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Review
. 2023 Feb;198(1):1-9.
doi: 10.1007/s10549-022-06850-7. Epub 2022 Dec 24.

Bioimpedance spectroscopy for breast cancer-related lymphedema assessment: clinical practice guidelines

Chirag Shah  1 , Pat Whitworth  2 , Stephanie Valente  3 , Graham S Schwarz  4 , Megan Kruse  5 , Manpreet Kohli  6 , Kirstyn Brownson  7 , Laura Lawson  2 , Beth Dupree  8 , Frank A Vicini  9
Affiliations
Review

Bioimpedance spectroscopy for breast cancer-related lymphedema assessment: clinical practice guidelines

Chirag Shah et al. Breast Cancer Res Treat. 2023 Feb.

Abstract

Purpose: Breast cancer-related lymphedema (BCRL) represents a significant concern for patients following breast cancer treatment, and assessment for BCRL represents a key component of survivorship efforts. Growing data has demonstrated the benefits of early detection and treatment of BCRL. Traditional diagnostic modalities are less able to detect reversible subclinical BCRL while newer techniques such as bioimpedance spectroscopy (BIS) have shown the ability to detect subclinical BCRL, allowing for early intervention and low rates of chronic BCRL with level I evidence. We present updated clinical practice guidelines for BIS utilization to assess for BCRL.

Methods and results: Review of the literature identified a randomized controlled trial and other published data which form the basis for the recommendations made. The final results of the PREVENT trial, with 3-year follow-up, demonstrated an absolute reduction of 11.3% and relative reduction of 59% in chronic BCRL (through utilization of compression garment therapy) with BIS as compared to tape measurement. This is in keeping with real-world data demonstrating the effectiveness of BIS in a prospective surveillance model. For optimal outcomes patients should receive an initial pre-treatment measurement and subsequently be followed at a minimum quarterly for first 3 years then biannually for years 4-5, then annually as appropriate, consistent with previous guidelines; the target for intervention has been changed from a change in L-Dex of 10 to 6.5. The lack of pre-operative measure does not preclude inclusion in the prospective surveillance model of care.

Conclusion: The updated clinical practice guidelines present a standardized approach for a prospective model of care using BIS for BCRL assessment and supported by evidence from a randomized controlled trial as well as real-world data.

Keywords: Bioimpedance spectroscopy; Breast cancer; Clinical guidelines; L-Dex; Lymphedema.

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Conflict of interest statement

Chirag Shah- Scientific Consultant ImpediMed, Consultant PreludeX, Consultant Evicore, Consultant Videra Surgical. Frank Vicini- CMO ImpediMed. Stephanie Valente- Oncology Advisory Board/Consultant for ImpediMed, AxoGen, Merit and Pacira. Pat Whitworth- Partner TME LLC, Consultant Impedimed. Graham Schwarz- Consultant Impedimed, Quest Medical Imaging. Megan Kruse declares that she has no conflicts of interest. Manpreet Kohli- Oncology Advisory Board, Impedimed. Kirstyn Brownson- Oncology Advisory Board, Impedimed. Laura Lawson- Oncology Advisory Board, Impedimed. Beth Dupree declares that she has no conflicts of interest.

Figures

Fig. 1
Fig. 1
Reading from SOZO device
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References

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