Paula Donahue, PT, DPT, MBA, CLT-LANA, spoke at our Lighthouse Lymphedema Network (LLN) 2023 Conference. Dr. Donahue conducts research, teaches, and provides clinical care for patients at the Vanderbilt University medical center. Her recent article, “Advances in the prevention and treatment of breast cancer-related lymphedema,” emphasizes the importance of surveillance, patient education, and early intervention to prevent latter-stage lymphedema after cancer treatment. ¹

Vanderbilt served as the coordinating/lead site for a recent clinical trial comparing bioimpedance spectroscopy (BIS) to tape measurements for detecting early-stage or subclinical lymphedema in  breast cancer survivors (S-BCRL).² Early-stage lymphatic dysfunction is hard to see externally, so lymphedema has typically gone undetected and untreated until later stages when it is more difficult to reverse. But this trial concluded that regular surveillance of cancer survivors, patient education, and early intervention with compression garments and other conservative treatments can reduce the progression of BCRL for many patients. These findings can benefit melanoma survivors and patients with lower-limb lymphedema as well.

Donahue reviews various methods for diagnosing lymphedema. Therapists and patients have long depended on the tape measure, a simple and economical tool to follow changes in circumference of a limb. These measurements can indicate internal fluid build-up and the effectiveness of lymphedema treatment. At the other end of the spectrum, highly advanced imaging techniques like incandescent green (ICG) lymphography, lymphoscintigraphy and magnetic resonance imaging (MRI) lymphangiography are very expensive and not easily available. Perometry and bioimpedance spectroscopy (BIS) are becoming more accessible and valuable for lymphedema screening as their expense is covered by large medical centers and insurance.

Perometry uses a highly sensitive measurement device that produces a 3-D silhouette of the limb with volume calculations. The perometer uses infrared optoelectronic technology to detect and quantify limb volume changes. Perometry is non-invasive.

Research studies have found a high correlation between perometry measurements and BIS, though the tests measure inflammation differently.³ The BIS device measures the resistance of different types of tissue to electric current. Extracellular fluid, which may indicate inflammation or lymphedema, has the least resistance. After comparing extracellular fluid in limbs affected by cancer treatment or other inflammatory triggers versus unaffected limbs, the device produces a score that quantifies the difference. This number is an estimate based on population-specific data, not a true volume of the limb. Fluid volume changes may be an early indicator of BCRL.

I have experienced both perometry and bioimpedance spectroscopy (seen in photo) this year. Both tests are painless and take around 30 seconds. For BIS, one stands barefoot on two metal plates, and places one’s hands on two other plates. I felt nothing unusual, as the small amount of current flowed through me. My printed report will serve as a good baseline, because my Stage 1 lymphedema was not flaring up.

Cindy Robinson is a certified fitter for compression supplies at the Lacey Drug Company medical supply shop in Marietta, GA. She complimented the ease of use with the SOZO BIS device and also the value of patient education. Many survivors (like me) are worried about lymphedema after cancer treatment, and relieved when the test shows normal levels of extracellular fluid. When subclinical lymphedema appears, patients are encouraged to use compression garments, as recommended in clinical trials [2]. Cindy also encourages patient referral to certified lymphedema therapists if extracellular fluid is over a certain threshold.

This is a good example of using emerging technology to support the prospective surveillance model (PSM) for cancer survivors at risk of lymphedema. The PSM recommends baseline clinical assessment, repeated interval screening, patient education, and early intervention [3]. As Paula Donahue writes, “BCRL screening and education in at-risk patients are imperative, and an individualized approach to goal setting is recommended to improve adherence” [1]. I enjoyed meeting Paula Donahue, and learning about Advances in Lymphedema and Lipedema Diagnosis and Treatment at our LLN conference on October 21, 2023.

~ By Sharon S. Shepard, M.Ed., The Lighthouse Newsletter Editor

Originally published in The Lighthouse, Lymphedema Network Newsletter, 2023.

References

1. Donahue PMC, MacKenzie A, Filipovic A, Koelmeyer L. Advances in the prevention and treatment of breast cancer-related lymphedema. Breast Cancer Res Treat. 2023 Jul;200(1):1-14. doi: 10.1007/s10549-023-06947-7. Epub 2023 Apr 27. PMID: 37103598; PMCID: PMC10224871. ↩︎
2. Ridner SH, Dietrich MS, Boyages J, Koelmeyer L, Elder E, Hughes TM, French J, Ngui N, Hsu J, Abramson VG, Moore A, Shah C. A Comparison of Bioimpedance Spectroscopy or Tape Measure Triggered Compression Intervention in Chronic Breast Cancer Lymphedema Prevention. Lymphat Res Biol. 2022 Dec;20(6):618-628. doi: 10.1089/lrb.2021.0084. Epub 2022 Jan 28. PMID: 35099283; PMCID: PMC9810346. ↩︎
3. McLaughlin SA, Stout NL, Schaverien MV. Avoiding the Swell: Advances in Lymphedema Prevention, Detection, and Management. Am Soc Clin Oncol Educ Book. 2020 Mar;40:1-10. doi: 10.1200/EDBK_280471. PMID: 32315238. ↩︎