Breast Cancer Clinical Trial
Official title:
Early Detection of Lymphedema With Bio-Electrical Impedance Analysis in Patients After Breast Cancer Surgery
Bio-electrical impedance analysis and Tissue Dielectric Constant measurements are objective methods in clinical usage to detect lymphedema in early stage. The aim of this study is to reveal comparative relation these two methods on detecting lymphedema in an early stage.The another aim of this study is to determine impedance ratios and lymphedema index (L-dex) by using bio-electrical impedance analysis in patients after breast cancer surgery.
Lymphedema is characterized by accumulation of protein rich fluid in interstitial spaces. It
is also a chronic condition that needs lifelong care. Untreated lymphedema leads to chronic
inflammation, cellulitis, pain, tiredness, cosmetic deformities, restriction of individual's
motion, mobility problems and dysfunctional use of affected extremity. Undiagnosed lymphedema
worsens gradually thus detecting lymphedema in an early stage have a place in matter. It was
indicated that early treatment of lymphedema improves treatment outcomes.
Bio-Electrical Impedance Analysis is a non-invasive method that measures extracellular fluid
proportion and impedance of related extremity by an advanced low intensity electrical current
passes through body. It was stated that Bio-Electrical Impedance Analysis measures impedance
ratio and it is useful in detecting lymphedema in an early stage. Bio-Electrical Impedance
Analysis (BIA) gives important informations in the assessment of lymphedema by measuring
directly tissue fluid changes. Lymphedema Index (L-dex) is found by dividing impedance ratios
of unaffected extremity to affected extremity's impedance ratio with bio-electrical impedance
analysis. Impedance of extremity lessens by developing lymphedema so L-dex value gets higher.
Tissue Dielectric Constant (TDC) is an objective and non-invasive measurement method to
evaluate early tissue fluid changes. A 300 megahertz signal is generated in a control unit
and transmitted to tissue by probe. Reflected electromagnetic wave depends on dielectric
constant of tissue. Free and bound water molecules proportion in tissue effect tissue
dielectric constant. Reflected electromagnetic wave is processed in the control unit and
relative tissue dielectric constant is calculated. Dielectric constant of pure water is 78.5
in room temperature. The Scale ranges between 1-80. It was stated that comparing affected and
unaffected extremities regarding lymphedema existence with TDC measurement, TDC value was
higher than 1.2 in the experimental group. In the control group, TDC value was lower than 1.2
. It was also emphasized that this proportion is probably valuable on assessment of upper
extremity lymphedema. TDC could be done in different depth. 0.5, 1.5, 2.5 and 5.0 mm probes
are possible for usage.In this study, Moisture Meter-D compact (MMDc) device will be used for
assessment. It allows evaluation in 2.5 mm depth. In this study, TDC will be applied to upper
extremity both affected and unaffected side. 6 cm lower point of cubital crease, 8 cm upper
point of cubital crease and 10 cm lower point of armpit will be marked on two sides with a
soft pen before measurement.
Between 18-65 years old total 60 women will be recruited into the study in 3 separate
groups.The first group will contain patients who had breast cancer surgery yet having no
lymphedema. The inclusion criteria for involving the first group is surgery time. No one will
be involved into the first group if surgery was applied 18 months ago before enrollment to
this study. The second group will contain patients who had breast cancer surgery and having
upper extremity lymphedema. The third group will contain healthy women. The aim of this study
whether BIA and TDC methods are in capable of detecting lymphedema in an early stage.
Measurements will be done at baseline, 6th month and 12th month. Exclusion criteria include
being involuntary to recruit the study, bilaterally breast surgery history, having
bilaterally upper extremity lymphedema, active infection, active chemotherapy and
radiotherapy process, being in malignity period, and having mentally and cognitive disorders.
Lymphedema treatment may be quite costly due to materials used in the treatment and special
producted compression stockings. If we take into account that compression stocking must
change every six months, it carries too much importance regarding cost-effectivity that
preventing lymphedema before manifesting.Even if lymphedema manifested already, detecting
lymphedema in an early stage before aggravation improves treatment outcomes and individual's
quality of life.
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