The Early Detection of Breast Cancer Treatment-Related Lymphedema of the Arm

Background: It is recognized that the early detection of breast cancer treatment related lymphedema (BCRL) leading to earlier intervention may improve long-term outcomes. This study aimed to determine whether limb volume measurement or bioimpedance spectroscopy (BIS) was the better tool for the early detection of BCRL. It also aimed to identify factors, which may be used to assess the risk of development of BCRL for individual patients. Methods and Results: This was a large prospective multicenter study of 1100 patients, who had had axillary node clearance for breast cancer, carried out in the United Kingdom. Limb volumes (by Perometer) and BIS (L-Dex by Impedimed U400) measurements were taken preoperatively and postsurgery with a follow-up period of 5 years. Details of the cancer, its treatment, body mass index (BMI), and age were recorded. BCRL was defined by relative arm volume increase (RAVI) ≥10%. At 24 months, the incidence of BCRL defined by RAVI was 22.8% and that defined by L-Dex >10 was 45.6%. Independent risk factors for the development of BCRL at 36 months were RAVI ≥5%-<10%, at 1 month, 10 or more positive nodes, BMI >30 and taxane chemotherapy. A risk assessment tool based on these was developed. Conclusions: Limb volume measurements performed better than BIS in the early detection of BCRL. Pre- and postoperative monitoring of limb volume measurements is useful in the early detection of, and prediction of those likely to develop, BCRL and allow early intervention.