OBJECTIVES:

Lymphedema (LE) is a potentially serious complication of breast cancer treatments. Monitoring progression towards LE with bioimpedance spectroscopy (BIS) may allow earlier detection. The purpose of this study is to evaluate chronic breast cancer-related lymphedema (BCRL) incidence rates among patients monitored by BIS compared to circumference monitoring and control rates.

METHODS:

We conducted a meta-analysis of BCRL incidence rates. Eligible peer-reviewed studies were published in English from 2013 onward and conducted in North America, Europe, or Oceania. Incidence rates were abstracted from studies using circumference monitoring, BIS monitoring, or background rates (no monitoring with circumference or BIS). A random effects model was used to calculate a pooled annualized estimate of BCRL incidence while accounting for clinical and methodological heterogeneity. Subgroup analyses assessed effects of differences in study design, including duration of follow-up, and different treatment modalities.

RESULTS:

50 studies met inclusion criteria representing over 67,000 women. Annualized incidence of LE was 4.9% (95% CI: 4.3-5.5) for background studies, 1.5% (95% CI: 0.6-2.4) for BIS-monitored studies, and 7.7% (95% CI: 5.6-9.8) for circumference-monitored studies. Differences between studies did not result in significant heterogeneity in most cases. Progression rates in BIS-monitored patients were reduced by 69% compared to control rates and 81% compared to circumference-monitored patients. BIS-monitoring was consistently associated with statistically significantly lower progression rates compared with circumference-monitoring in studies with high rates of patients at high risk for BCRL. A sensitivity analysis showed lower BCRL rates among BIS-monitored studies compared to background studies was consistent among studies both with and without active monitoring.

CONCLUSIONS:

There is ample evidence that active monitoring of LE significantly reduces risk of BCRL. BIS monitoring enables detection of subclinical LE and significantly reduces the rate of BCRL compared to circumference-monitoring, particularly in high-risk patients, by triggering earlier interventions to prevent BCRL.