Clinical Evidence

A Prospective Study of L-Dex Values in Breast Cancer Patients Pretreatment and Through 12 Months Postoperatively.

At the time of breast cancer diagnosis, L-Dex values are similar to normative values. Identified maximum changes in L-Dex values 12 months postoperatively suggest that frequent L-Dex measurements during that time frame are of potential clinical benefit. Our findings are consistent with research supporting an L-Dex value of >7 as indicative of clinical lymphedema with subclinical lymphedema logically occurring at somewhat lower likely, near >6.5.

Utilization of bioimpedance spectroscopy in lieu of invasive monitoring for monitoring fluid overload.

The total body impedance measured from the SOZO unit correlated with PAD with a correlation coefficient of 0.876. The findings from this case suggest that BIS may provide an additional noninvasive tool to detect extracellular fluid excess and impending congestion before hospitalization. BIS correlates well with diastolic PA pressures and may prove a useful adjunct in the management of HF. Further research is needed in a larger more diverse group of patients to assess the role BIS plays in the management of HF.

Reducing Breast Cancer-Related Lymphedema (BCRL) Through Prospective Surveillance Monitoring Using Bioimpedance Spectroscopy (BIS) and Patient Directed Self-Interventions.

Our results demonstrated that early conservative intervention for breast cancer patients high risk for BCRL who were prospectively monitored by utilizing BIS significantly lowers rates of BCRL. These findings support early prospective screening and intervention for BCRL. Early detection with patient-directed interventions improves patient outcomes and decreases the risk of persistent BCRL.

Preventing Breast Cancer-Related Lymphedema in High-Risk Patients: The Impact of a Structured Surveillance Protocol Using Bioimpedance Spectroscopy.

The results of this analysis underscore previously published data on the efficacy of prospective BCRL surveillance and early intervention using BIS. Of the 93 high-risk patients prospectively followed and managed in this structured BCRL protocol, only 11% required CDP and only 3% required continued therapy. These excellent outcomes are superior to contemporary studies of conventional measures reporting BCRL rates in similarly treated high-risk patients.

2018 NAPBC Standards Manual

STANDARD 2.15 – Support and Rehabilitation

Supportive services may include:
• Lymphedema management and risk reduction practices

RESOURCES
National Accreditation Program for Breast Centers (NAPBC) Accreditation Resources,
facs.org/quality-programs/napbc/accreditation/resources
Resource links to NLN guidelines

Utilization of bioimpedance spectroscopy in the prevention of chronic breast cancer-related lymphedema.

In summary, BIS represents a valuable and practical tool for the early detection of subclinical BCRL in patients undergoing prospective monitoring. In this prospective surveillance study, use of BIS allowed for early intervention and a reduction in the predicted rate of chronic BCRL compared to historical controls (no cases of persistent, chronic BCRL were observed after early intervention even in the highest risk patients). Such an approach represents not only a valuable strategy to address the recent NCCN guidelines on survivorship for monitoring for BCRL but also a cost-effective strategy to prevent and manage the potentially devastating effects of chronic BCRL.

Reducing chronic breast cancer-related lymphedema utilizing a program of prospective surveillance with bioimpedance spectroscopy.

In summary, prospective surveillance of breast cancer patients (most of whom were considered high risk) for the development of BCRL using BIS permitted the detection and simple pre-emptive management of subclinical disease resulting in a very low rate of chronic lymphedema compared to the established, expected range. These findings (which represent the largest group of patients monitored in a structured, program for early detection of BCRL using BIS) support the cost-effective allocation of resources for prospective, BIS assisted, BCRL surveillance within guidelines-based breast cancer survivorship programs. For women at risk for BCRL, this protocol represents a useful option to meet NCCN guidelines for the education, monitoring and treatment of BCRL.

Diagnosis of Upper Quadrant Lymphedema Secondary to Cancer: Clinical Practice Guideline From the Oncology Section of the American Physical Therapy Association.

Practice Recommendations Based on Patient Presentation At Risk/Early Upper Extremity Lymphedema (ILS Stage 0-I)

Bioimpedance analysis (BIA) should be used to detect subclinical/early stage lymphedema (Grade B)
– Cutpoint of >7.1 L-Dex score should be used for diagnosis of breast cancer–related lymphedema when preoperative baseline measures are not available (Grade B)
– Cutpoint of >10 L-Dex score above preoperative baseline should be used for diagnosis of breast cancer–related lymphedema (Grade B)
– Preoperative assessment using BIA may enhance the ability to detect changes in tissue fluid earlier indicating lymphedema (Grade B)

Lymphedema: Improving Screening and Treatment Among At-Risk Breast Cancer Survivors

A protocol for BIS via the L-Dex device should be established in clinical practice; this provides APNs with a consistent, objective approach to detect subclinical lymphedema, assists the APN with evidence-based decision making for PT referral, and provides improved lymphedema education from the APN for at-risk survivors. The protocol could decrease clinical lymphedema incidence, improving functional ability and quality of life among survivors by decreasing arm edema and reducing joint and muscle aches, limb tightness, infection rates, and overall medical costs for chronic lymphedema treatment.

The Impact of L-Dex Measurements in Assessing Breast Cancer-Related Lymphedema as Part of Routine Clinical Practice.

The results of this retrospective study demonstrate that L-Dex assessments can be incorporated into routine breast cancer programs as part of follow-up. This is critically important given the recent changes in the NCCN survivorship guidelines for post-treatment follow-up care for breast cancer patients establishing that health-care providers “educate, monitor, and refer for lymphedema management.” Additionally, the analyses suggest that L-Dex assessments can identify subclinical BCRL and subsequently monitor the return to baseline following conservative interventions. Further studies are required to demonstrate the long-term benefits of early detection and subsequently early intervention predicated upon subclinical detection of BCRL.

Bioimpedance Spectroscopy for Breast Cancer Related Lymphedema Assessment: Clinical Practice Guidelines

With increasing data supporting early detection and treatment of BCRL, BIS has emerged as an important diagnostic modality due to its ability to detect subclinical lymphedema. BIS can be utilized as part of routine breast cancer clinical care starting with measurements prior to locoregional therapy and continued as part of survivorship using an increase of 10 to trigger early herapy for BCRL.

Diagnosis of upper limb lymphedema: development of an evidence-based approach.

This is the first study to establish evidence-based diagnostic criteria for LE against an appropriate reference standard. The two thresholds with the highest sensitivity, as well as good specificity, for detection of mild LE were determined from a normative population, accounting for normal inter-limb variations as well as limb dominance. These findings support the adoption of a more liberal diagnostic threshold set at 2SD above the mean, instead of the previously suggested 3SD threshold.