Abstract
Objective: Breast cancer related lymphedema (BCRL) may be assessed through objective measurement of limb swelling with common techniques
including volumetric measurement using a tape measure or perometry, and measurement of extracellular water using bioimpedance spectroscopy (BIS).
This study aimed to evaluate the performance of a stand-on BIS device for detection of BCRL, introduce a novel graphical method to compare volumetric
and BIS methods alongside traditional specificity and sensitivity analysis, and determine and compare BIS thresholds with those published previously.
Materials and Methods: Female participants with indocyanine green lymphography confirmed unilateral arm lymphedema (n=197) and healthy
controls (n = 267) were assessed using a cross-sectional study design. BIS and volumetric measures were obtained in a single session.
Results: The BIS lymphedema index (L-Dex) method had a significantly higher sensitivity than the excess volume approach (area under the curve = 0.832
vs. 0.649, p = 0.0001). A threshold of L-Dex 6.5 had a higher true positive rate (70.6%) than L-Dex 10 (68.5%) although false positive rate increased from
0.4% to 2.6%. A threshold of 5% excess volume improved the true positive rate (68.5%) compared with 10% excess volume (49.7%) however the false
positive rate increased to an unacceptable 47%. The L-Dex ranges in this study were not significantly different from previously published ranges.
Conclusion: BIS was superior for identifying BCRL compared with volume measurements, reaffirming the value of this technique. However, it is
recommended that BIS be used in conjunction with comprehensive evaluation of symptoms and clinical presentation. The proposed graphical method
provides a simple and easily interpretable approach to compare and define concordance between the two commonly used methods for BCRL assessment
namely limb volume and BIS L-Dex indices. The existing BIS (L-Dex) thresholds for presence of BCRL were also validated.
including volumetric measurement using a tape measure or perometry, and measurement of extracellular water using bioimpedance spectroscopy (BIS).
This study aimed to evaluate the performance of a stand-on BIS device for detection of BCRL, introduce a novel graphical method to compare volumetric
and BIS methods alongside traditional specificity and sensitivity analysis, and determine and compare BIS thresholds with those published previously.
Materials and Methods: Female participants with indocyanine green lymphography confirmed unilateral arm lymphedema (n=197) and healthy
controls (n = 267) were assessed using a cross-sectional study design. BIS and volumetric measures were obtained in a single session.
Results: The BIS lymphedema index (L-Dex) method had a significantly higher sensitivity than the excess volume approach (area under the curve = 0.832
vs. 0.649, p = 0.0001). A threshold of L-Dex 6.5 had a higher true positive rate (70.6%) than L-Dex 10 (68.5%) although false positive rate increased from
0.4% to 2.6%. A threshold of 5% excess volume improved the true positive rate (68.5%) compared with 10% excess volume (49.7%) however the false
positive rate increased to an unacceptable 47%. The L-Dex ranges in this study were not significantly different from previously published ranges.
Conclusion: BIS was superior for identifying BCRL compared with volume measurements, reaffirming the value of this technique. However, it is
recommended that BIS be used in conjunction with comprehensive evaluation of symptoms and clinical presentation. The proposed graphical method
provides a simple and easily interpretable approach to compare and define concordance between the two commonly used methods for BCRL assessment
namely limb volume and BIS L-Dex indices. The existing BIS (L-Dex) thresholds for presence of BCRL were also validated.
| Original language | English |
|---|---|
| Pages (from-to) | 141-148 |
| Number of pages | 8 |
| Journal | European Journal of Breast Health |
| Volume | 20 |
| Issue number | 2 |
| DOIs | |
| Publication status | Published - Apr 2024 |
Bibliographical note
Copyright the Turkish Federation of Breast Diseases Societies / European Journal of Breast Health 2024. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.Keywords
- Lymphedema
- bioimpedance spectroscopy
- impedance
- L-Dex