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The need for preoperative baseline arm measurement to accurately quantify breast cancer-related lymphedema

Breast Cancer Research and Treatment volume 157, pages 229–240 (2016)Cite this article

Abstract

Breast cancer-related lymphedema (BCRL) is a feared outcome of breast cancer treatment, yet the push for early screening is hampered by a lack of standardized quantification. We sought to determine the necessity of preoperative baseline in accounting for temporal changes of upper extremity volume. 1028 women with unilateral breast cancer were prospectively screened for lymphedema by perometry. Thresholds were defined: relative volume change (RVC) ≥10 % for clinically significant lymphedema and ≥5 % including subclinical lymphedema. The first postoperative measurement (pseudo-baseline) simulated the case of no baseline. McNemar’s test and binomial logistic regression models were used to analyze BCRL misdiagnoses. Preoperatively, 28.3 and 2.9 % of patients had arm asymmetry of ≥5 and 10 %, respectively. Without baseline, 41.6 % of patients were underdiagnosed and 40.1 % overdiagnosed at RVC ≥ 5 %, increasing to 50.0 and 54.8 % at RVC ≥ 10 %. Increased pseudo-baseline asymmetry, increased weight change between baselines, hormonal therapy, dominant use of contralateral arm, and not receiving axillary lymph node dissection (ALND) were associated with increased risk of underdiagnosis at RVC ≥ 5 %; not receiving regional lymph node radiation was significant at RVC ≥ 10 %. Increased pseudo-baseline asymmetry, not receiving ALND, and dominant use of ipsilateral arm were associated with overdiagnosis at RVC ≥ 5 %; increased pseudo-baseline asymmetry and not receiving ALND were significant at RVC ≥ 10 %. The use of a postoperative proxy even early after treatment results in poor sensitivity for identifying BCRL. Providers with access to patients before surgery should consider the consequent need for proper baseline, with specific strategy tailored by institution.

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Fig. 1

Abbreviations

BCRL:

Breast cancer-related lymphedema

RVC:

Relative volume change

DCIS:

Ductal carcinoma in situ

BMI:

Body mass index

CW:

Chest wall

ALND:

Axillary lymph node dissection

SLNB:

Sentinel lymph node biopsy

PBI:

Partial breast irradiation

RLNR:

Regional lymph node radiation

OR:

Odds ratio

CI:

Confidence interval

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Acknowledgments

The study described was supported by Award Number R01CA139118 (AGT) and Award Number P50CA089393 (AGT) from the National Cancer Institute and the Adele McKinnon Research Fund for BCRL. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute or the National Institutes of Health.

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Authors and Affiliations

  1. Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, 100 Blossom Street, Boston, MA, 02114, USA

    Fangdi Sun, Melissa N. Skolny, Meyha N. Swaroop, Cynthia L. Miller & Alphonse G. Taghian

  2. Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02115, USA

    Bhupendra Rawal & Paul J. Catalano

  3. Department of Physical and Occupational Therapy, Massachusetts General Hospital, Harvard Medical School, 100 Blossom Street, Boston, MA, 02114, USA

    Cheryl L. Brunelle

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  1. Fangdi Sun
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  2. Melissa N. Skolny
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  3. Meyha N. Swaroop
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  4. Bhupendra Rawal
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Correspondence to Alphonse G. Taghian.

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Sun, F., Skolny, M.N., Swaroop, M.N. et al. The need for preoperative baseline arm measurement to accurately quantify breast cancer-related lymphedema. Breast Cancer Res Treat 157, 229–240 (2016). https://doi.org/10.1007/s10549-016-3821-0

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  • DOI: https://doi.org/10.1007/s10549-016-3821-0

Keywords

  • Lymphedema
  • Breast cancer
  • Quantification
  • Standardization
  • Treatment morbidity
  • Temporal baseline