Comparison of multi-frequency bioimpedance with perometry for the early detection and intervention of lymphoedema after axillary node clearance for breast cancer

Abstract

The importance of early detection of lymphoedema by arm volume measurements before surgery and repeated measurements after surgery in women undergoing axillary node clearance (ANC) in order to enable early intervention is recognised. A prospective multi-centre study was performed which studied the difference between multi-frequency bioimpedance electrical analysis (BIS) and perometer arm measurement in predicting the development of lymphoedema. Women undergoing ANC underwent pre-operative and regular post-operative measurements of arm volume by both methods. The primary endpoint is the incidence of lymphoedema (≥10 % arm volume increase compared to contralateral arm by perometer) at 2 and 5 years after ANC. The threshold for intervention in lymphoedema was also assessed. Out of 964 patients recruited, 612 had minimum 6 months follow-up data. Using 1-month post-operative measurements as baseline, perometer detected 31 patients with lymphoedema by 6 months (BIS detected 53). By 6 months, 89 % of those with no lymphoedema reported at least one symptom. There was moderate correlation between perometer and BIS at 3 months (r = 0.40) and 6 months (r = 0.60), with a sensitivity of 73 % and specificity of 84 %. Univariate and multivariate analyses revealed a threshold for early intervention of ≥5 to <10 % (p = 0.03). Threshold for early intervention to prevent progression to lymphoedema is ≥5 to <10 % but symptoms alone do not predict lymphoedema. The modest correlation between methods at 6 months indicates arm volume measurements remain gold standard, although longer term follow-up is required.

Diagnosis of upper limb lymphedema: development of an evidence-based approach

“…As previous diagnosis of LE does not guarantee continued presence of LE, it is not an appropriate reference standard. Other studies have evaluated diagnostic thresholds using measurement tools, such as water displacement or BIS, with nonvalidated thresholds as the reference standard [18,19]. In contrast, the present study employed lymphoscintigraphy imaging as the reference standard.…”

Diagnosis of Upper-Quadrant Lymphedema Secondary to Cancer: Clinical Practice Guideline From the Oncology Section of APTA

“…Concurrent validity has been studied using a variety of assessment methods involving both clinical and research models of BIA devices. Moderate to strong correlations have been reported between BIA data and both self-report ( r = 0.71, research model46) and perometry results ( r = 0.71-0.93, research model34,42,43,47; r = 0.40-0.60, clinical model48). Correlation with circumferential measurement ranged from low (clinical model)49 to moderate (0.31-0.52, research model,50 clinical model41).…”

The Lymphatic System in Disease Processes and Cancer Progression

“…Alternatively, the clinician may use perometry or multifrequency bioimpedance measurements, which are automated LV scanning methods that eliminate interobserver variability, but these are more expensive. Comparison between these LV measurement methods shows that the use of a tape measure for early diagnosis of lymphedema in patients is effective, but the sensitivity of this technique leads to some uncertainty (186). …”