The Importance of a Pre-treatment Baseline When Screening Patients for Breast-Cancer-Related Lymphedema

The PREVENT randomized clinical trial showed that bioimpedance spectroscopy (BIS) screening for subclinical breast-cancer-related lymphedema (sBCRL) detection with early intervention is associated with lower progression to chronic breast-cancer-related lymphedema (cBCRL) than tape measurement (TM). This study explores the role of a pre-treatment baseline in detecting sBCRL.

A total of 1200 patients with breast cancer were randomized for screening using L-Dex (BIS) or relative interlimb volume difference (RILVD) from TM, with 918 patients being monitored for up to 36 months. sBCRL was identified in 209 patients by either an increase from baseline of ≥ 6.5 L-Dex units (n = 89) or ≥ 5% and < 10% increase in RILVD (n = 120). The pre-treatment and sBCRL trigger L-Dex and RILVD were analyzed using Mann-Whitney, independent t-tests, chi-squared, and analysis of variance (ANOVA) tests.

The baseline L-Dex or RILVD was less than zero in 587 (48.9%) and 596 (49.0%) patients, respectively. At sBCRL trigger, 70.8% BIS patients had L-Dex inside the normal range (L-Dex < 10), and 40.4% had L-Dex < 6.5, which could result in misclassification without a pre-treatment baseline. For TM patients, 87.5% had an RILVD inside the normal range (RILVD < 10%), and 51.7% had a RILVD < 5%, which would also cause misclassification without a pre-treatment baseline.

Many patients who triggered for sBCRL would not have been identified without a pre-treatment baseline, potentially missing opportunities for early intervention and increasing the risk of progression. Regardless of the measurement technique used, a recorded baseline is crucial for accurate detection and timely management of sBCRL.