression to lymphoedema is ≥5 to <10 % but symptoms alone do not predict lymphoedema. The modest correlation between methods at 6 months indicates arm volume measurements remain gold standard, although longer term follow-up is required.

Keywords

Lymphoedema Bioimpedance Breast cancer Axillary node clearance Threshold Prediction 

Notes

Acknowledgments

This article summarises independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (Grant Reference RP-PG-0608-10168). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health”. The manuscript was prepared on behalf of the Investigators of the BEA study who have recruited patients: Mr M Absar, Miss Janet Walls, North Manchester General Hospital; Mr Robert Kirby, University Hospital of North Staffordshire; Mr Brian Isgar, New Cross Hospital; Mr Mohammad Sharif, Stepping Hill Hospital.

Conflict of interests

The authors declare that they have no competing interests.

References

  1. 1.
    Badger BC (1987) Lymphoedema. Prof Nurse 2(4):100–102PubMedGoogle Scholar
  2. 2.
    Hodkinson M (1992) Lymphoedema: applying physiology to treatment. Eur J Cancer Care 1:19–22CrossRefGoogle Scholar
  3. 3.
    Norman SA, Localio AR, Kallan MJ, Weber AL, Simoes Torpey HA, Potashnik SL, Miller LT, Fox KR, DeMichele A, Solin LJ (2010) Risk factors for lymphedema after breast cancer treatment. Cancer Epidemiol Biomark Prev 19(11):2734–2746CrossRefGoogle Scholar
  4. 4.
    Czerniec SA, Ward LC, Refshauge KM, Beith J, Lee MJ, York S, Kilbreath SL (2010) Assessment of breast cancer-related arm lymphedema: comparison of physical measurement methods and self-report. Cancer Investig 28:54–62CrossRefGoogle Scholar
  5. 5.
    Golshan M, Smith B (2006) Prevention and management of arm lymphedema in the patient with breast cancer. Support Oncol 4(8):381–386Google Scholar
  6. 6.
    Greater Manchester and Cheshire Cancer Network (2004) Review of lymphoedema services 2003/4, report of the Working Group, March 2004 (confidential)Google Scholar
  7. 7.
    Poole K, Fallowfield LJ (2002) The psychological impact of post-operative arm morbidity following axillary surgery for breast cancer: a critical review. Breast 11:81–87CrossRefPubMedGoogle Scholar
  8. 8.
    Voogd AC, Ververs JM, Vingerhoets AJ, Roumen RM, Coebergh JW, Crommelin MA (2003) Lymphoedema and reduced shoulder function as indicators of quality of life after axillary node dissection for invasive breast cancer. Br J Surg 90(1):76–81CrossRefPubMedGoogle Scholar
  9. 9.
    Petrek JA, Senie RT, Peters M, Rosen PP (2001) Lymphedema in a cohort of breast carcinoma survivors 20 years after diagnosis. Cancer 92:1368–1377CrossRefPubMedGoogle Scholar
  10. 10.
    Armer JM, Stewart BR (2010) Post-breast cancer lymphedema: incidence increases from 12 to 30 to 60 months. Lymphology 43:118–127PubMedGoogle Scholar
  11. 11.
    Devoogdt N, Van Kampen M, Christiaens MR et al (2011) Short- and long-term recovery of upper limb function after axillary lymph node dissection. Eur J Cancer Care (Engl) 20:77–86CrossRefGoogle Scholar
  12. 12.
    Mortimer PS (1990) Investigation and management of lymphoedema. Vasc Med Rev 1:1–20CrossRefGoogle Scholar
  13. 13.
    Hayes S et al (2005) Comparison of methods to diagnose lymphoedema amongst breast cancer survivors: 6 month follow-up. Breast Cancer Res Treat 89:221–226CrossRefPubMedGoogle Scholar
  14. 14.
    Armer JM (2005) The problem of post-breast cancer lymphedema, impact and measurement issues. Cancer Investig 23:76–83CrossRefGoogle Scholar
  15. 15.
    Goltner E et al (1988) The importance of volumetry, lymphoscintigraphy and computer tomography in the diagnosis of brachial edema after mastectomy. Lymphology 21:134–143PubMedGoogle Scholar
  16. 16.
    Stanton AW et al (1997) Validation of an optoelectronic limb volumeter (Perometer). Lymphology 30(2):77–97PubMedGoogle Scholar
  17. 17.
    Cornish BH, Ward LC, Thomas BJ et al (1998) Quantification of lymphoedema using multi-frequency bioimpedance. Appl Radiat Isot 49(5–6):651–652CrossRefPubMedGoogle Scholar
  18. 18.
    Ward LC (2006) Bioelectrical impedance analysis: proven utility in lymphedema risk assessment and therapeutic monitoring. Lymphat Res Biol 4(1):51–56CrossRefPubMedGoogle Scholar
  19. 19.
    Cornish BH, Chapman M, Thomas BJ, Ward LC, Bunce IH, Hirst C (2000) Early diagnosis of lymphedema in postsurgery breast cancer patients. Ann N Y Acad Sci 904:571–575CrossRefPubMedGoogle Scholar
