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Vargo M, Aldrich M, Donahue P, Iker E, Koelmeyer L, Crescenzi R, Cheville A. Current diagnostic and quantitative techniques in the field of lymphedema management: a critical review. Med Oncol 2024; 41:241. [PMID: 39235664 PMCID: PMC11377676 DOI: 10.1007/s12032-024-02472-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Accepted: 08/02/2024] [Indexed: 09/06/2024]
Abstract
Lymphedema evaluation entails multifaceted considerations for which options continue to evolve and emerge. This paper provides a critical review of the current status of diagnostic and quantitative measures for lymphedema, from traditional and novel bedside assessment tools for volumetric and fluid assessment, to advanced imaging modalities. Modalities are contrasted with regard to empirical support and feasibility of clinical implementation. The manuscript proposes a grid framework for comparing the ability of each modality to quantify specific lymphedema characteristics, including distribution, dysmorphism, tissue composition and fluid content, lymphatic anatomy and function, metaplasia, clinical symptoms, and quality of life and function. This review additionally applies a similar framework approach to consider how well assessment tools support important clinical needs, including: (1) screening, (2) diagnosis and differential diagnosis, (3) individualization of treatment, and (4) monitoring treatment response. The framework highlights which clinical needs are served by an abundance of assessment tools and identifies others that have problematically few. The framework clarifies which tools have greater or lesser empirical support. The framework is designed to assist stakeholders in selecting appropriate diagnostic and surveillance modalities, gauging levels of confidence when applying tools to specific clinical needs, elucidating overarching patterns of diagnostic and quantitative strengths and weaknesses, and informing future investigation.
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Affiliation(s)
- Mary Vargo
- Department of Physical Medicine and Rehabilitation, MetroHealth Rehabilitation Institute, Case Western Reserve University, Cleveland, OH, USA
| | | | - Paula Donahue
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Emily Iker
- Lymphedema Center, Santa Monica, CA, USA
| | - Louise Koelmeyer
- Australian Lymphoedema Education, Research & Treatment (ALERT) Program, Macquarie University, Sydney, Australia.
| | - Rachelle Crescenzi
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Andrea Cheville
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
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Anik AR, Hasan K, Islam MM, Hasan MM, Ali MF, Das SK. Non-Invasive Portable Technologies for Monitoring Breast Cancer Related Lymphedema to Facilitate Telehealth: A Scoping Review. IEEE J Biomed Health Inform 2023; 27:4524-4535. [PMID: 37247315 DOI: 10.1109/jbhi.2023.3280196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Breast cancer related lymphedema (BCRL) is a common, debilitating condition that can affect up to one in five breast cancer surviving patients (BCSP). BCRL can significantly reduce the quality of life (QOL) of patients and poses a significant challenge to healthcare providers. Early detection and continuous monitoring of lymphedema is crucial for the development of client-centered treatment plans for post-cancer surgery patients. Therefore, this comprehensive scoping review aimed to investigate the current technology methods used for the remote monitoring of BCRL and their potential to facilitate telehealth in the treatment of lymphedema. Initially, five electronic databases were systematically searched and analyzed following the PRISMA flow diagram. Studies were included, specifically if they provided data on the effectiveness of the intervention and were designed for the remote monitoring of BCRL. A total of 25 included studies reported 18 technological solutions to remotely monitor BCRL with significant methodological variation. Additionally, the technologies were categorized by method of detection and wearability. The findings of this comprehensive scoping review indicate that state-of-the-art commercial technologies were found to be more appropriate for clinical use than home monitoring, with portable 3D imaging tools being popular (SD 53.40) and accurate (correlation 0.9, p 0.05) for evaluating lymphedema in both clinic and home settings with expert practitioners and therapists. However, wearable technologies showed the most future potential for accessible and clinical long-term lymphedema management with positive telehealth outcomes. In conclusion, the absence of a viable telehealth device highlights the need for urgent research to develop a wearable device that can effectively track BCRL and facilitate remote monitoring, ultimately improving the quality of life for patients following post-cancer treatment.
