Correlation of Bioimpedance Spectroscopy with Risk Factors for the Development of Breast Cancer-Related Lymphedema

Background: We reviewed serial bioimpedance measurements in order to quantify the relationship between changes in these scores and a patient's risk for developing breast cancer-related lymphedema (BCRL). Methods and Results: From April 2010 through November 2016, 505 patients were prospectively evaluated using bioimpedance spectroscopy (BIS/L-Dex). Patients received preoperative and postoperative L-Dex measurements and were categorized based upon risk for BCRL with respect to axillary staging procedure, radiation use, taxane use, and body mass index (BMI). L-Dex change was associated with the type and number of BCRL risk factors. Both axillary lymph node dissection (ALND) and regional nodal irradiation (RNI) were associated with a greater change in L-Dex (p < 0.001), although elevated BMI was not associated. The median, maximal change in L-Dex for patients treated with ALND, RNI, and taxanes was 16.7 versus 5.2 for ALND alone and 3.7 for sentinel lymph node biopsy (SLNB) alone (p = 0.016). In a model using all four risk factors to predict the maximal change in L-Dex, ALND and RNI remained significantly associated with maximum change (p < 0.05). The time required to reach maximal change in L-Dex was shorter in patients treated with ALND or RNI (the time for 25% of patients achieving an L-Dex ≥7 was 4.3 months for ALND, RNI, and taxanes patients versus 30.8 months for SLNB-alone patients). Conclusions: Risk factors for development of BCRL were associated with both the magnitude and timing of change in L-Dex scores. These findings demonstrate the utility of serial L-Dex measurements in providing an objective assessment of a patient's lymphedema status and the value of L-Dex serial measurements to assist in monitoring patients for the development of BCRL. This supports the clinical utilization of serial L-Dex scores to follow patients at risk for BCRL.