Improving detection of upper limb lymphoedema

Abstract

Prospective monitoring for onset of breast cancer-related lymphoedema (BCRL) following surgery for breast cancer may improve early detection and treatment outcomes. In situations in which prospective monitoring programs are not available or feasible, such as rural and remote areas, BCRL may not be detected until it is difficult to treat. This program of research investigated the capacity for patient self-assessment to inform BCRL detection. In the first study, a novel technique to detect mild and localised BCRL using bioimpedance spectroscopy (BIS) was undertaken using impedance measurements of four 10cm segments along the arm and hand (SEG-BIS). In the second study, SEG-BIS was tested against currently used whole arm BIS (ARM-BIS) thresholds in a group of women with a history of breast cancer and known BCRL status. The third study focused on the BIS instrumentation, evaluating potential sources of error and the impact of different electrodes on measurement. In the last study, a combination of SEG-BIS and ARM-BIS measurements were undertaken to determine associations between patient-reported symptoms and specific physical signs and BCRL presence. Determination of arm and hand SEG-BIS thresholds led to the development of two SEG-BIS detection criteria which detected BCRL without falsely identifying the condition. Patients accurately identified specific physical signs of BCRL in their arm. Patient-reported swelling and forearm tissue-pinch were highly associated with BIS-detected BCRL, with an absence of both identifying those who did not have the condition. A BCRL self-assessment (BCRL-SAS) tool incorporating swelling and forearm tissue-pinch is therefore proposed. Validation of the BCRL-SAS is required. If effective, this tool could inform patient decisions regarding the need or lack of need for lymphoedema assessment. This capacity may improve patient treatment burden and outcomes, particularly where prospective monitoring is not available.