title: The importance of detection of subclinical lymphedema for the prevention of breast cancer-related clinical lymphedema after axillary lymph node dissection; a prospective observational study.
abstract: OBJECTIVE
  Early detection and timely intervention have potential to reduce late-stage lymphedema (LE) in patients with breast cancer undergoing axillary lymph node dissection (ALND). This study aims to determine if detection and early treatment of subclinical LE by using prospective monitoring with bioimpedance spectroscopy (BIS) can lead to reduced development of clinical LE.
  
  
  RESULTS
  Subclinical LE was prospectively detected using an L-Dex(®) U400 analyzer to measure BIS in 186 patients who underwent ALND between 2010 and 2013 through our LE monitoring program. Baseline measurements were obtained and at 3-6 month intervals for 5 years. Patients diagnosed with subclinical LE received short-term physical therapy, compression garments, and education about exercise, elevation, infection precautions, BMI, and hand usage. The control group had a preoperative baseline L-Dex(®) measurement, but had only clinical follow-ups with circumferential arm measurements. Mean age and BMI were 56 years and 28.3 kg/m(2), respectively. The majority of the women underwent mastectomy (61%) and received chemotherapy (89%) and radiotherapy (77%). Thirty-three percent patients who had repeated L-Dex measurements were diagnosed with subclinical LE and received early intervention. Progression to clinical lymphedema occurred in 4.4% over an average of 20 months follow-up. In the control group, the incidence of clinical LE was 36.4%.
  
  
  CONCLUSIONS
  Periodic monitoring of women at high risk for LE with BIS allows early detection and timely intervention for LE, which reduces the incidence of clinical LE from 36.4% to 4.4%. This may have implications for quality of life and health care costs.
authors.affiliation: Breast Unit, Department of Surgical Oncology, Magee-Womens Hospital of UPMC , Pittsburgh, Pennsylvania.
authors.forename: Atilla
authors.initials: A
authors.lastname: Soran
authors.forename: Tolga
authors.initials: T
authors.lastname: Ozmen
authors.forename: Kandace P
authors.initials: KP
authors.lastname: McGuire
authors.forename: Emilia J
authors.initials: EJ
authors.lastname: Diego
authors.forename: Priscilla F
authors.initials: PF
authors.lastname: McAuliffe
authors.forename: Marguerite
authors.initials: M
authors.lastname: Bonaventura
authors.forename: Gretchen M
authors.initials: GM
authors.lastname: Ahrendt
authors.forename: Lori
authors.initials: L
authors.lastname: DeGore
authors.forename: Ronald
authors.initials: R
authors.lastname: Johnson
mesh_terms: D001365:Axilla; D001943:Breast Neoplasms / Q000473:pathology / Q000601:surgery*; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects*; D008209:Lymphedema / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control*; D008408:Mastectomy / Q000009:adverse effects*; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D021701:Sentinel Lymph Node Biopsy / Q000009:adverse effects*