Abstract P5-08-18: A novel free-to-use software for upper limb volume quantification in breast cancer related lymphedema: implementing cutting-edge technology in the individualized therapeutic approaches of breast cancer survivors
Authors: Lippi Lorenzo , Nascimben Mauro , de Sire Alessandro , Folli Arianna , Fusco Nicola , Rimondini Lia , Invernizzi Marco 
Published: March 2023

Abstract
BACKGROUND: Breast cancer related lymphedema (BCRL) is a detrimental condition affecting a growing number of breast cancer (BC) survivors worldwide [1]. Effective screening programs and early diagnosis are mandatory in the clinical management of this disabling condition and limb volume assessment plays a crucial role [1]. However, a reproducible volumetric assessment is still challenging in clinical practice. In this scenario, augmented reality tools have been recently proposed for volumetric quantification of BCRL [2]. Despite the advantages in safety and time effectiveness, the integration of these devices in clinical practice is affected by several barriers, and free-to-use software for volume quantification are still lacking [3]. Therefore, the aim of this study was to develop and validate a free-to-use software for volume quantification of BCRL in order to overcome barriers to technology implementation in the complex management of BC patients. METHODS: A cohort of mixed-gender young adults was assessed by tridimensional laser scanning, centimetric method, and water displacement method. The upper limb volume measures were saved and processed using a software package composed of three programs (Edit 3D, Slice 3D, Cut 3D). The novel software package was specifically developed and freely released on the online site https://mn-visions.gitbook.455io/software-kit-for-3dls-limb-volume-quantification/. In addition, hand volume has been assessed two groups (experimental group and optimization group). Digital volume quantification algorithms have been specifically designed using the gift wrapping (GW) or cubic tessellation (TE) method. The novel software package was subsequently used to assess a small pilot sample of BCRL patients. The upper limb volumes were analyzed to assess linear regression and correlation, level of agreement, and consistency between the different methods. RESULTS: Fourty upper limb volumes of 20 participants were assessed in the present study. The linear regression analysis showed a statistically significant correlation between laser scanning method and centimetric method (R2= 0.99, p&lt; 0.0001). A high level of agreement was reported (R2 interval from 0.93 to 0.97, r ranged from 0.965 to 0.984) between the centimetric method and the novel software package. Hand volume has been assessed in 5 subjects (experimental group). The optimization group (n: 4) demonstrated that the hand volumes calculated from digital method (tessellation method) show a high correlation with the values obtained with water displacement (ρ = 0.83; p &lt; 0.05). Preliminary data from BCRL women were recently assessed (n:3) and suggested a high correlation between LS3D and centimetric method (R2= 0.96). CONCLUSION: Our data underlined promising results for the implementation in clinical setting of the three programs Edit 3D, Slice 3D, Cut 3D for the upper limb volume quantification. In addition, significant correlations between water displacement method (gold standard) and hand digital volume method were highlighted, suggesting intriguing implications in a precise quantification of hand volume in clinical setting. These findings might provide advantages in reproducibility between different operators enhancing data sharing between different centers. Future data on BCRL patients are needed to confirm the role of this novel free-to-use software in the rehabilitation management of breast cancer survivors. REFERENCES: 1. Heller DR et al. Prevention Is Key: Importance of Early Recognition and Referral in Combating Breast Cancer–Related Lymphedema. Journal of Oncology Practice 2019;15:263–4. 2. Invernizzi M et al. Integrating Augmented Reality Tools in Breast Cancer Related Lymphedema Prognostication and Diagnosis. J Vis Exp. 2020 6;(156). 3. Kassamani YW et al. Diagnostic Criteria for Breast Cancer-Related Lymphedema of the Upper Extremity: The Need for Universal Agreement. Ann Surg Oncol. 2022;29(2):989-1002
Citation Format: Lorenzo Lippi, Mauro Nascimben, Alessandro de Sire, Arianna Folli, Nicola Fusco, Lia Rimondini, Marco Invernizzi. A novel free-to-use software for upper limb volume quantification in breast cancer related lymphedema: implementing cutting-edge technology in the individualized therapeutic approaches of breast cancer survivors [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P5-08-18.