A NEW STUDY has found that early detection along with a simple intervention can be highly effective in preventing breast cancer–related lymphedema for at-risk women. According to data presented at the 2018 Annual Meeting of the American Society of Breast Surgeons,1 82% of women identified at an early stage of lymphatic impairment returned to their normal pretreatment measurements following patient-administered therapies that combined compression sleeve garments and self-directed massage. The researchers, who used bioimpedance spectroscopy to measure extracellular fluid, emphasized that early screening of lymphatic function is crucial to address subtle lymphatic changes before they become permanent.
“Early detection using bioimpedance spectroscopy with easy, patient-directed self-intervention for early-stage lymphedema can significantly improve patient outcomes and decrease the development of persistent lymphedema,” said Lyndsey Kilgore, MD, a surgical resident at the University of Kansas Cancer Center. “Prospective surveillance programs focusing on comprehensive education, early identification, and intervention that emphasizes compression garments and self-directed massage can have a high success rate for reducing persistent breast cancer–related lymphedema.”
“Early detection using bioimpedance spectroscopy with easy, patient-directed self-intervention for early-stage lymphedema can significantly improve patient outcomes….”— Lyndsey Kilgore, MD
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As Dr. Kilgore reported at a press briefing, breast cancer–related lymphedema is a chronic, debilitating swelling of the arm that can result from surgeries involving the lymph nodes. It can lead to decreased arm range of motion and infection and have a significant impact on patients’ quality of life as well as health-care costs. She noted that rates have been reported as high as 20% to 40% in patients undergoing axillary lymph node dissection. Furthermore, the condition frequently goes undiagnosed until it is clinically apparent, when it cannot be reversed.
Bioimpedance spectroscopy is a newer technology that directly measures tissue resistance to an electrical current to determine extracellular fluid volume. This method can be used to monitor subtle changes in patients to provide an opportunity for early intervention and prevention of breast cancer–related lymphedema progression prior to the development of any clinical symptoms. For this study, Dr. Kilgore and her mentor, Dr. Jamie Wagner, also sought to identify patient and tumor characteristics that place patients at a higher risk for the development of breast cancer–related lymphedema.
THE RESEARCHERS prospectively evaluated 146 patients with breast cancer who underwent axillary lymph node dissection from November 2014 to December 2017. Baseline bioimpedance spectroscopy measurements were obtained preoperatively with serial postoperative surveillance with at least two follow-up visits. A bioimpedance spectroscopy at 2 standard deviations above baseline quantified as a greater than 10-point change defines breast cancer–related lymphedema. Standardized at-home conservative interventions, including compression garments and patient-directed self-massage, were instituted for 4 to 6 weeks for each patient.
After surgery, 9 patients (34%) enrolled in the study developed breast cancer–related lymphedema. Following home therapy intervention, however, 40 of these patients (82%) experienced resolution of their lymphedema, for a clinically persistent rate of 6%. Patients whose bioimpedance measurements remained elevated were referred for more comprehensive complete decongestive therapy. According to Dr. Kilgore, patients with persistent lymphedema often have significantly more positive lymph nodes on final surgical pathology, and 89% of these patients were identified as having N2 or N3 disease.
Notably, subclinical breast cancer–related lymphedema resolved in all 25 patients. Two patients with stage 1 (mild) lymphedema that did not have resolution of their lymphedema had significant disease and died secondary to their breast cancer. However, no patients with stage 2 (moderate) or 3 (severe) lymphedema experienced resolution of lymphedema, reported Dr. Kilgore, who noted the majority of patients with persistent lymphedema were obese, compared with 48% in the group that had resolution of symptoms.
‘Good News for Patients’
ACCORDING TO Dr. Kilgore, these data suggest that persistent breast cancer–related lymphedema may be a negative predictor for survival, but the use of bioimpedance spectroscopy to monitor early lymph fluid retention bodes well for at-risk patients. “This study is good news for breast cancer patients,” said Dr. Kilgore. “We hope this research will usher in a new protocol involving precise, highly controlled monitoring and immediate intervention to reverse early lymphatic changes prior to damage that leads to chronic, irreversible lymphedema.”
The cost of the program should also help make this approach feasible for administrators. According to Dr. Kilgore, the bioimpedance spectroscopy device costs approximately $3,500, with an additional $60 for providers to perform the test for each patient. ■
DISCLOSURE: Dr. Kilgore reported no conflicts of interest.
1. Kilgore L, Korentager S, Hangge A, et al: 2018 American Society of Breast Surgeons Annual Meeting. Abstract 404018. Presented May 4, 2018.
Sarah Blair, MD
SARAH BLAIR, MD, a breast surgeon at the University of California San Diego, noted that lymphedema remains a significant clinical problem, although the rates of lymphedema are decreasing, as fewer full axillary node dissections are performed.
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