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Son WC, Kwon JG, Hong JP, Park CS, Kim SA, Do JH, Cheon H, Gelvosa MN, Suh HS, Jeon JY. Clinical Utility of Bioelectrical Impedance Analysis Parameters for Evaluating Patients with Lower Limb Lymphedema after Lymphovenous Anastomosis. J Reconstr Microsurg 2023; 39:171-178. [PMID: 35817050 DOI: 10.1055/s-0042-1750126] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND In lymphedema, lymphatic fluid accumulates in the interstitial space, and localized swelling appears. Lymphovenous anastomosis (LVA) is the most widely used surgery to rebuild a damaged lymphatic system; however, assessing outcome of LVA involves performing volume measurements, which provides limited information on body composition changes. Therefore, we analyzed the bioelectrical impedance analysis (BIA) parameters that can reflect the status of lymphedema patients who underwent LVA. METHODS We retrospectively reviewed records of 42 patients with unilateral lower extremity lymphedema who had LVA. We measured the perioperative BIA parameters such as extracellular water (ECW) ratio and volume as defined by the percentage of excess volume (PEV). We evaluated the relationship between the amount of change in PEV and in BIA parameters before and after surgery. We confirmed the correlation between ΔPEV and BIA parameters using Spearman's correlation. RESULTS Most patients included had secondary lymphedema due to cancer. Average age was 51.76 years and average body mass index was 23.27. PEV and all BIA parameters after surgery showed a significant difference (p < 0.01) compared with preoperative measurements. The ECW ratio aff/unaff showed the strongest correlation with PEV with a correlation coefficient of 0.473 (p < 0.01). CONCLUSION Our findings suggest that BIA parameters, especially ECW ratio aff/unaff could reflect the status of patients with lower limb lymphedema after LVA. Appropriate use of BIA parameters may be useful in the postoperative surveillance of patients.
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Affiliation(s)
- Woo Chul Son
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Geun Kwon
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Joon Pio Hong
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang Sik Park
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Ah Kim
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung Hwa Do
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hwayeong Cheon
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea
| | - Ma Nessa Gelvosa
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyun Suk Suh
- Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Yong Jeon
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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4
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Houwen F, Stemkens J, van Sonsbeek D, van Sonsbeek R, van der Hulst R, van Langen H. New Device to Measure Cross-Sectional Areas and Segmental Volumes of Objects and Limbs. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2023; 16:101-110. [PMID: 37101742 PMCID: PMC10124626 DOI: 10.2147/mder.s401060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 03/23/2023] [Indexed: 04/28/2023] Open
Abstract
Purpose High accuracy volume measurements have important implications in different medical and non-medical situations. All methods used to date have challenges to achieve a usable clinical accuracy. Moreover, current methods have limitations to measure segmental volumes. We developed a new device that is able to measure a continuous profile of the cross-sectional areas along an object. Herewith the total volume of an object or any part of it are correspondingly determined. Methods The Peracutus Aqua Meth (PAM) generates continuous profiles of cross-sectional areas. Water is pumped in or out of a measuring unit at a nearly fixed flow rate and the speed of the water level (dh/dt) is measured continuously using a pressure sensor at the bottom. The change of the water level is a measure for the cross-sectional area of an object at any height. Signal processing is required to obtain valuable measurements. Three static objects and an arm of a test object were measured to demonstrate the accuracy and repeatability of the new device. Results Cross-sectional areas of a PVC pipe obtained with the PAM and with a caliper were compared. The differences between the two methods were less than 1.3%. Volume measurements of two mannequin arms show standard deviations of 0.37% and 0.34%, respectively, whereas the standard deviation of the volume measurement of a genuine arm was only 1.07%. These figures surpass reported clinical accuracy. Conclusion The new device demonstrates that determining the cross-section and its volumes of objects is possible in an accurate, reliable, and objective way. The results show that segmental volume measurements of human limbs are possible. Application in clinical and non-clinical situations seems meaningful.
