‘At Risk’ Lymphoedema Limb Monitoring

‘At Risk’ Lymphoedema Monitoring for Peace of Mind

One in five (20%) of people will develop lymphoedema following treatments for cancer; including surgery to remove lymph nodes, chemotherapy and radiotherapy. The risk of developing lymphoedema depends on the extent of the treatments you received. If lymphoedema is detected at a sub-clinical stage, it can be stopped from progressing completely.

Monitoring for lymphoedema couldn’t be easier. I have one of the only SOZO platforms in the UK, outside of research hospitals and facilities. Monitoring and surveillance services are commonplace in Australia and the USA. It is my hope that the UK will follow soon.

The SOZO platform uses Bioimpedance Spectroscopy and L-Dex technology to scan healthy limbs to monitor for early changes in tissue fluid levels, which identify the onset of lymphoedema at a sub-clinical stage; up to 10 months before it can be felt or seen. It detects rises in tissue fluid levels, as small as 2.4 tablespoons. At this stage, following the protocol of a randomised clinical trial, if a class 1 garment is worn for 6 months, the progression of lymphoedema can be reduced by 95%.  The SOZO is validated for detecting changes in legs and arms.

Optimum baseline readings can be taken before any cancer treatments commence, but anytime after surgery will be able to test for rising fluid levels. Scans should be repeated every 2-3 months for the first 2 years after treatments, as most lymphoedema occurs during this time frame.

To have a scan, after being weighed, step onto the platform with bare hands and feet, and in less than a minute, step off, without having felt a thing. The results are immediately transferred to a screen, where your progress and history is mapped under your personal profile.

Beneath the hand and foot plates, there are electrodes which pass 256, low frequency signals through the body. The currents differentiate between fluid inside (intracellular) and outside (extracellular) of your cells. The L-Dex score is calculated as a ratio of the resistance and reactance to the current between the ‘at risk’ limb and the healthy non affected limb. There is also a setting if both limbs are ‘at risk’.

If lymphoedema begins to develop, the additional fluid is easier for the current to pass through and offers less resistance. An increased reading of 6.5 units, indicates a sub-clinical increase in fluid and preventative treatment begins. This includes the use of a prescription garment, exercises and self-massage techniques and further monitoring, to potentially reverse symptoms or stop them progressing to stage 1.

The L-Dex Test, Trigger, Treat Protocol

  • 1 in 5 breast cancer patients will develop lymphoedema following their treatment2
  • In the largest randomized trial to assess lymphoedema prevention in breast cancer patients, 92% of patients with early detection using L-Dex and intervention did not progress to chronic lymphedema1

The L-Dex score is designed to detect lymphedema-related fluid changes in the limbs.

  • The L‑Dex score is designed to detect small lymphedema-related fluid changes in the limbs.
  • L‑Dex compares the fluid in a limb at-risk for lymphedema to a healthy limb in order to help detect lymphedema.
  • Validated for unilateral and bilateral secondary lymphedema of the arms and legs in women and men.

Accurate Detection

  • L‑Dex is validated to detect lymphedema at its earliest, subclinical stage
  • Detects fluid changes as small as 36 ml (2.4 tablespoons)1
  • Validated against lymphoscintigraphy 2
  • 80% Sensitive and 90% Specific in detecting subclinical lymphedema following cancer surgery with a 6.5 change of reading from a pre-treatment baseline3

Demonstrated Outcomes

  • 92% of patients with early detection using L-Dex and intervention did not progress to chronic lymphedema4
  • Significantly lower progression to chronic lymphedema with early detection using L-Dex and intervention versus using tape measure4
  • L-Dex more precise and reliable than tape measure4

References

  1. Ward, L. Is BIS ready for prime time as the gold standard measure. Jrn Lymphoedema 2009;4(2).
  2. Dylke ES, et al. Diagnosis of upper limb lymphedema: development of an evidence-based approach. Acta Oncologica 2016;55(12):1477-83.
  3. Fu MR, et al. L-Dex ratio in detecting breast cancer-related lymphedema: reliability, sensitivity, and specificity. Lymphology 2013;46:85-96.
  4. Ridner SH, et al. A Comparison of Bioimpedance Spectroscopy or Tape Measure Triggered Compression Intervention in Chronic Breast Cancer Lymphedema Prevention. Lymphatic Research and Biology