Abstract PS9-34: Initial experience using the SOZO bio-impedance device over a 2 year surveillance period for identifying subclinical breast cancer related lymphedema (BCRL) in patients attending a multidisciplinary breast clinic
Authors: Pfeiffer Denise , Lord Meagan , Lamb Caroline , Damrill Kristi , Stewart Katrina , Rock David T 
Published: February 2021

Abstract
Lymphedema is a leading posttreatment complication for many cancer patients. Roughly 1 of 3 women treated for breast cancer with surgery, radiation, or taxane based chemotherapy will develop chronic lymphedema. Lymphedema is characterized by buildup of lymphatic fluid that causes painful and debilitating tightness and swelling of the extremity with decreased range of motion and increased risk of infection. Unfortunately, it is rarely diagnosed until it has become symptomatic due to fibrotic changes and lipid deposition caused by protein rich extracellular fluid stasis. If the condition is diagnosed when it is preclinical, stage 0, it is reversible with outpatient intervention. Traditional screening methods for lymphedema include limb measurements with a tape measure or by volume displacement however, these techniques can be inaccurate and require significant volume change in the affected limb for detection. The SOZO is a relatively new device that uses noninvasive bioimpedance spectroscopy (BIS) which can detect fluid changes as small as 36 cc. This allows detection of lymphedema at the preclinical stage allowing early intervention with decompressive therapy and compression garments which can reduce the progression of lymphedema by 95%. We reviewed our initial 2-year experience using the SOZO device for lymphedema screening in our multidisciplinary breast clinic. Of the 239 patients who were seen in the multidisciplinary breast clinic, 160 patients had a baseline measurement prior to intervention and 128 of those patients had posttreatment measurements. Of those patients, 35 (27%) were referred for lymphedema therapy. Of those patients referred, 62% were stage 0, 28% were stage I, and 6% were stage II. One patient with stage 0 lymphedema at the initial postoperative measurement progressed to stage I but returned to baseline after treatment. None of the remaining stage 0 patients developed disease progression. Of the 10 patients that had developed stage I lymphedema at the time of their initial postoperative measurement, 6 were down staged to stage 0 after appropriate treatment, 2 continue to receive lymphedema therapy but have not progressed beyond stage I, and 2 were lost to follow-up. It is important to note that 30 of the 35 patients referred for lymphedema therapy were also referred to physical therapy or occupational therapy for functional impairments including decreased range of motion, axillary cording, and scar restriction. These early results showed that a surveillance program using the SOZO bioimpedance technology with pretreatment and posttreatment measurements allows early detection of breast cancer related lymphedema in the preclinical and early clinical stages when therapeutic intervention is most effective. Early stage lymphedema was also found to be associated with an increased incidence of functional impairment including decreased range of motion, axillary cording, and scar contracture. Evaluation for those impairments should be considered in all patients who develop lymphedema.
Citation Format: Denise Pfeiffer, Meagan Lord, Caroline Lamb, Kristi Damrill, Katrina Stewart, David T Rock. Initial experience using the SOZO bio-impedance device over a 2 year surveillance period for identifying subclinical breast cancer related lymphedema (BCRL) in patients attending a multidisciplinary breast clinic [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS9-34.