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. 2020 Jul;123(1):17-25.
doi: 10.1038/s41416-020-0844-4. Epub 2020 May 4.

Increases in arm volume predict lymphoedema and quality of life deficits after axillary surgery: a prospective cohort study

Nigel Bundred  1   2 , Phil Foden  3   4 , Chris Todd  3   4   5 , Julie Morris  3   4 , Donna Watterson  3   4 , Arnie Purushotham  6 , Maria Bramley  7 , Katie Riches  8 , Tracey Hodgkiss  7 , Abigail Evans  9 , Anthony Skene  10 , Vaughan Keeley  8   11 ; Investigators of BEA/PLACE studies
Affiliations

Increases in arm volume predict lymphoedema and quality of life deficits after axillary surgery: a prospective cohort study

Nigel Bundred et al. Br J Cancer. 2020 Jul.

Abstract

Background: Lymphoedema develops after axillary clearance (ANC) in 25% of patients. This prospective, multi-centre study compared multi-frequency bioimpedance spectroscopy (BIS) with arm volume measurement to: (1) determine which test has better diagnostic accuracy, (2) identify factors predicting development of lymphoedema, and its effect on quality-of-life.

Methods: Participants (N = 1100) underwent measurements pre and post-ANC surgery for breast cancer. Relative arm volume increase (RAVI) of >10% diagnosed lymphoedema. Predictors of lymphoedema were determined using logistic regression. Optimal diagnostic method was assessed using diagnostic accuracy. Quality-of-life was assessed using the FACT B + 4 questionnaire.

Results: Lymphoedema was diagnosed in 22.8% women using RAVI > 10%, 45.6% using BIS criteria, while 24.5% underwent compression sleeve application by 24 months. BMI > 30 was an independent factor for both development (p = 0.005) and progression (p = 0.015) of lymphoedema. RAVI at 1 month, BMI > 30 and number of involved nodes contributed to a novel scoring model to predict lymphoedema by 36 months. Larger decreases in QoL scores post-surgery occurred in lymphoedema patients (p < 0.001). Progression to moderate lymphoedema occurred in 15% patients after sleeve application.

Conclusions: RAVI measurement was the best diagnostic tool for lymphoedema. BIS alone is not appropriate for lymphoedema screening or diagnosis. BMI > 30 predicted lymphoedema diagnosis and progression.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Changes in self-reported symptoms from ARM subscale and objective measures of arm swelling compared to Lymphoedema sleeve application.
Frequency of self-reported and objective symptoms of lymphoedema compared to Lymphoedema sleeve application. Diagnosis of Lymphoedema based on RAVI > 10%. Frequency of objective and self-reported definitions of Lymphoedema by time. The B3 question is part of the Fact-B + 4 self-reported questionnaire and the heaviness and swelling are from the lymphoedema checklist questionnaire. N represents the number assessed for each modality at baseline and the numbers at each timepoint.
Fig. 2
Fig. 2. CONSORT diagram showing recruitment to BEA study and numbers with arm volume increase >10%: 4–9% or less than 4% over the first 9 months of the study.
Bottom boxes show patients lost to followup, or dying.
See this image and copyright information in PMC

Comment in

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