P3: Diagnosing lymphedema after axillary surgery: which method is superior?

Thursday, March 23, 2023

9:11 AM – 9:16 AM

Location: SSO HUB: Breast & Endocrine Zone

Poster Presenter(s)

Brian Diskin, MD (he/him/his)

Breast Service, Department of Surgery
Memorial Sloan Kettering Cancer Center
New York, United States

Disclosure information not submitted.

Author(s)

Brian Diskin, MD (he/him/his)

Breast Service, Department of Surgery
Memorial Sloan Kettering Cancer Center
New York, United States

Disclosure information not submitted.
BA

Bayley Axelrod, BS

Sloan Kettering Institute
Memorial Sloan Kettering Cancer Center, United States

Disclosure information not submitted.
VS

Varadan Sevilimedu, MBBS, DrPH

Biostatistics Service, Department of Epidemiology and Biostatistics
Memorial Sloan Kettering Cancer Center, United States

Disclosure information not submitted.
Monica Morrow, MD, FACS

Chief, Breast Surgical Service; Anne Burnet Windfohr Chair of Clinical Oncology, Memorial Sloan Kettering Cancer Center; Professor of Surgery Weill Cornell Medical College
Memorial Sloan Kettering Cancer Center
New York, New York, United States

Disclosure(s): No financial relationships to disclose
BM

Babak J. Mehrara, MD

Plastic and Reconstructive Surgical Service, Department of Surgery
Memorial Sloan Kettering Cancer Center, United States

Disclosure information not submitted.
Andrea Barrio, MD

Associate Attending
Memorial Sloan Kettering Cancer Center

Disclosure information not submitted.

Disclosure(s):

Monica Morrow, MD, FACS: No financial relationships to disclose

Introduction: Perometer measurements are reproducible and correlate with clinically evident lymphedema but are not feasible in all settings. L-Dex and tape measure (TM) are more accessible options but may be less accurate. We compared L-Dex and TM to perometer in a prospective cohort of breast cancer patients treated with axillary lymph node dissection (ALND).

Methods: Breast cancer patients undergoing ALND were enrolled in a lymphedema screening study. Bilateral arm measurements were performed preoperatively and every 6 months using three methods: perometer, L-Dex, and TM (estimating arm volume using the volume of a truncated cone). Lymphedema diagnosis was made by perometer (relative volume change [RVC] ≥10%). Sensitivity and specificity of L-Dex and TM were calculated using lymphedema by perometer as the standard method. Concordance between perometer, L-Dex, and TM was assessed using Pearson correlations. Performance of L-Dex as a predictor of future lymphedema was based on whether patients had an abnormal L-Dex prior to lymphedema development.

Results:

From 11/2016 to 03/2020, 304 patients treated with ALND were enrolled; 281 had at least 6 months of follow-up and are included. At a median follow-up of 2.3 years, 175 patients had an abnormal L-Dex (increase in ≥6.5 from baseline), and 18 patients developed lymphedema without a prior L-Dex abnormality. Of the 175 abnormal L-Dex patients, only 49 subsequently developed lymphedema, for a total of 67 patients with lymphedema (23.8%). As a predictor of future lymphedema, positive predictive value of L-Dex was 28% (49/175), with a false-positive rate of 59%. When lymphedema was present, L-Dex and TM were abnormal in 94% (63/67) and 99% (66/67) of patients, respectively. Overall, 281 patients had 1188 L-Dex and 1178 TM measurements. Correlating all measurements, sensitivity and specificity of L-Dex compared with perometer were 93% and 68%, respectively, and of TM with perometer were 78% and 89%, respectively. Correlation of perometer with L-Dex (r=0.66, p< 0.001) and volume changes by TM (r=0.67, p< 0.001) was moderate (Figure).

Conclusions:

In a prospective cohort of patients treated with ALND undergoing lymphedema screening, L-Dex and TM accurately diagnosed lymphedema identified by perometer over 90% of the time. More than 60% of patients had an abnormal L-Dex, and few developed lymphedema. The high false-positive rate of L-Dex results in overdiagnosis and precludes its use as a sole diagnostic method for lymphedema.

Learning Objectives:

Participants should know the accuracy of L-Dex and tape measure in diagnosing lymphedema identified by perometer.
Participants should know the sensitivity and specificity of L-Dex and tape measure compared to perometer.
Participants should know the positive predictive value and false-positive rate of L-Dex in predicting future lymphedema risk.