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Affiliation(s)
- Frans Houwen
- Peracutus B.V., Kronenberg, the Netherlands
- Correspondence: Frans Houwen, Peracutus B.V., Peelstraat 4a, Kronenberg, 5976 NL, the Netherlands, Tel +31-650234240, Email
| | | | | | | | - René van der Hulst
- Department of Plastic and Reconstructive Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Herman van Langen
- Department of Medical Physics and Devices, VieCuri Medical Centre, Venlo, the Netherlands
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Nascimben M, Lippi L, Fusco N, Invernizzi M, Rimondini L. A Software Suite for Limb Volume Analysis Applicable in Clinical Settings: Upper Limb Quantification. Front Bioeng Biotechnol 2022; 10:863689. [PMID: 36798789 PMCID: PMC9928154 DOI: 10.3389/fbioe.2022.863689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 04/18/2022] [Indexed: 02/01/2023] Open
Abstract
In medicine, tridimensional scanning devices produce digital surfaces that replicate the bodies of patients, facilitating anthropometric measurement and limb volume quantification in pathological conditions. Free programs that address this task are not commonly found, with doctors mainly relying on proprietary software. This aspect brings reduced reproducibility of studies and evaluation of alternative measures. A software package made up of three programs has been developed and released together with supporting materials to enhance reproducibility and comparisons between medical centers. In this article, the functions of the programs and steps for volume assessment were introduced together with a pilot study for upper limb volume quantification. This initial experiment aimed to also verify the performance of digital volumes derived from the convex-hull gift-wrapping algorithm and the alternative analysis methods enclosed in the software. Few of these digital volumes are parameter-dependent, requiring a value selection. The experiment was conducted on a small mixed-gender group of young adults without correction for factors like arm dominance or specific physical training. In the sample under investigation, the analysis confirmed the substantial agreement between the clinical and current configurations of digital volumes produced by the package (R 2 interval from 0.93 to 0.97, r ranged from 0.965 to 0.984); in addition, as a general consideration, gender appears as a variable that could influence upper limb volume quantification if a single model is built.
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Affiliation(s)
- Mauro Nascimben
- Department of Health Sciences, Center for Translational Research on Autoimmune and Allergic Diseases-CAAD, Università Del Piemonte Orientale (UPO), Novara, Italy,Enginsoft SpA, Padova, Italy,*Correspondence: Mauro Nascimben ,
| | - Lorenzo Lippi
- Physical and Rehabilitative Medicine Unit, Department of Health Sciences, Università Del Piemonte Orientale (UPO), Novara, Italy
| | - Nicola Fusco
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy,Division of Pathology, European Institute of Oncology IRCCS, Milan, Italy
| | - Marco Invernizzi
- Physical and Rehabilitative Medicine Unit, Department of Health Sciences, Università Del Piemonte Orientale (UPO), Novara, Italy,Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Translational Medicine, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Lia Rimondini
- Department of Health Sciences, Center for Translational Research on Autoimmune and Allergic Diseases-CAAD, Università Del Piemonte Orientale (UPO), Novara, Italy
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Mastick J, Smoot BJ, Paul SM, Kober KM, Cooper BA, Madden LK, Conley YP, Dixit N, Hammer MJ, Fu MR, Piper M, Cate SP, Shepherd J, Miaskowski C. Assessment of Arm Volume Using a Tape Measure Versus a 3D Optical Scanner in Survivors with Breast Cancer-Related Lymphedema. Lymphat Res Biol 2022; 20:39-47. [PMID: 33761290 PMCID: PMC8892974 DOI: 10.1089/lrb.2020.0119] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Background: Lymphedema (LE) is a significant clinical problem for breast cancer survivors. While the water displacement test and circumferential assessment using a tape measure (TM) are common methods to assess differences in arm volumes, faster and more reliable methods are needed. Study purposes, in breast cancer survivors (n = 294), were to compare the average total arm volumes and interlimb volume ratios for women with and without a history of LE, using a TM and three-dimensional (3D), whole-body surface scanner (3D scan); compare the level of agreement between arm volumes and interlimb volume ratios obtained using the two devices; and evaluate the percent agreement between the two measures in classifying cases of LE using three accepted thresholds. Methods and Results: Measurements were done using a spring-loaded TM and Fit3D ProScanner. Paired t-tests and Bland-Altman analyses were used to achieve the study aims. For circumference and volume comparisons, compared with the 3D scan, values obtained using the TM were consistently smaller. In terms of level of agreement, the Bland-Altman analyses demonstrated large biases and wide limits of agreement for the calculated arm volumes and volume ratios. In terms of the classification of caseness, using the 200-mL interlimb volume difference criterion resulted in 81.6% overall agreement; using the >10% volume difference between the affected and unaffected arms resulted in 78.5% overall agreement; and using the volume ratio ≥1.04 criterion resulted in 62.5% overall agreement. For all three accepted threshold criteria, the percentage of cases was significantly different between the TM and 3D scan techniques. Conclusions: The 3D technology evaluated in this study has the potential to be used for self-initiated surveillance for LE. With improvements in landmark identification and software modifications, it is possible that accurate and reliable total arm volumes can be calculated and used for early detection.
