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Reducing Breast Cancer-Related Lymphedema (BCRL) Through Prospective Surveillance Monitoring Using Bioimpedance Spectroscopy (BIS) and Patient Directed Self-Interventions

Annals of Surgical Oncology volume 25, pages 2948–2952 (2018)Cite this article

Abstract

Background

Breast cancer-related lymphedema (BCRL) is a chronic progressive disease that results from breast cancer treatment and nodal surgery. NCCN guidelines support baseline measurements with prospective assessment for early diagnosis and treatment. We sought to determine if baseline measurement with bioimpedance spectroscopy (BIS) and serial postoperative evaluations provide early detection amenable to conservative interventions that reduce BCRL.

Methods

Breast cancer patients with unilateral disease high-risk for BCRL from a single institution were evaluated from November 2014 to December 2017. High risk was defined as axillary lymph node dissection with radiation and/or taxane chemotherapy. Patients received preoperative baseline BIS measurements followed by postoperative measurements with at least two follow-ups. Patients with BIS results that were 2 standard deviations above baseline (10 + points) started home conservative interventions for 4–6 weeks. Postintervention measurements were taken to assess improvement.

Result

A total of 146 patients high-risk for BCRL were included. Forty-nine patients (34%) developed early BCRL and started self-directed treatment. Forty patients (82%) had elevated BIS measurements return to normal baseline range. Nine (6%) patients had persistent BCRL requiring referral for advanced therapy. Patients with persistent BCRL had significant nodal burden on surgical pathology; eight (89%) had N2/N3 disease. Six (76%) with BCRL refractory to conservative measures died of their breast cancer.

Conclusion

Our results demonstrated that early conservative intervention for breast cancer patients high risk for BCRL who were prospectively monitored by utilizing BIS significantly lowers rates of BCRL. These findings support early prospective screening and intervention for BCRL. Early detection with patient-directed interventions improves patient outcomes and decreases the risk of persistent BCRL.

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Authors and Affiliations

  1. Division of Breast Surgery, Department of Surgery, University of Kansas Cancer Center, Kansas City, KS, USA

    Lyndsey J. Kilgore MD, Sabrina S. Korentager MSN, CLT-UE, Amanda N. Hangge DO, Amanda L. Amin MD, Christa R. Balanoff MD, Kelsey E. Larson MD & Jamie L. Wagner DO

  2. Department of Radiation Oncology, University of Kansas Cancer Center, Kansas City, KS, USA

    Melissa P. Mitchell MD

  3. Office of Scholarly, Academic and Research Mentoring, University of Kansas Cancer Center, Kansas City, KS, USA

    John G. Chen PhD & Emily Burgen MPH

  4. Department of Medical Oncology, University of Kansas Cancer Center, Kansas City, KS, USA

    Qamar J. Khan MD, Anne P. O’Dea MD, Lauren Nye MD & Priyanka Sharma MD

Authors
  1. Lyndsey J. Kilgore MD
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  2. Sabrina S. Korentager MSN, CLT-UE
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  3. Amanda N. Hangge DO
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  4. Amanda L. Amin MD
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  5. Christa R. Balanoff MD
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  6. Kelsey E. Larson MD
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  7. Melissa P. Mitchell MD
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  8. John G. Chen PhD
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  9. Emily Burgen MPH
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  10. Qamar J. Khan MD
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  11. Anne P. O’Dea MD
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  12. Lauren Nye MD
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  13. Priyanka Sharma MD
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  14. Jamie L. Wagner DO
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Correspondence to Jamie L. Wagner DO.

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Kilgore, L.J., Korentager, S.S., Hangge, A.N. et al. Reducing Breast Cancer-Related Lymphedema (BCRL) Through Prospective Surveillance Monitoring Using Bioimpedance Spectroscopy (BIS) and Patient Directed Self-Interventions. Ann Surg Oncol 25, 2948–2952 (2018). https://doi.org/10.1245/s10434-018-6601-8

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  • DOI: https://doi.org/10.1245/s10434-018-6601-8

Keywords

  • Breast Cancer-related Lymphedema (BCRL)
  • Bioimpedance Spectroscopy (BIS)
  • Lymphedema (LE)
  • Axillary Lymph Node Dissection (ALND)
  • Taxane Chemotherapy