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Bioimpedance spectroscopy reduces progression of breast cancer-related lymphedema
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Post-treatment surveillance with bioimpedance spectroscopy — which uses an electric current to measure intercellular fluid volume — reduced progression of breast cancer-related lymphedema requiring complex decongestive physiotherapy compared with conventional tape measure assessment, according to results of a randomized study presented at American Society of Breast Surgeons Annual Meeting.
Lymphedema — chronic, debilitating arm swelling caused from lymph node surgery — is generally diagnosed by measuring arm circumference with a tape measure. However, at that point, it is too late to be reversed, potentially leading to decreased arm range of motion, infection and comprised quality of life.
“Despite advances in breast-conserving surgery, improved radiation protocols, the advent of certain biopsies and chemotherapy regimens, breast cancer related-lymphedema remains a major source of morbidity and concern in this patient population,” Sheila H. Ridner, PhD, RN, Martha Rivers Ingram professor of nursing at Vanderbilt University School of Nursing, said during a webcast. “Because it is thought that early identification of swelling in the limbs, coupled with a compression intervention may reduce the risk for ... developing full-blown clinical lymphedema, clinicians are proposing to use a prospective surveillance model to follow breast cancer survivors post-surgery in order to assess limbs in a routine fashion and instigate preventative mechanisms early.”
Researchers randomly assigned 508 women (median age, 58.8 years; 77% white) to surveillance with either bioimpedance spectroscopy (ImpediMed; n = 263) or tape measure (n = 245).
Eligible patients had stage 1 to stage 3 invasive breast cancer — with most patients (n = 288) having stage 1 disease, and 198 having stage 2 or stage 3 disease — or ductal carcinoma in situ. Women underwent mastectomy, axillary treatment or taxane-based chemotherapy.
Median BMI was 27.9 kg/m2 (interquartile range [IQR], 24-33) and most comorbidities were cardiovascular (n = 223).
Lymphedema progression requiring complex decongestive physiotherapy served as the study’s primary outcome measure.
Median follow-up was 17.8 months (IQR, 13-23).
Results showed that a total of 109 patients triggered pre-threshold interventions, including 68 in the tape measure group and 41 in the bioimpedance spectroscopy group.
Overall, bioimpedance spectroscopy was associated with a lower rate of trigger (15.8% vs. 28.5%) and longer times to trigger (9.5 months vs. 2.8 months; P = .002) than tape measure, suggesting measuring arm circumference has a higher false-positive rate.
Ten patients in the tape measure group and two patients in the bioimpedance spectroscopy group progressed to complex decongestive physiotherapy.
Overall, these data suggest bioimpedance spectroscopy identifies patients at risk for lymphedema at an earlier stage when it can still be treated prior to progression. Patients referred early for intervention via bioimpedance spectroscopy had a 9.8% absolute and 67% relative reduction in risk for clinically diagnosed lymphedema.
“We believe the interim results support the concept that post-treatment surveillance using bioimpedance spectroscopy for early detection of lymphedema, coupled with early intervention, does have clinical advantages for the patient,” Ridner said. – by John DeRosier
Reference:
Ridner S, et al. Interim analysis lymphedema ‘PREVENT’ trial. Presented at: American Society of Breast Surgeons Annual Meeting; April 30-May 5, 2019; Dallas.
Disclosures: This study was funded by ImpediMed Inc. Ridner reports research funding from ImpediMed Inc. Please see the abstract for all other authors’ relevant financial disclosures.
Perspective
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Hank Schmidt, MD, PhD
Whether this study will change the standard of surveillance for women at risk for breast cancer-related lymphedema will remain an open question for now as this is an interim report. The results of this study are encouraging, and they corroborate other data we have that show the importance of early intervention and prospective screening for early evidence of lymphedema. The L-Dex bioimpedance spectroscopy tool facilitates all of that.
Patients who have had several axillary lymph nodes removed as part of their breast cancer treatment are at risk for lymphedema. Patients treated in this way for breast cancer have about a 20% risk. Once a patient develops lymphedema it requires physical therapy and long-term management. It can be a significant limiting factor for a patient’s lifestyle.
The tape measure method uses actual arm circumference measurement at multiple points, which historically is one of the ways to prospectively monitor patients for development of lymphedema. One of the questions this study addresses is that the tape measure triggers patients more often to go on compressive therapy for a number of weeks. It seems that bioimpedance spectroscopy was more efficient, and at this point in the study showed a nonsignificant trend toward fewer patients progressing to more severe forms of lymphedema.
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