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Affiliation(s)
- Judy Mastick
- School of Nursing, University of California San Francisco, San Francisco, California, USA
| | - Betty J. Smoot
- School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Steven M. Paul
- School of Nursing, University of California San Francisco, San Francisco, California, USA
| | - Kord M. Kober
- School of Nursing, University of California San Francisco, San Francisco, California, USA
| | - Bruce A. Cooper
- School of Nursing, University of California San Francisco, San Francisco, California, USA
| | | | - Yvette P. Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Niharika Dixit
- School of Medicine, University of California San Francisco, San Francisco, California, USA
| | | | - Mei R. Fu
- School of Nursing, Boston College, Boston, Massachusetts, USA
| | - Merisa Piper
- School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Sarah P. Cate
- ICAHN School of Medicine at Mount Sinai, New York, New York, USA
| | - John Shepherd
- University of Hawaii Cancer Center, Manoa, Hawaii, USA
| | - Christine Miaskowski
- School of Nursing, University of California San Francisco, San Francisco, California, USA
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Mastick J, Smoot BJ, Paul SM, Kober KM, Hamolsky D, Madden LK, Conley YP, Dixit N, Hammer MJ, Fu MR, Miaskowski C. A Comparison of Supine Versus Stand-on Bioimpedance Devices to Assess Breast Cancer-Related Lymphedema. Lymphat Res Biol 2021; 19:553-561. [PMID: 33567232 PMCID: PMC8792492 DOI: 10.1089/lrb.2020.0058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: While supine bioimpedance devices are used to evaluate for lymphedema (LE), stand-on devices are gaining popularity. Because research on differences in bioimpedance values between the two devices is limited, this study's purposes were to: (1) determine the average upper limb impedance values and inter-limb ratios for women who self-reported having (n = 34) or not having (n = 61) a history of LE, using a single-frequency supine device and a multifrequency stand-on device; (2) compare the level of agreement in inter-limb impedance ratios between the two devices; evaluate the percent agreement between the two devices in classifying cases of LE using established supine thresholds; and evaluate the percent agreement in classifying cases of LE between the supine device using previously established supine thresholds and the stand-on device using two published standing thresholds. Methods and Results: Bioimpedance measures were done using the two devices. For the entire sample, absolute impedance values for both the affected and unaffected limbs were significantly higher for the stand-on device in women with and without LE. Impedance values for the two methods were highly correlated. Bland-Altman analysis determined that for the entire range of impedance ratios the values for the two devices could not be used interchangeably. Conclusions: Findings suggest that the stand-on device can be a useful and valid tool to assess for LE. However, because agreement is not perfect, values obtained from the two devices should not be used interchangeably to evaluate for changes in impedance ratios, particularly for ratios of >1.20.
