Abstract P6-12-16: L-Dex surveillance of breast cancer-related lymphoedema: A retrospective study
Authors: Koelmeyer LA , Borotkanics R , Winch CJ , Prah P , Alcorso JM , Nakhel K , Boyages J 
Published: February 2018

Abstract
Objectives: Breast cancer-related lymphoedema involves chronic, progressive, and incurable swelling in the treated breast or ipsilateral arm, hand, and/or trunk. The traditional referall-based model of care involves women being referred to a lymphoedema therapist after the onset of symptoms. Clinical guidelines from the United States, United Kingdom, and Australia have urged that lymphoedema surveillance and early intervention be implemented routinely after breast cancer treatment. Bioimpedance spectroscopy (BIS) is a candidate diagnostic modality for lymphoedema surveillance because BIS may measure the accumulating extracellular fluid that is characteristic of early lymphoedema. This cohort study aimed to determine whether prospective surveillance using BIS resulted in earlier detection and effective management of lymphoedema.
Method: The study cohort were women with breast cancer referred to a single lymphoedema therapist at a private multidisciplinary practice in Sydney, Australia. Data was collected prospectively between 1 January 2007 and 31 December 2016, during which 824 women were measured using an ImpediMed L-Dex® U400 BIS device. Women were defined as surveillance if monitoring began pre-surgery (n = 292/824) or within 90 days post-surgery (n = 148/824) and continued for at least 90 days thereafter. Women were defined as referrals if monitoring began after 90 days post-surgery (n = 318/824). Lymphoedema was diagnosed if BIS indicated extracellular fluid levels had increased by &gt;10 L-Dex points from a woman's pre-surgical baseline, or exceeded the normative range by &gt;10 L-Dex points or were maintained below these levels only by ongoing compression use. International Society of Lymphology stage at diagnosis was recorded. Swelling within 90 days of surgery or 270 days of commencing taxane-based chemotherapy was not defined as lymphoedema.
Results: Patient chart data was analysed retrospectively. The L-Dex measurements in the referral group were taken significantly longer post-surgery (Med = 784 days, IQR = 356-1977) than the surveillance group (Med = 124 days, IQR = 104-188, p &lt; 0.001). A higher proportion of women in the surveillance group were diagnosed at the subclinical and mild stages of lymphoedema (Stage 0 and Stage 1) in comparison to women in the referral group who were more likely to be diagnosed in the moderate or severe stages of lymphoedema (Stage 2 and Stage 3). Higher median L-Dex values were found for women in the referral group (Med = 4.3, IQR = -0.8-13.6) than those in the surveillance group (Med = 2.2, IQR = -1.9-5.8, p &lt; 0.001).
Conclusion: Prospective surveillance may result in earlier intervention with L-Dex measurements, earlier diagnosis of lymphoedema and lower L-Dex values. Ongoing statistical analyses will inform the clinical risk factors leading to increased lymphoedema incidence. This study has important implications for breast cancer clinical practice guidelines.
Citation Format: Koelmeyer LA, Borotkanics R, Winch CJ, Prah P, Alcorso JM, Nakhel K, Boyages J. L-Dex surveillance of breast cancer-related lymphoedema: A retrospective study [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-12-16.