Bioimpedence Spectroscopy (BIS) for the Early Detection of Lymphedema (LE) after
Surgical Axillary Nodal Staging (SANS)
Shirley Mandeville, NP, Michelle S. Han, MD, Rachel Farkas, MD, and Kristin A. Skinner, MD
University of Rochester Medical Center, Department of Surgery, Division of Surgical Oncology
Results
Introduction
LE develops in up to 68% of women undergoing SANS
for breast cancer, resulting in decreased quality of life.
BIS is marketed as a method for early detection of LE,
allowing early intervention to minimize its impact. We
Demographics
reviewed the use of BIS in patients undergoing SANS as
part of their breast cancer treatment to determine its
impact on LE detection.
Surgery
Methods
Baseline BIS prior to SANS
Repeat BIS at 1, 3, 6, 9,
12, and 18 months post
SANS
Other Therapies
Pathology
Lymphedema (LE) Categories
Clinical (C):
Subclinical:
Arm measurement (∆ Any BIS increase ≥
≥ 2cm) by a trained LE 10 (BIS+10)
therapist
Subjective (S):
visual assessment of arm
size and symptom review
at each time point
Pathologic Staging
Any patient with either
BIS+10 or SLE was
referred to a LE therapist
for further evaluation,
education, and treatment
 Inclusion: baseline BIS, at least one postop BIS, at
least 6 months follow up  Data collection.
 Associations were determined by univariate and
multivariate analyses.
Lymphedema Metrics
Table 1
CLE
No CLE
Mean (Rang) or Mean (Rang) or
%
%
N
12 (11.7%)
90
Univariate Multivariate
Pvalue
Pvalue
NS
Age
BMI>30
61 (43-81)
58.3%
60 (22-87)
33.3%
NS
0.09
Postmenopausal
FU Length (Months)
Breast Conserving Surgery
Sentinel Node Biopsy
Axillary Dissection
Chemotherapy
Breast/Chest Wall Radiation
Regional Nodal Radiation
Neoadjuvant Systemic Therapy
T Size
# Nodes Removed
# Positive Nodes
Extranodal Extension
Lymphovascular Invasion (LVI)
T0
Tis
T1
T2
T3
N0
N1
N2
N3
0
66.7%
14 (7-19)
66.7%
50.0%
50.0%
58.3%
83.3%
33.3%
8.3%
40 (11-120)
13.5 (1-31)
3 (0-12)
100%
50.0%
0.0%
8.3%
41.7%
41.7%
8.3%
58.3%
16.7%
8.3%
16.7%
8.3%
75.6%
14 (6-23)
60.0%
91.1%
8.9%
30.0%
73.3%
16.7%
8.9%
24.4 (0-116)
3.4 (1-22)
0.3 (0-8)
33.3%
13.3%
1.1%
10.0%
55.6%
27.8%
5.6%
84.4%
14.4%
1.1%
0.0%
11.1%
NS
NS
NS
<0.0001
<0.0001
0.05
NS
NS
NS
0.02
<0.0001
<0.0001
0.01
0.002
NS
1
2
3
BIS + 10
Multiple Measures of BIS + 10
Subjective Lymphedema
33.3%
33.3%
25.0%
75.0%
50.0%
75.0%
50.0%
32.2%
6.7%
10.0%
1.3%
7.8%
0.0009
0.008
NS
NS
0.01
0.01
NS
0.018
NS
NS
NS
<0.0001
<0.0001
<0.0001
<0.0001
0.000
<0.0001




102 patients met inclusion criteria.
Average age was 60 (range 22-87).
Mean follow up was 14 months (range 6-23).
CLE developed in 11.7% of all patients undergoing
SANS (SN 6.8%, AD 42.8%).
 Patients with and without CLE are compared in Table 1.
 The time to BIS+10 and time to SLE were not
significantly different (p=0.26).
Conclusions
 BIS+10 is an independent predictor of CLE
 44% of the patients with BIS+10 never developed CLE
during the observed time, suggesting that BIS testing,
leading to further evaluation and education on LE
precautions, may have prevented CLE in these patients.
 Cases with documented CLE without BIS+10 all had arm
measurements done in the acute postoperative period
and none had subsequent problems with CLE or
BIS+10, suggesting that documented increase in arm
measurements during the postoperative period does not
predict persistent problems with CLE.
 The lack of time differential between BIS+10 and the
detection of SLE suggests that in many cases it does not
detect LE earlier than careful questioning and arm
evaluation.
 BIS is an effective tool for office assessment of LE
and may help prevent this complication by identifying
patients most at risk.