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Affiliation(s)
- Judy Mastick
- Department of Physiological Nursing, School of Nursing, University of California San Francisco, San Francisco, California, USA
| | - Betty J. Smoot
- Department of Medicine, School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Steven M. Paul
- Department of Physiological Nursing, School of Nursing, University of California San Francisco, San Francisco, California, USA
| | - Kord M. Kober
- Department of Physiological Nursing, School of Nursing, University of California San Francisco, San Francisco, California, USA
| | - Deborah Hamolsky
- Department of Physiological Nursing, School of Nursing, University of California San Francisco, San Francisco, California, USA
| | | | - Yvette P. Conley
- Department of Health Promotion and Development, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Niharika Dixit
- Department of Medicine, School of Medicine, University of California San Francisco, San Francisco, California, USA
| | | | - Mei R. Fu
- School of Nursing, Boston College, Boston, Massachusetts, USA
| | - Christine Miaskowski
- Department of Physiological Nursing, School of Nursing, University of California San Francisco, San Francisco, California, USA
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Houwen F, Stemkens J, de Schipper PJ, van der Wouw P, Heitink M, van Langen H. Estimates for Assessment of Lymphedema: Reliability and Validity of Extremity Measurements. Lymphat Res Biol 2021; 20:48-52. [PMID: 33751914 PMCID: PMC8892971 DOI: 10.1089/lrb.2019.0082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Measuring lymphedema with high accuracy is important for several reasons. The aim of this study was to assess the reliability and validity of three routinely used methods to estimate limb volumes. Methods and Results: Inverse water displacement, girth measurements, and Perometer measurements were executed. Although standard techniques were used, extra precautions were taken to maximize accuracy within and between observers. Water displacement, and girth and Perometer measurements resulted in standard deviations of 0.7%–0.8%, 0.5%, and 0.4%–1.0%, respectively. Conclusion: Measuring limb volumes using routine methods is not easy. Even under optimal conditions, the measurements are quite dependent on the observer. For practical situations, an easy, objective, and reliable method is lacking.
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Affiliation(s)
| | | | - Peter J de Schipper
- Health Innovations and Technology, Fontys University of Applied Sciences, Eindhoven, The Netherlands
| | - Pim van der Wouw
- Health Innovations and Technology, Fontys University of Applied Sciences, Eindhoven, The Netherlands
| | - Martijn Heitink
- Department of Dermatology, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Herman van Langen
- Department of Medical Physics and Devices, VieCuri Medical Centre, Venlo, The Netherlands
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White BN, Okoli J, Dixon JB, Yuan L, Yang S, Gabram-Mendola SGA. Use of a portable infrared 3D scanning device measuring limb volume in a safety net hospital breast clinic. Breast J 2021; 27:559-561. [PMID: 33724606 DOI: 10.1111/tbj.14221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 02/25/2021] [Accepted: 02/25/2021] [Indexed: 11/27/2022]
Affiliation(s)
| | - Joel Okoli
- Morehouse School of Medicine/Grady Memorial Hospital, Atlanta, GA, USA
| | | | - Liu Yuan
- Winship Cancer Institute, Atlanta, GA, USA
| | - Steven Yang
- School of Medicine, Emory University, Atlanta, GA, USA
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10
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White BN, Lu IM, Kao LS, Dixon JB, Weiler MJ, Frank ND, Binkley J, Subhedar P, Okoli J, Buhariwalla K, Suarez-Ligon A, Gabram-Mendola SGA. An infrared 3D scanning device as a novel limb volume measurement tool in breast cancer patients. World J Surg Oncol 2020; 18:278. [PMID: 33109204 PMCID: PMC7592580 DOI: 10.1186/s12957-020-02043-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 10/02/2020] [Indexed: 12/24/2022] Open
Abstract
Abstract Background Lymphedema is a common complication of breast cancer treatment that affects one in five breast cancer survivors, yet there is no reliable method to detect lymphedema in the subclinical range. The objective of this study was to determine the feasibility and reliability of using an infrared 3D scanning device (ISD) as a peri-operative limb volume measurement tool. Methods Fifteen patients were analyzed based on inclusion criteria. Peri-operative measurements were obtained using tape measure and an ISD. Volumes were calculated using a standard algorithm for tape measure and a custom algorithm for ISD measurements. Linear regression models were used to assess ISD and tape measurement volume and circumference correlation. One-way ANOVA was used to compare change in percent difference at set time points post-operatively (2–3 weeks, 4–6 weeks, and 7–12 weeks) for both ISD and tape measure. t tests for unequal variances with the Bonferroni correction were performed among these groups. Results There is a positive linear correlation (R2 = 0.8518) between absolute volume measurements by the ISD and tape measure. Analyses over 2–10 weeks post-operatively showed that the ISD was able to detect volume changes in both the unaffected and the affected arm. Furthermore, the affected arm tended to have a greater increase in volume in the majority of patients, indicating these patients could be at risk for lymphedema. Conclusions Technology utilizing infrared 3D scanners can reliably measure limb volume pre- and post-treatment similarly to tape measure in a small sample of patients. Further research using 3D scanning technology with a longer follow up is warranted.