  20. 20.
    Ward LC, Czerniec S, Kilbreath SL (2009) Operational equivalence of bioimpedance indices and perometry for the assessment of unilateral arm lymphedema. Lymphat Res Biol 7(2):81–85CrossRefPubMedGoogle Scholar
  21. 21.
    Lymphoedema: supportive care for health professionals. MedNews. National Cancer Institute (www.cancer.gov). Accessed 17 June 2014
  22. 22.
    Mansel RE, Fallowfield L, Kissin M, Goyal A, Newcombe RG, Dixon JM, Yiangou C, Horgan K, Bundred N, Monypenny I, England D, Sibbering M, Abdullah TI, Barr L, Chetty U, Sinnett DH, Fleissig A, Clarke D, Ell PJ (2006) Randomized multicenter trial of sentinel node biopsy versus standard axillary treatment in operable breast cancer: the ALMANAC trial. J Natl Cancer Inst 98(9):599–609 (May 3)CrossRefPubMedGoogle Scholar
  23. 23.
    Morais S, Morris J, Heslop T et al (2008) Early arm swelling predicts development of lymphoedema after axillary clearance (ASGBI abstracts). Br J Surg 95(S3):1–84CrossRefGoogle Scholar
  24. 24.
    Stout Gergich NL, Pfalzer LA, McGarvey C, Springer B, Gerber LH, Soballe P (2008) Preoperative assessment enables the early diagnosis and successful treatment of lymphedema. Cancer 112(12):2809–2819CrossRefPubMedGoogle Scholar
  25. 25.
    Specht MC, Miller CL, Russell TA, Horick N, Skolny MN, O’Toole JA, Jammallo LS, Niemierko A, Sadek BT, Shenouda MN, Finkelstein DM, Smith BL, Taghian AG (2013) Defining a threshold for intervention in breast cancer-related lymphoedema: what level of arm volume increase predicts progression? Breast Cancer Res Treat 140:485–494CrossRefPubMedCentralPubMedGoogle Scholar
  26. 26.
    Armer JM, Stewart DR (2005) A comparison of four diagnostic criteria for lymphoedema in a post-breast cancer population. Lymphat Res Biol 3(4):208–217CrossRefPubMedGoogle Scholar
  27. 27.
    Bland JM, Altman DG (2007) Agreement between methods of measurement with multiple observations per individual. J Biopharm Stat 17(4):571–582CrossRefPubMedGoogle Scholar
  28. 28.
    Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 327:307–310CrossRefGoogle Scholar
  29. 29.
    Bar AdV, Dutta PR, Solin LJ, Hwang W-T, See Tan K, Stefan Both, Cheville A, Harris E (2012) Time-course of arm lymphedema and potential risk factors for progression of lymphedema after breast conservation treatment for early stage breast cancer. Breast J 18(3):219–225CrossRefGoogle Scholar
  30. 30.
    Armer JM, Radina ME, Porock D, Culbertson SD (2003) Predicting breast cancer-related lymphedema using self-reported symptoms. Nurs Res 52(6):370–379CrossRefPubMedGoogle Scholar
  31. 31.
    Lopez Penha TR, Slangen JJG, Heuts EM, Voogd AC, Von Meyenfeldt MF (2011) Prevalence of lymphoedema more than 5 years after breast cancer treatment. Eur J Surg Oncol. doi: 10.1016/j.ejso.2011.09.001 PubMedGoogle Scholar
  32. 32.
    Swenson KK, Nissen MJ, Leach JW, Post-White J (2009) Case-control study to evaluate predictors of lymphedema after breast cancer surgery. Oncol Nurs Forum 36(2):185–193CrossRefPubMedGoogle Scholar
  33. 33.
    Soran A, D’Angelo G, Begovic M, Ardic F, Harlak A, Wieand HS, Vogel VG, Johnson RR (2006) Breast cancer-related lymphedema—what are the significant predictors and how they affect the severity of lymphedema? Breast J 12(6):536–543CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Nigel J. Bundred
    • 1
    Email author
  • Charlotte Stockton
    • 2
  • Vaughan Keeley
    • 3
  • Katie Riches
    • 3
  • Linda Ashcroft
    • 4
  • Abigail Evans
    • 5
  • Anthony Skene
    • 6
  • Arnie Purushotham
    • 7
  • Maria Bramley
    • 8
  • Tracey Hodgkiss
    • 8
  • The Investigators of BEA/PLACE studies
  1. 1.University Hospital of South ManchesterManchesterUK
  2. 2.Nightingale and Genesis Prevention CentreUniversity Hospital of South ManchesterManchesterUK
  3. 3.Nightingale Macmillan UnitRoyal Derby Hospital, Derby Hospitals NHS Foundation TrustDerbyUK
  4. 4.Clinical Trials Co-ordination UnitThe Christie Hospital NHS TrustManchesterUK
  5. 5.Poole Hospital NHS Foundation TrustPooleUK
  6. 6.Royal Bournemouth & Christchurch Hospitals NHS Foundation TrustBournemouthUK
  7. 7.Research OncologyKing’s College LondonLondonUK
  8. 8.North Manchester General HospitalThe Pennine Acute Hospitals NHS TrustManchesterUK

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