Abstract P6-08-07: Optimal method of detection and threshold for early intervention to prevent lymphoedema: A multi-centre prospective study
Authors: Bundred Nigel J , Stockton Charlotte , Riches Katie , Ashcroft Linda , Evans Abigail , Skene Anthony , Bramley Maria , Hodgkiss Tracey , Purushotham Arnie , Keeley Vaughan ,   BEA Investigators
Published: May 2015

Abstract
Introduction
Women who undergo axillary surgery are at risk of developing lymphoedema. Early detection is recommended by measuring arm volume from a baseline before surgery to enable early intervention. The optimal measurement method to enable early detection and time to intervention are unclear. This prospective multi-centre study compares multi-frequency bioimpedance spectroscopy (BIS, ImpediMed) with the validated perometer method to determine which test is more sensitive for detecting the optimal threshold to prevent lymphoedema.
Methods
Participants (N = 960) undergoing axillary clearance at 9 UK centres have pre-operative and regular arm volume measurements post-surgery (1, 3, 6, 9 & 12 months, then 6 monthly), by the validated arm perometry compared with BIS (L-Dex) measurements as well as self-reported symptoms questionnaire. Change in arm volume was calculated using relative arm volume change (RAVC). The predictors of lymphoedema development and optimal method were assessed.
Results
Currently 612 patients, median age 55 (range 24 to 90) years, have 6 month follow-up data and 327 have 18 month follow-up data. Seventy six percent were ER positive and received endocrine therapy, 84% percent received radiotherapy and 67% received chemotherapy in addition to surgery. Lymphoedema by 18 months was detected in 19% (n=79) of women by perometry (≥10% RAVC) and a change in L-Dex of 10 was observed in 31% of women. A 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% was found.
Univariate analysis revealed a threshold for early intervention to prevent lymphoedema was RAVC ≥5%-&lt;10% (p=0.03). Multivariate analysis indicated that Oestrogen Receptor (ER) negative breast cancer (p=0.01, hazard ratio (HR)=0.43, 95% confidence interval (CI)=0.24 to 0.84), number of positive nodes (p=0.01, HR=1.05, 95% CI=1.01 to 1.09) and a measurement of ≥5%-&lt;10% (p=0.04, HR=1.67, 95% CI=1.03 to 3.54) at 6 months after surgery predicted development of lymphoedema. Further investigation of why ER negative patients are at increased risk of developing lymphoedema is planned.
Conclusions
The optimal threshold for early intervention to prevent progression to lymphoedema is ≥5%-&lt;10% relative arm volume change by perometry. Further data on the sensitivity of BIS will be obtained in this study. Arm volume measurements remain necessary before and after ANC to allow early intervention.
(Funded by NIHR Programme Grant).
Citation Format: Nigel J Bundred, Charlotte Stockton, Katie Riches, Linda Ashcroft, Abigail Evans, Anthony Skene, Maria Bramley, Tracey Hodgkiss, Arnie Purushotham, Vaughan Keeley, BEA Investigators. Optimal method of detection and threshold for early intervention to prevent lymphoedema: A multi-centre prospective study [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P6-08-07.