Is bioimpedance spectroscopy a useful tool for objectively assessing lymphovenous bypass surgical outcomes in breast cancer-related lymphedema?

Sutherland, Amanda; Wagner, Jamie L.; Korentager, Sabrina S.; Butterworth, James A.; Amin, Amanda L.; Balanoff, Christa; Hangge, Amanda N.; Larson, Kelsey E.

doi:10.1007/s10549-020-06059-6

Cited by 9 publications

(10 citation statements)

References 19 publications

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“…Both Cho et al and Cavezzi et al considered that bioimpedance analysis is feasible for detecting slight extracellular fluid changes after complex decongestive therapy [36,37], and therefore, is practical for outcome monitoring. For surgical intervention of lymphedema, Sutherland et al first utilized BIS to assess the effect of lymphovenous bypass for breast cancer-related lymphedema, and reported clinically significant improvement after lymphovenous bypass [38]. The above modalities measure the entire limb rather than the segmental measurement.…”

Section: Discussionmentioning

confidence: 99%

Novel Wireless Bioimpedance Device for Segmental Lymphedema Analysis Post Dual-Site Free Vascularized Lymph Node Transfer: A Prospective Cohort Study

Chang

Jan

Juan

et al. 2021

Sensors

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An innovative wireless device for bioimpedance analysis was developed for post-dual-site free vascularized lymph node transfer (VLNT) evaluation. Seven patients received dual-site free VLNT for unilateral upper or lower limb lymphedema. A total of 10 healthy college students were enrolled in the healthy control group. The device was applied to the affected and unaffected limbs to assess segmental alterations in bioimpedance. The affected proximal limb showed a significant increase in bioimpedance at postoperative sixth month (3.3 [2.8, 3.6], p = 0.001) with 10 kHz currents for better penetration, although the difference was not significant (3.3 [3.3, 3.8]) at 1 kHz. The bioimpedance of the affected distal limb significantly increased after dual-site free VLNT surgery, whether passing with the 1 kHz (1.6 [0.7, 3.4], p = 0.030, postoperative first month; 2.8 [1.0, 4.2], p = 0.027, postoperative third month; and 1.3 [1.3, 3.4], p = 0.009, postoperative sixth month) or 10 kHz current ((1.4 [0.5, 2.7], p = 0.049, postoperative first month; 3.2 [0.9, 6.3], p = 0.003, postoperative third month; and 3.6 [2.5, 4.1], p < 0.001, postoperative sixth month). Bioimpedance alterations on the affected distal limb were significantly correlated with follow-up time (rho = 0.456, p = 0.029 detected at 10 kHz). This bioimpedance wireless device could quantitatively monitor the interstitial fluid alterations, which is suitable for postoperative real-time surveillance.

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Section: Discussionmentioning

confidence: 99%

Novel Wireless Bioimpedance Device for Segmental Lymphedema Analysis Post Dual-Site Free Vascularized Lymph Node Transfer: A Prospective Cohort Study

Chang

Jan

Juan

et al. 2021

Sensors

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“…6 BIS, which uses resistance to electrical current to compare composition of fluid compartments, is a cost-effective, reliable, and accurate tool for early detection, staging, and assessment of breast-cancer related lymphedema. [7][8][9] BIS measurement is non-invasive and rapid, allowing point of care testing. Using BIS was shown in the PREVENT trial to be more effective at preventing lymphedema progression than using traditional measures of arm circumference to trigger intervention.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Association between Bioimpedance Spectroscopy and Magnetic Resonance Lymphangiography in the Diagnosis and Assessment of Lymphedema

Varagur

Shetty

Saoud

et al. 2023

J Reconstr Microsurg

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Background: This study assesses associations between bioimpedance spectroscopy (BIS) and magnetic resonance lymphangiography (MRL) in staging and assessment of lymphedema. Methods: Adults who received MRL and BIS between 2020-2022 were included. We collected fluid, fat, and lymphedema severity ratings, and measured fluid stripe thickness, subcutaneous fat width, and lymphatic diameter on MRL. BIS Lymphedema Index (L-Dex®) scores were collected from patient charts. We assessed sensitivity and specificity of L-Dex scores to detect MRL-identified lymphedema, and examined associations between L-Dex scores and MRL imaging measures. Results: 48 limbs across 40 patients were included. L-Dex scores had 72.5% sensitivity and 87.5% specificity for detecting MRL-defined lymphedema, with a 96.7% estimated positive predictive value and 38.9% negative predictive value. L-Dex scores were associated with MRL fluid and fat content scores (p≤0.05), and lymphedema severity (p=0.01), with better discrimination between fluid than fat content levels on pairwise analysis, and poor discrimination between adjacent severity levels. L-Dex scores were correlated with distal and proximal limb fluid stripe thickness (distal: rho=0.57, p<0.01; proximal: rho=0.58, p<0.01), partially correlated with distal subcutaneous fat thickness when accounting for BMI (rho=0.34, p=0.02), and were not correlated with lymphatic diameter (p=0.25). Conclusion: L-Dex scores have high sensitivity, specificity, and positive predictive value for the identification of MRL-detected lymphedema. L-Dex has difficulty distinguishing between adjacent severity levels of lymphedema and a high false negative rate, explained in part by reduced discrimination between levels of fat accumulation

