Assessing Lymphedema in Breast Cancer Survivors

Breast cancer survivor lymphedema was accurately assessed with bioelectrical impedance analysis

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) One of the long-term side effects of breast cancer treatment is a condition called lymphedema. It’s a swelling of the arm that not only affects appearance, but can also be painful and interfere with function.

A new study looked at how lymphedema can best be assessed to ease breast cancer survivors’ fear about the condition or help them seek early treatment.

The study showed that a method called bioelectrical impedance analysis (BIA) can accurately detect lymphedema by measuring lymph fluid changes and calculating a lymphedema index called L-Dex ratio.

The researchers developed a diagnostic cut-off point they said could be a reliable sign of lymphedema.

"Talk to your oncologist about lymphedema."

Mei R. Fu, PhD, RN, ACNS-BC, associate professor of Chronic Disease Management at New York University College of Nursing (NYUCN), led a team of researchers in this study of the reliability of the L-Dex ratio as a means of detecting lymphedema in breast cancer survivors.

Depending on the type of surgery involved, lymphedema is seen in up to one in five women who have been treated for breast cancer.

Lymphedema is the result of the lymphatic system, which is a key part of the immune system, being compromised by surgical removal of lymph nodes and/or radiotherapy.

Dr. Fu said in a statement, "Given that all the women who are treated for breast cancer are at a lifetime risk for lymphedema, using assessment methods that can accurately identify true lymphedema cases among at-risk breast cancer survivors is of the ultimate importance for clinical practice."

For this study, the researchers gathered information from 250 women, including breast cancer survivors with lymphedema, survivors at risk for the condition and healthy female adults.

Medical histories were taken, demographic (age, education, marital status, etc.) information was recorded, and each participant’s BMI (body mass index) was calculated.

Dr. Fu and colleagues used an FDA-approved BMIA device (Imp XCA) to measure lymph fluid. BIA is typically used to measure body composition, particularly body fat.

The BIA device calculates a lymphedema index ratio that ranges from -10 to +10.

The researchers concluded that the best cut-off point for diagnosing lymphedema is a ratio that's greater than +7.1.

The authors cautioned, “It is important to note that because using a cutoff of L-Dex ratio [greater than] +7.1 still misses 20 percent of true lymphedema cases, it is important for clinicians to integrate other assessment methods (such as self-report, clinical observation, or perometry) to ensure the accurate detection of lymphedema.”

“Our study provided evidence to support BIA using L-Dex ratio as a highly reliable method to assess lymphedema among healthy women and breast cancer survivors at-risk for lymphedema,” the researchers wrote.

This study was published in the journal Lymphology.

The research was supported by the Avon Foundation, National Institutes of Health, New York University (NYU) Hartford Institute for Geriatric Nursing and Vital Fund.

No conflicts of interest were reported.

Review Date: 
November 15, 2013
Last Updated:
November 16, 2013