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- W2972633883 abstract "Breast cancer-related lymphedema can significantly compromise physical and psychosocial quality of life. Bioimpedance spectroscopy (BIS) is an established tool for measuring extracellular fluid in lymphedema. The purpose of this study was to determine the incidence of BIS-detected lymphedema using the L-Dex® and identify risk factors associated with a positive L-Dex® score. We performed a retrospective review of our institutional database to identify patients who underwent L-Dex® U400 measurements from 2014 to 2018. Patients receiving treatment for an ipsilateral recurrence or with a history of a contralateral breast cancer were excluded. Patients with a score of >10 L-Dex® units or with an increase of >10 units from baseline were considered to have a positive score. Clinical lymphedema was determined by documentation in the chart at the time of positive L-Dex® measurement. Otherwise, patients were considered to have subclinical lymphedema. All therapies received with at least 30 days of follow-up at the time of most recent measurement were recorded. Patient, disease, and treatment related factors were collected and compared using the Chi-squared and Fisher’s exact tests. Fifty-three patients met the study criteria. Median age was 51 (range, 30-84), and median follow-up from surgery to most recent L-Dex® measurement was 215 days (range, 43-2,938). Thirty patients (56.6%) underwent mastectomy, and 22 (41.5%) underwent axillary lymph node dissection (ALND). Median number of LNs removed with ALND was 10 and with sentinel node biopsy (SLNB) was 2. Thirty-three patients (62.3%) received whole breast radiation, with 23 (43.4%) receiving treatment to the regional LNs. Twelve patients (22.6%) had a positive L-Dex® score, 8 from the ALND subset (36.4%) and 4 from the SLNB subset (12.9%). There were no significant differences in age, race, tumor laterality, breast surgery, T stage, N stage, receipt of chemotherapy, or RT fields (none, breast only, and breast with regional LNs; p=0.16) in patients with a positive L-Dex® score. ALND was significantly more common (66.7% vs. 34.2%, p=0.04). BMI>30 approached significance (58.3% vs. 29.3%, p=0.06). Subclinical lymphedema was noted in 7 of the 12 patients (58.3%). No significant differences were identified comparing patients with subclinical lymphedema to those with negative scores. Among the 5 patients with clinical lymphedema, all were included in the subset of patients undergoing ALND and receiving regional nodal RT (n=18). No patients who received any other combination of axillary surgery and RT developed clinical lymphedema, (p=0.009 and p=0.039, respectively). Mean number of LNs removed in patients with clinical lymphedema was 14.2 (SD=5.6). The combination of ALND and regional nodal RT is strongly associated with the development of clinical lymphedema, with an incidence rate of 27.8% in this study. It is difficult to identify patients at risk for subclinical BIS-detected lymphedema." @default.
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- W2972633883 date "2019-09-01" @default.
- W2972633883 modified "2023-09-27" @default.
- W2972633883 title "Risk Factors for the Development of Clinical and Subclinical Lymphedema Detected by Bioimpedance Spectroscopy" @default.
- W2972633883 doi "https://doi.org/10.1016/j.ijrobp.2019.06.2396" @default.
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