A Prospective Study of L-Dex Values in Breast Cancer Patients Pretreatment and Through 12 Months Postoperatively

Abstract

At the time of breast cancer diagnosis, L-Dex values are similar to normative values. Identified maximum changes in L-Dex values 12 months postoperatively suggest that frequent L-Dex measurements during that time frame are of potential clinical benefit. Our findings are consistent with research supporting an L-Dex value of ≥7 as indicative of clinical lymphedema with subclinical lymphedema logically occurring at somewhat lower likely, near ≥6.5.

Early surveillance is associated with less incidence and severity of breast cancer–related lymphedema compared with a traditional referral model of care

“…Although our study supports early surveillance and intervention using BIS, recent literature suggests that earlier detection may be even more beneficial using a lower threshold of a 6.5 rather than a 10 L-Dex-unit change for the detection of subclinical lymphedema. 28,37,39 Current practice in Australia requires that "atrisk" women regularly attend clinics to be monitored for lymphedema. Typically, this occurs on a 3-month to 6-month cycle, depending on the individuals' risk of lymphedema.…”

“…28,37,39 Current practice in Australia requires that "atrisk" women regularly attend clinics to be monitored for lymphedema. Although our study supports early surveillance and intervention using BIS, recent literature suggests that earlier detection may be even more beneficial using a lower threshold of a 6.5 rather than a 10 L-Dex-unit change for the detection of subclinical lymphedema.…”

Body Positional Effects on Bioimpedance Spectroscopy Measurements for Lymphedema Assessment of the Arm

“…It is recommended to avoid using the two devices interchangeably, particularly for serial monitoring of patients in prospective surveillance and early intervention model of care programs, where 6.5 L-Dex (&2 SD impedance ratio) or 10 L-Dex (3 SD) unit change may be considered clinically significant and trigger early intervention. 40,41…”

Bioimpedance spectroscopy: The breast cancer survivorship vital sign

“…Traditionally, this has been done with tape measurement, surveys, or asking patients about symptoms; however, these techniques are not highly sensitive, can be costly, cannot detect subclinical BCRL, and have significant interobserver variability . In light of growing data demonstrating increased sensitivity to detect subclinical BCRL (as well as initial outcomes from a randomized trial identifying a clinically actionable score to intervene for subclinical BCRL), bioimpedance spectroscopy (BIS) represents an attractive alternative to these traditional methods . Just as importantly, data have demonstrated the small footprint required for use of BIS with the L‐Dex device, the short amount of time required to obtain measurements, and the ease of incorporating such a program into a robust clinical practice .…”

“…3,10 In light of growing data demonstrating increased sensitivity to detect subclinical BCRL (as well as initial outcomes from a randomized trial identifying a clinically actionable score to intervene for subclinical BCRL), bioimpedance spectroscopy (BIS) represents an attractive alternative to these traditional methods. 11,12 Just as importantly, data have demonstrated the small footprint required for use of BIS with the L-Dex device, the short amount of time required to obtain measurements, and the ease of incorporating such a program into a robust clinical practice. 13 Finally, clinical practice guidelines are available to help clinicians identify appropriate patients for screening, measurement techniques, and surveillance schedules with BIS performed with the L-Dex device.…”