Segmental Limb Volume Change as a Predictor of the Onset of Lymphedema in Women With Early Breast Cancer

• Published in: PM & R Vol. 3; no. 12; pp. 1098 - 1105
• Main Authors: Stout, Nicole L., PT, MPT, CLT-LANA, Pfalzer, Lucinda A., PT, MA, PhD, FACSM, FAPTA, Levy, Ellen, PT, OCS, McGarvey, Charles, PT, DPT, MS, FAPTA, Springer, Barbara, PT, PhD, OCS, SCS, Gerber, Lynn H., MD, Soballe, Peter, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2011
• Subjects: Adult; Aged; Aged, 80 and over; Breast Neoplasms - complications; Female; Humans; Lymphedema - diagnosis; Lymphedema - etiology; Lymphedema - prevention & control; Middle Aged; Multivariate Analysis; Physical Medicine and Rehabilitation; Retrospective Studies; Upper Extremity - pathology
• ISSN: 1934-1482; 1934-1563
• DOI: 10.1016/j.pmrj.2011.07.021

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. Design 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). Setting 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. Main Outcome Measurements 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 r2 = 0.952, and at 10-20 cm it was r2 = 0.845, suggesting that these segments predicted TLV changes. Conclusion Serial interval assessment of limb volume segments may be an important clinical tool to detect early-onset lymphedema before TLV changes.