title: Segmental limb volume change as a predictor of the onset of lymphedema in women with early breast cancer.
abstract: OBJECTIVE
  To demonstrate that segmental changes along the upper extremity occur before the onset of breast cancer-related lymphedema (BCRL). These changes may be subclinical in nature and may be predictive of the onset of chronic lymphedema.
  
  
  METHODS
  A retrospective subset analysis of a larger prospective cohort trial. PATIENT COHORT: A total of 196 patients provided consent and were enrolled in the prospective study. Subclinical lymphedema developed in 46 of these patients. Limb volume data were available for 45 of these 46 patients from visits before the onset of lymphedema and were used in this analysis. We compared this group with an age-matched control group without BCRL from the same cohort (n = 45).
  
  
  METHODS
  Military hospital outpatient breast care center.
  
  
  METHODS
  Women were enrolled and assessed preoperatively. Baseline measures of limb volume were obtained with the use of optoelectronic perometry, and reassessment was conducted at 1, 3, 6, 9, and 12 months postoperatively. BCRL was identified in 46 of 196 women at an average of 6.9 months postoperatively. A retrospective analysis was conducted in which we examined volume changes over four 10-cm segments of the limb at the visits before the onset of BCRL. By using repeated-measures multivariate analysis of variance, we compared segmental volumes between groups at preoperative baseline, time of diagnosis of BCRL, and time of follow-up after early intervention. Linear regression analysis was performed to determine the strength of the relationship between total limb volume change with segmental volumes at the time of diagnosis of BCRL.
  
  
  METHODS
  We hypothesized that segmental volume changes occur and can be measured in the limb before the onset of lymphedema.
  
  
  RESULTS
  At arm segments 10-20 cm (P = .044) and 20-30 cm (P <.001), a significant volume increase was noted before the diagnosis of subclinical BCRL. Segmental volume changes correlated to the total limb volume (TLV) change. At segments 20-30 cm, the coefficient of determination was r(2) = 0.952, and at 10-20 cm it was r(2) = 0.845, suggesting that these segments predicted TLV changes.
  
  
  CONCLUSIONS
  Serial interval assessment of limb volume segments may be an important clinical tool to detect early-onset lymphedema before TLV changes.
authors.affiliation: National Naval Medical Center, 8901 Wisconsin Avenue, Breast Care Center Bldg. 19, 3rd floor, Bethesda, MD 20889-5600(†).
authors.forename: Nicole L
authors.initials: NL
authors.lastname: Stout
authors.affiliation: University of Michigan-Flint, Flint, MI(‡).
authors.forename: Lucinda A
authors.initials: LA
authors.lastname: Pfalzer
authors.affiliation: National Institutes of Health, Bethesda, MD(§).
authors.forename: Ellen
authors.initials: E
authors.lastname: Levy
authors.affiliation: National Institutes of Health, Bethesda, MD, and CLM Consulting Rockville, MD(∥).
authors.forename: Charles
authors.initials: C
authors.lastname: McGarvey
authors.affiliation: Office of the Surgeon General, Falls Church, VA(¶).
authors.forename: Barbara
authors.initials: B
authors.lastname: Springer
authors.affiliation: National Institutes of Health, Bethesda, MD, and George Mason University, Fairfax, VA(⁎⁎).
authors.forename: Lynn H
authors.initials: LH
authors.lastname: Gerber
authors.affiliation: National Naval Medical Center, Breast Care Center, Bethesda, MD, and Naval Medical Center San Diego, CA(††).
authors.forename: Peter
authors.initials: P
authors.lastname: Soballe
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000150:complications*; D005260:Female; D006801:Humans; D008209:Lymphedema / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D034941:Upper Extremity / Q000473:pathology*