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Is bioimpedance spectroscopy a useful tool for objectively assessing lymphovenous bypass surgical outcomes in breast cancer-related lymphedema?

Abstract

Purpose

We sought to determine if bioimpedance spectroscopy (BIS) measurements can accurately assess changes in breast cancer-related lymphedema (BCRL) in patients undergoing lymphovenous bypass (LVB).

Methods

Patients undergoing LVB for BCRL refractory to conservative treatment from 1/2015 to 12/2018 were identified from an IRB-approved prospectively maintained database at a single institution. All breast cancer patients were assessed with baseline BIS measurements prior to any oncologic surgery and serial BIS during follow-up office visits including before and after LVB. Clinicopathologic information, LVB operative details, and pre- and post-LVB operative BIS measurements were collected. Analysis focused on clinically significant BIS change, defined as two standard deviations (SD), and comparing LVB anastomosis to BIS changes.

Results

During the study timeframe, nine patients underwent LVB for treatment of BCRL. The majority (78%) received radiation, taxane chemotherapy, and underwent axillary dissection. An average of 5.6 LVB anastomoses were performed per patient. The average change in BIS following LVB was a 3SD reduction, indicating a clinically significant change. This improvement was stable over time, with persistent 2SD reduction at 22 months postoperatively. The number of LVB anastomoses performed did not significantly correlate with the degree of BIS change.

Conclusions

This is the first study to utilize BIS measurements to assess response to LVB surgical intervention for BCRL. BIS measurements demonstrated clinically significant improvement after LVB, providing objective evidence in support of this surgical treatment for BCRL. BIS changes should be reported as key objective data in future studies assessing BCRL interventions, including response to LVB.

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References

  1. Ashikaga T, Krag DN, Land SR et al (2010) Morbidity results from the NSABP B-32 trial comparing sentinel lymph node dissection versus axillary dissection. J Surg Oncol 102(2):111–118

    Article  Google Scholar 

  2. Bulley C, Gaal S, Coutts F et al (2013) Comparison of breast cancer-related lymphedema (upper limb swelling) prevalence estimated using objective and subjective criteria and relationship with quality of life. Biomed Res Int 2013:807569

    Article  Google Scholar 

  3. Dayan JH, Ly CL, Kataru RP, Mehrara BJ (2017) Lymphedema: Pathogenesis and Novel Therapies. Annu Rev Med 69:263–276

    Article  Google Scholar 

  4. Hayes S, Di Sipio T, Rye S et al (2011) Prevalence and prognostic significance of secondary lymphedema following breast cancer. Lymphat Res Biol 9(3):135–141

    Article  Google Scholar 

  5. McLaughlin SA, Wright MJ, Morris KT et al (2008) Prevalence of lymphedema in women with breast cancer 5 years after sentinel lymph node biopsy or axillary dissection: objective measurements. J Clin Oncol 26(32):5213–5219

    Article  Google Scholar 

  6. Fu MR, Cleland CM, Guth AA et al (2013) L-dex ratio in detecting breast cancer-related lymphedema: reliability, sensitivity, and specificity. Lymphology 46(2):85–96

    CAS  PubMed  PubMed Central  Google Scholar 

  7. Shah C, Vicini FA, Arthur D (2016) Bioimpedance Spectroscopy for Breast Cancer Related Lymphedema Assessment: Clinical Practice Guidelines. Breast J 22(6):645–650

    Article  Google Scholar 

  8. Jain MS, Danoff JV, Paul SM (2010) Correlation between bioelectrical spectroscopy and perometry in assessment of upper extremity swelling. Lymphology 43(2):85–94

    CAS  PubMed  Google Scholar 

  9. Kilgore LJ, Korentager SS, Hangge AN et al (2018) Reducing breast cancer-related lymphedema (BCRL) through prospective surveillance monitoring using bioimpedance spectroscopy (BIS) and patient directed self-interventions. Ann Surg Oncol 25(10):2948–2952

    Article  Google Scholar 

  10. Soran A, Ozmen T, McGuire KP et al (2014) The importance of detection of subclinical lymphedema for the prevention of breast cancer-related clinical lymphedema after axillary lymph node dissection; a prospective observational study. Lymphat Res Biol 12(4):289–294

