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Perometry versus simulated circumferential tape measurement for the detection of breast cancer-related lymphedema

Abstract

Purpose

Despite increasing emphasis on screening and early intervention for breast cancer-related lymphedema (BCRL), there is marked heterogeneity in diagnostic methodology, including for volumetric measures. This retrospective study compared two volumetric modalities, perometry and simulated circumferential tape measurement (anatomic- and interval-based), for BCRL detection.

Methods

Between 2005 and 2017, 287 female patients with unilateral breast cancer were prospectively screened for BCRL by perometry and the relative volume change (RVC) formula. Circumferential measurement was performed by sampling at five anatomic landmark-based points or 4-cm intervals from pairs of perometer arm diameter measurements. Volumetric conversion was by a frustum model. The Bland–Altman method was used to compare segmental volume differences. Confusion matrix analysis was performed for each circumferential measurement technique against perometry.

Results

Median follow-up was 34.7 months over 4 postoperative visits. There was no difference in total arm volume comparing any of the circumferential measurement techniques to perometry. Landmark-based methods significantly underestimated upper arm volume (mean difference − 207 mL [− 336, − 78 mL]) and overestimated forearm volume (mean difference + 170 mL [+ 105, + 237 mL]). Landmark-based methods had greater sensitivity and specificity compared to 4-cm interval methods for detection of both RVC ≥ 10 and 5–10%. Landmark-based methods were comparable to perometry for detection of RVC ≥ 10%, but sensitivity was only 63.2–66.7% for RVC 5–10%.

Conclusions

This hypothesis-generating study suggested the superiority of anatomic landmark-based circumferential tape measurement compared to interval-based methods, while generating questions about the underestimation of upper arm volume and overestimation of forearm volume of circumferential tape measurement compared to perometry.

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Abbreviations

ALND:

Axillary lymph node dissection

BCRL:

Breast cancer-related lymphedema

BIS:

Bioimpedance spectroscopy

BMI:

Body mass index

CI:

Confidence interval

NLN:

National Lymphedema Network

NPV:

Negative predictive value

PBI:

Partial breast irradiation

PPV:

Positive predictive value

RVC:

Relative volume change

RLNR:

Regional lymph node radiation

SLNB:

Sentinel lymph node biopsy

SN:

Sensitivity

SP:

Specificity

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Acknowledgements

The project was supported by Award Number R01CA139118 (AG Taghian) and Award Number P50CA08393 (AG Taghian) from the National Cancer Institute. 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. This program is supported by the Adele McKinnon Research Fund for Breast Cancer-Related Lymphedema.

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Correspondence to Fangdi Sun.

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Conflict of interest

AG Taghian has been loaned equipment from ImpediMed for use in an investigator initiated clinical trial. ImpediMed has was not involved in the conception or reporting of our research activities. AG Taghian has been a consultant for VisionRT (image-guidance radiation oncology). The other authors have no conflicts of interest to declare.

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Sun, F., Hall, A., Tighe, M.P. et al. Perometry versus simulated circumferential tape measurement for the detection of breast cancer-related lymphedema. Breast Cancer Res Treat 172, 83–91 (2018). https://doi.org/10.1007/s10549-018-4902-z

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  • DOI: https://doi.org/10.1007/s10549-018-4902-z

Keywords

  • Lymphedema
  • Edema
  • Breast neoplasms
  • Quantification