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Preoperative assessment enables the early detection and successful treatment of lymphedema

In Cancer, Stout Gergich et al demonstrated the successful treatment of lymphedema in breast cancer patients who were presurgically base-lined and postoperatively monitored for subclinical lymphedema . The data support prospective assessment and periodic surveillance. There were 2 limitations. First, the lack of a randomized-control design allowing some patients to have lymphedema progression. Second, the optoelectrical device is not Food and Drug Administration (FDA) cleared and may not be practical. A randomized control study is ethically difficult. It would have allowed extracellular fluid to accumulate and put these patients at risk of permanent damage to their lymphatic systems. In 2007, the FDA cleared a device for clinical assessment and monitoring of lymphedema. The technology uses a low-frequency bioelectrical current that passes through the extracellular space of the patient’s limb. The device compares the patient’s at-risk limb and her contralateral uninvolved limb. The result of that ratio is the Lymphedema Index score. An abnormal score can identify subclinical lymphedema up to 10 months before clinical presentation. At the Breast Care Center at Mercy Medical Center in Springfield, Massachusetts, all breast cancer patients are evaluated preoperatively using the Lymphedema Index. Repeat measurements are obtained on the first visit postoperatively, before initiation of radiation, and with completion. They have repeat evaluation every 3 months for 2 years and then every 6 months thereafter. If chemotherapy is involved, measurements are obtained before, monthly throughout the course, and when completed. The patients having mastectomy also have a physical therapy consult for teaching and postoperative management for the first 1-2 weeks. With this new technology not only will we be able to identify subclinical lymphedema, but we will be able to prevent the chronic sequelae of the disease process, and may be able to identify the risk factors associated with lymphedema.