    Article  Google Scholar 

  11. Terada M, Yoshimura A, Sawaki M et al (2019) Patient-reported outcomes and objective assessments with arm measurement and bioimpedance analysis for lymphedema among breast cancer survivors. Breast Cancer Res Treat 179(1):91–100

    Article  Google Scholar 

  12. Schaverien MV, Coroneos CJ (2019) Surgical Treatment of Lymphedema. Plast Reconstr Surg 144(3):738–758

    CAS  Article  Google Scholar 

  13. AlJindan FK, Lin CY, Cheng MH (2019) Comparison of Outcomes between Side-to-End and End-to-End Lymphovenous Anastomoses for Early-Grade Extremity Lymphedema. Plast Reconstr Surg 144(2):486–496

    CAS  Article  Google Scholar 

  14. Chang DW, Suami H, Skoracki R (2013) A prospective analysis of 100 consecutive lymphovenous bypass cases for treatment of extremity lymphedema. Plast Reconstr Surg 132(5):1305–1314

    CAS  Article  Google Scholar 

  15. Patel KM, Manrique O, Sosin M, Hashmi MA, Poysophon P, Henderson R (2015) Lymphatic mapping and lymphedema surgery in the breast cancer patient. Gland Surg 4(3):244–256

    PubMed  PubMed Central  Google Scholar 

  16. Chang DW (2012) Lymphaticovenular bypass surgery for lymphedema management in breast cancer patients. Handchir Mikrochir Plast Chir 44(6):343–347

    CAS  Article  Google Scholar 

  17. Garza RM, Chang DW (2018) Lymphovenous bypass for the treatment of lymphedema. J Surg Oncol 118(5):743–749

    Article  Google Scholar 

  18. Torrisi JS, Joseph WJ, Ghanta S et al (2015) Lymphaticovenous bypass decreases pathologic skin changes in upper extremity breast cancer-related lymphedema. Lymphat Res Biol 13(1):46–53

    CAS  Article  Google Scholar 

  19. Qin ES, Bowen MJ, Chen WF (2018) Diagnostic accuracy of bioimpedance spectroscopy in patients with lymphedema: A retrospective cohort analysis. Journal of Plastic, Reconstructive & Aesthetic Surgery 71(7):1041–1050

    Article  Google Scholar 

  20. Cornish BH, Bunce IH, Ward LC, Jones LC, Thomas BJ (1996) Bioelectrical impedance for monitoring the efficacy of lymphoedema treatment programmes. Breast Cancer Res Treat 38(2):169–176

    CAS  Article  Google Scholar 

  21. Ridner SH, Dietrich MS, Spotanski K et al (2018) A prospective study of L-Dex values in breast cancer patients pretreatment and through 12 months postoperatively. Lymphat Res Biol 16(5):435–441

    Article  Google Scholar 

  22. Scaglioni MF, Fontein DBY, Arvanitakis M, Giovanoli P (2017) Systematic review of lymphovenous anastomosis (LVA) for the treatment of lymphedema. Microsurgery 37(8):947–953

    Article  Google Scholar 

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Acknowledgements

The authors thank Holly R. Zink, MSA of the Department of Surgery, University of Kansas, Kansas City, KS, for providing medical writing and editorial support for this research.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Correspondence to Kelsey E. Larson.

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The authors have no financial or non-financial conflicts of interest to report.

Ethical approval

IRB approval was obtained for this study. Ethics approval and consent to participate were not required per IRB.

Research involved in human and animal rights

All procedures performed in studies involving human participants 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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Sutherland, A., Wagner, J.L., Korentager, S. et al. Is bioimpedance spectroscopy a useful tool for objectively assessing lymphovenous bypass surgical outcomes in breast cancer-related lymphedema?. Breast Cancer Res Treat 186, 1–6 (2021). https://doi.org/10.1007/s10549-020-06059-6

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  • DOI: https://doi.org/10.1007/s10549-020-06059-6

Keywords

  • Breast cancer-related lymphedema
  • Lymphedema
  • Lymphovenous bypass
  • Bioimpedance spectroscopy