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Affiliation(s)
- Bernadette N White
- Emory University School of Medicine and Grady Memorial Hospital Avon Comprehensive Breast Center, Atlanta, GA, USA
| | - Iris M Lu
- Georgia Institute of Technology, Atlanta, GA, USA
| | - LeslieAnn S Kao
- Emory University School of Medicine and Grady Memorial Hospital Avon Comprehensive Breast Center, Atlanta, GA, USA
| | | | | | | | - Jill Binkley
- TurningPoint Breast Cancer Rehabilitation, Atlanta, GA, USA
| | - Preeti Subhedar
- Emory University School of Medicine and Grady Memorial Hospital Avon Comprehensive Breast Center, Atlanta, GA, USA
| | - Joel Okoli
- Morehouse School of Medicine, Atlanta, GA, USA
| | | | | | - Sheryl G A Gabram-Mendola
- Emory University School of Medicine and Grady Memorial Hospital Avon Comprehensive Breast Center, Atlanta, GA, USA.
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11
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Living with leg lymphedema: developing a novel model of quality lymphedema care for cancer survivors. J Cancer Surviv 2020; 15:140-150. [PMID: 32712757 PMCID: PMC7822774 DOI: 10.1007/s11764-020-00919-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 07/10/2020] [Indexed: 11/03/2022]
Abstract
Purpose Lower-extremity lymphedema (LEL) is a lifelong consequence of cancer therapy and can lead to serious physical and psychosocial complications for many cancer survivors. However, clinical knowledge and treatment of LEL remain minimal. The purpose of this study was to integrate perspectives of lymphedema patients and healthcare providers (HCPs) on LEL to develop a novel model for quality lymphedema care. Methods A mixed-methods approach was implemented. Standardized questionnaires and semi-structured interviews were used to assess psychosocial well-being and experiences of LEL patients. Interviews were also used to evaluate the clinical experiences of HCPs working within tumour groups associated with cancer-related LEL. Thematic analysis was used to analyse qualitative data. Results Twenty-two patients and eleven HCPs participated in this study. Patient QOL, generalized anxiety and depressive symptom scores revealed a complex interplay between psychosocial well-being and supportive LEL care after cancer. Three themes emerged from interviews with patients (n = 19) and HCPs (n = 11): level of lymphedema knowledge, effectiveness of rehabilitation oncology services and barriers to care. Implications for Cancer Survivors We developed a novel model for quality lymphedema care that emphasizes the importance of continued physical and psychosocial support for LEL patients, while illustrating the importance of HCPs in facilitating a smooth transition for patients to LEL care after cancer treatment. Electronic supplementary material The online version of this article (10.1007/s11764-020-00919-2) contains supplementary material, which is available to authorized users.
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12
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Ness KK, Gilchrist L. Innovations in Rehabilitation for People Who Have Cancer or Who Have Survived Cancer. Phys Ther 2020; 100:361-362. [PMID: 32154896 DOI: 10.1093/ptj/pzaa001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 01/01/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Kirsten K Ness
- Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis
| | - Laura Gilchrist
- Doctor of Physical Therapy Program, St Catherine University, Minneapolis, Minnesota
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