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Prediction of the probability of breast cancer-related lymphedema after axillary lymph node dissection.

140 Background: Early detection and timely intervention demonstrate the greatest promise of reducing incidence of late-stage lymphedema (LE) in breast cancer patients undergoing axillary lymph node dissection (ALND). A nomogram was developed for predicting the risk of arm LE in this group. This study's aim was to test the preoperative prediction model for the early diagnosis of clinical and subclinical LE in ALND including patients prospectively monitored by bioimpedance spectroscopy (BIS).


METHODS
Patients with pre-existing clinical LE were selected from our existing database. In addition, data on subclinical LE was prospectively collected through our LE monitoring program. This program tracks patients from a baseline, using an L-Dex U400 measurement preoperatively or postoperatively (if no clinical LE), and at 3-6 month intervals. The 5 year probability of LE after ALND was calculated using The Cleveland Clinic Risk Calculator. The discrimination of the nomogram was assessed by calculating the area under (AUC) the receiver operating characteristic curve (ROC); AUC values between 0.7-0.8 represent considerable discrimination.


RESULTS
A total of 334 patients who underwent ALND were included in this study; 116 patients with previously diagnosed clinical LE and 218 patients at-risk of LE (monitored with BIS since 2010). Since BIS monitoring began, a total of 58 patients were diagnosed with subclinical LE; a total of 174 patients with clinical or subclinical LE (LE group). The mean age was 60.6+11.4 years in LE group and 57.8+12.03 years in No-LE group (p=0.03). BMI was higher in LE group compared with no LE group (29.8 + 7.4 vs.28.3+6.3 kg/m2(p=0.05). The AUC value was calculated from the nomogram (AUC=0.609).


CONCLUSIONS
The recently created preoperative prediction model for the diagnosis of LE in ALND is not accurate in predicting who will develop clinical or subclinical LE. Periodic monitoring of women at high risk for LE, with modern technology, helps early detection and timely intervention for LE, which can minimize or eliminate more advanced LE among women undergoing ALND.