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Magnetic resonance imaging and bioimpedance evaluation of lymphatic abnormalities in patients with breast cancer treatment-related lymphedema

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Abstract

Purpose

Breast cancer treatment-related lymphedema (BCRL) evaluation is frequently performed using portable measures of limb volume and bioimpedance asymmetry. Here quantitative magnetic resonance imaging (MRI) is applied to evaluate deep and superficial tissue impairment, in both surgical and contralateral quadrants, to test the hypothesis that BCRL impairment is frequently bilateral and extends beyond regions commonly evaluated with portable external devices.

Methods

3-T MRI was applied to investigate BCRL topographical impairment. Female BCRL (n = 33; age = 54.1 ± 11.2 years; stage = 1.5 ± 0.8) and healthy (n = 33; age = 49.4 ± 11.0 years) participants underwent quantitative upper limb MRI relaxometry (T2), bioimpedance asymmetry, arm volume asymmetry, and physical evaluation. Parametric tests were applied to evaluate study measurements (i) between BCRL and healthy participants, (ii) between surgical and contralateral limbs, and (iii) in relation to clinical indicators of disease severity. Two-sided p-value < 0.05 was required for significance.

Results

Bioimpedance asymmetry was significantly correlated with MRI-measured water relaxation (T2) in superficial tissue. Deep muscle (T2 = 37.6 ± 3.5 ms) and superficial tissue (T2 = 49.8 ± 13.2 ms) relaxation times were symmetric in healthy participants. In the surgical limbs of BCRL participants, deep muscle (T2 = 40.5 ± 4.9 ms) and superficial tissue (T2 = 56.0 ± 14.8 ms) relaxation times were elevated compared to healthy participants, consistent with an edematous micro-environment. This elevation was also observed in contralateral limbs of BCRL participants (deep muscle T2 = 40.3 ± 5.7 ms; superficial T2 = 56.6 ± 13.8 ms).

Conclusions

Regional MRI measures substantiate a growing literature speculating that superficial and deep tissue, in surgical and contralateral quadrants, is affected in BCRL. The implications of these findings in the context of titrating treatment regimens and understanding malignancy recurrence are discussed.

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Acknowledgements

Research funding provided by the National Institutes of Health National Institute for Nursing Research 1R01NR015079 and the Lipedema Foundation postdoctoral fellowship

Funding

This study was funded by the National Institutes of Health (NIH) National Institute for Nursing Research (NINR) grant number 1R01NR015079.

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Authors and Affiliations

  1. Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA

    Paula M. C. Donahue

  2. Vanderbilt Dayani Center for Health and Wellness, Nashville, TN, USA

    Paula M. C. Donahue

  3. Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA

    Rachelle Crescenzi, Maria Garza, Kalen J. Petersen & Manus J. Donahue

  4. Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA

    Chelsea Lee & Niral J. Patel

  5. Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA

    Manus J. Donahue

  6. Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA

    Manus J. Donahue

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  1. Paula M. C. Donahue
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  2. Rachelle Crescenzi
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Correspondence to Manus J. Donahue.

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Conflicts of interest

Author Manus J. Donahue has received research-related funding from the NIH, receives research-related support from Philips Healthcare, is a paid consultant for Global Blood Therapeutics, Pfizer, and bluebird bio, and is the CEO of biosight, LLC which provides healthcare technology consulting services.

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All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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All human subjects provided informed, written consent (IRB #181698).

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Donahue, P.M.C., Crescenzi, R., Lee, C. et al. Magnetic resonance imaging and bioimpedance evaluation of lymphatic abnormalities in patients with breast cancer treatment-related lymphedema. Breast Cancer Res Treat 183, 83–94 (2020). https://doi.org/10.1007/s10549-020-05765-5

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  • DOI: https://doi.org/10.1007/s10549-020-05765-5

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