Integrating Augmented Reality Tools in Breast Cancer Related Lymphedema Prognostication and Diagnosis

Summary

Breast cancer related lymphedema is frequent in breast cancer survivors, but there are not widely employed guidelines for its diagnosis and quantification. Here, we introduce a reliable and cost-effective protocol to define, quantify, and compare upper limb volume in breast cancer patients.

Abstract

Breast cancer related lymphedema (BCRL) is a detrimental condition characterized by fluid accumulation in the upper limb in breast cancer patients subjected to axillary surgery and/or radiations. Its etiology is multifactorial and include also tumor-specific pathological features, such as lymphovascular invasion (LVI) and extranodal extension (ENE). To date, no widely employed guidelines for the early diagnosis of BCRL are available. Here, we illustrate a protocol for a digitally assisted BCRL assessment using a 3D laser scanner (3DLS) and a tablet computer. It has been specifically optimized in a discovery cohort of high-risk breast cancer patients. This study provides a proof-of-principle that augmented reality tools, such as 3DLS, can be incorporated into the clinical workup of BCRL to allow for a precise, reproducible, reliable, and cheap diagnosis.

Introduction

Breast cancer related lymphedema (BCRL) is fluid retention in the upper extremity occurring after axillary surgery and/or radiation therapy in approximately 20-80% of breast cancer patients with lymph node metastases (N>1)^1,2,3. This condition results in swelling of the limb with subsequent reduced functionality, increased risk of comorbidities, frustration, anxiety, and depression^4,5. BCRL is currently considered a long-standing threat for breast cancer survivors given that it can arise up to 9 years after surger....

Protocol

This study was approved by the Institutional Review Boards from the Authors' Institutions. This protocol applies to node-positive (i.e., N>1 according to the TNM staging system)¹⁴ breast cancers showing LVI and/or ENE.

1. Real time arm measurements

1. Install the free downloadable application (e.g., Captevia) on a tablet computer.
2. Take a marker of the highest-contrast color compared to the skin of the patient (e.g., white, black).
   1. .......

Discussion

The use of an accurate and reliable tool for limb volume measurement is mandatory in breast cancer survivors, given that an early diagnosis of BCRL is related to improved outcomes. In addition, the identification of high-risk individuals should consider not only clinical and surgical data but also tumor-specific pathological features. This study demonstrates the reproducibility and reliability of a new portable 3DLS device in upper limb volume measurement both in healthy subjects and in a BCRL women with high-risk featur.......

Materials

Name	Company	Catalog Number	Comments
Structure sensor + Captevia V3.1	Rodin4D, Rodin SAS		Three dimensional laser scanner