Screening for breast cancer related lymphoedema (LE) is recommended best practice to allow early detection and early intervention, potentially preventing progression of LE. Bioimpedance spectroscopy (BIS) is used to screen for LE in patients pre and post axillary surgery, and is used to screen LE at the Peter MacCallum Cancer Centre (PMCC). Known predictors of LE in this population include; number of lymph nodes removed, number of positive nodes, extent of surgery, and BMI >30.
A retrospective cohort study was conducted reviewing patient histories of all patients undergoing axillary surgery at PMCC from 2007-2013. 192 patients were included in the study who had BIS screening pre and/or post operatively with 172 from the breast stream. A logistic regression analysis categorised patients into ‘LE diagnosis’ or ‘No LE diagnosis’. Potential covariates were: age, gender, BMI; hand dominance; cancer diagnosis, tumour stream, and surgery type; number of nodes removed and number of nodes positive; hospital length of stay; post-operative complications; neoadjuvant and adjuvant therapies; BIS measures pre- and post-operatively (and time point); time point LE was detected; and interventions post LE diagnosis.
The prevalence of LE was 15.1% in the included patient cohort. BIS has a statistically significant predictive utility of 84% when the pre-operative and first three post-operative measures have been taken (p=0.006). Two individual variables were significantly associated with the development of LE; post-operative complications (p=0.026) and year of surgery (p=0.007).
BIS is a highly effective clinical tool with high predictive utility suggesting at least 17 months of screening post axillary surgery to capture all cases of LE.