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“…Despite several established methods for lymphedema evaluation including water displacement, perometry, and circumferential measurements; biompedence spectroscopy (BIS) has emerged as a valid diagnostic modality for monitoring subclinical disease and trending clinical lymphedema 1 . By measuring tissue resistance to an electrical current, BIS selectively quantifies extracellular fluid in an extremity, which may then be compared with the unaffected limb to provide an objective measurement of lymphedema, the Lymphedema Index (LDEX) 4,5,16 . Previously employed as a consistent, reproducible modality for monitoring response to delayed lymphaticovenular bypass, utilization in monitoring subclinical lymphedema after ILR is a topic currently under exploration 5 .…”

mentioning

confidence: 99%

“…1 By measuring tissue resistance to an electrical current, BIS selectively quantifies extracellular fluid in an extremity, which may then be compared with the unaffected limb to provide an objective measurement of lymphedema, the Lymphedema Index (LDEX). 4,5,16 Previously employed as a consistent, reproducible modality for monitoring response to delayed lymphaticovenular bypass, utilization in monitoring subclinical lymphedema after ILR is a topic currently under exploration. 5 Biompedence spectroscopy is noninvasive, relatively inexpensive, and broadly applicable in the community as compared with other modalities.…”

mentioning

confidence: 99%

“…4,5,16 Previously employed as a consistent, reproducible modality for monitoring response to delayed lymphaticovenular bypass, utilization in monitoring subclinical lymphedema after ILR is a topic currently under exploration. 5 Biompedence spectroscopy is noninvasive, relatively inexpensive, and broadly applicable in the community as compared with other modalities.…”

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confidence: 99%

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Relationship of Adjuvant Radiation and the Lymphedema Index

et al. 2022

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Background Immediate lymphaticovenular bypass (immediate lymphatic reconstruction [ILR]) at the time of axillary lymph node dissection has emerged as a preventative paradigm to decrease the incidence of breast cancer–related lymphedema in high-risk patients. These patients are often treated with adjuvant therapies, including radiation. Bioimpedance spectroscopy is a validated tool for trending breast cancer–related lymphedema and identifying subclinical disease. Lymphedema Index (LDEX) values are commonly obtained in ILR patients; however, postoperative trends and relationships with adjuvant treatments are yet to be reported in the literature. Methods After International Review Board approval, 100 consecutive patients underwent axillary lymph node dissection with axillary reverse lymphatic mapping and ILR at a tertiary cancer center. These patients were then followed prospectively in a multidisciplinary lymphedema clinic at 3-month intervals with clinical examination, circumferential limb girth measurements and bioimpedance spectroscopy (LDEX). Results Seventy-two patients met inclusion for analysis at 3 months, 60 at 6 months, 51 at 9 months, 45 at 12 months, 41 at 15 months, and 22 at 18 months. A majority of the patients included underwent adjuvant radiation. Average LDEX score for patients who developed lymphedema was 3.02 at 3 months, at 29.1 months, 17.8 at 9 months, 15.05 at 12 months, 18.75 at 15 months, and 7.7 at 18 months. Patients who went on to develop lymphedema had a higher LDEX score at 6 months (29.1 vs 3.20, P = 0.1329), which reached a significant difference beginning at 9 months (17.8 vs 3.19, P = 0.0004). All patients who went on to develop lymphedema received adjuvant radiation. Conclusions These data provide valuable insight guiding follow-up after ILR. Six-month LDEX is much higher in patients who developed lymphedema, all of which underwent adjuvant radiation therapy, which correlates with the time of completion of their treatment. Average LDEX value after this remains significantly higher in this population. Patients who demonstrate this increase in LDEX and received adjuvant radiation are at highest risk to develop lymphedema despite ILR. All patients who developed lymphedema despite ILR had adjuvant radiation, and this is likely a contributing factor. Injury from adjuvant radiation and its impact after ILR is not insignificant and warrants further studies.

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Is bioimpedance spectroscopy a useful tool for objectively assessing lymphovenous bypass surgical outcomes in breast cancer-related lymphedema?

Cited by 9 publications

References 19 publications

Novel Wireless Bioimpedance Device for Segmental Lymphedema Analysis Post Dual-Site Free Vascularized Lymph Node Transfer: A Prospective Cohort Study

Novel Wireless Bioimpedance Device for Segmental Lymphedema Analysis Post Dual-Site Free Vascularized Lymph Node Transfer: A Prospective Cohort Study

Association between Bioimpedance Spectroscopy and Magnetic Resonance Lymphangiography in the Diagnosis and Assessment of Lymphedema

Relationship of Adjuvant Radiation and the Lymphedema Index

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