Home Print this page Email this page
Users Online: 746
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents  
ORIGINAL ARTICLE
Year : 2014  |  Volume : 3  |  Issue : 1  |  Page : 52-55

Bioelectric impedance phase angle in breast carcinoma


1 Department of Physiology, Subharti Medical College, Meerut, Uttar Pradesh, India
2 Department of Surgery, Subharti Medical College, Meerut, Uttar Pradesh, India

Date of Web Publication15-Apr-2014

Correspondence Address:
Ruchi Tyagi
Department of Physiology, Subharti Medical College, Meerut 250 005, Uttar Pradesh
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2278-344X.130617

Rights and Permissions
  Abstract 

Context: Worldwide breast cancer is the most frequently diagnosed life threatening cancer and the leading cause of death in women. Bioelectric impedance analysis (BIA) affords an emerging opportunity to assess prognosis because of its ability to non invasively assess cell and plasma membrane structure and function by means of phase angle. Aims: To compare the phase angle between patients of breast cancer and their matched control with the help of BIA. Settings and Design: After taking clearance from ethical committee, a total of 34 female cases of histologically proven infiltrating ductal breast carcinoma were included from the surgery IPD, department of surgery. Equal numbers of the matched controls were recruited from the friends and relatives of cases. Materials and Methods: Bio Electrical Impedance Analyzer (BIA) BODY STAT QUAD SCAN 4000 was used to measure resistance (R) and reactance (Xc) by recording a voltage drop in applied current. Phase angle is the ratio of reactance to resistance and is a measure of cell vitality. Statistical analysis used: Unpaired "t" test was applied. Results: In control group, the phase angle showed a mean of 5.479 whereas in test group, it showed a mean value of 4.726. The P value showed a significant difference (P < 0.0001). The smaller the phase angle values were higher was the tumor, nodes, metastases (TNM) staging. The phase angles differed significantly from the healthy age matched control values. Conclusions: This study demonstrated that phase angle is a strong predictor of severity of breast cancer and differed significantly between the two groups.

Keywords: Bio electrical impedance analyzer, breast cancer, phase angle


How to cite this article:
Tyagi R, Mishra S, Kumar M, Gaur N, Misra R, Prasad A. Bioelectric impedance phase angle in breast carcinoma. Int J Health Allied Sci 2014;3:52-5

How to cite this URL:
Tyagi R, Mishra S, Kumar M, Gaur N, Misra R, Prasad A. Bioelectric impedance phase angle in breast carcinoma. Int J Health Allied Sci [serial online] 2014 [cited 2021 Jan 16];3:52-5. Available from: https://www.ijhas.in/text.asp?2014/3/1/52/130617


  Introduction Top


Worldwide breast cancer is the most frequently diagnosed life threatening cancer in women and the leading cause of death in females. [1] More than 1 million new cases of female breast cancer are diagnosed each year. Between one half and two thirds of American women diagnosed at Stage II and III, an annual figure estimated at 45,000-50,000, will develop metastatic breast disease within five years of diagnosis. In combination with the estimated 10,000-15,000 women who present with stage IV disease each year, and the 25 percent whose disease recurs after five years, this means that every year between 73,000 and 86,000 American women discover that they have metastatic breast cancer. [2] The inability to predict and prevent metastatic breast cancer is a major problem.

We know that breast cancer is now no longer seen as a single disease but a multifaceted disease comprised of distinct biological subtypes presenting a varied spectrum of clinical, pathological and molecular features with different prognostic and therapeutic implications. Malignant cells exhibit numerous anomalies in cell and its membrane which includes high aerobic lactate production, abnormal plasma membrane transport, altered cell to cell communication, appearance of new antigens, shift in ion ratios etc. All these changes lead to disturbed cell physiology and thus altered tissue electrical properties. Bioelectric impedance analysis (BIA) affords an emerging opportunity to improve prognosis because of its ability to non-invasively detect changes in tissue electrical properties. The altered tissue electrical properties documented in cancer patients occur even before the appearance of overt signs of cachexia. [3]

BIA is simple, easy to use, objective, quick and easily reproducible technique to measure body composition. BIA works on the principle that a low voltage current is applied and the lean tissue which consists essentially of electrolytes containing water conduct the electrical current whereas fat acts as an insulator. [4] Impedance of the body is thus determined. [5] Impedance is a measure of how current is slowed or stopped as it passes through the body. It has two components -Resistance (R) and Reactance (Xc). Resistance is the restriction to the flow of an electric current whereas reactance is the resistive effect produced by tissue interfaces and cell membrane. [6] Reactance causes the current to lag behind the voltage creating a phase shift, which is quantified geometrically as the angular transformation of the ratio of resistance to reactance or the phase angle. [7] Phase angle is the marker of cell and cell membrane structure and functional status. Low phase angle suggests cell death or decreased cell integrity whereas higher phase angle suggests healthy cell and cell membrane. [8] A low phase angle has been associated with an impaired outcome in tumor diseases such as pancreatic cancer, colorectal cancer, and lung cancer as well as in HIV/AIDS, liver cirrhosis, dialysis, pulmonary disease, bacteremia and sepsis. [8],[9],[10],[11],[12],[13],[14]

The primary objective of this study was to evaluate the association of BIA derived phase angle with TNM staging of breast cancer.


  Materials and Methods Top


After taking clearance from ethical committee, 34 cases of histologically proven infiltrating ductal breast carcinoma from the Dept of Surgery were included in the study. A set of 34 healthy volunteers (friends and relatives of patients) matched by age and sex was the control group. All of them were subjected to under mentioned rigorous inclusion and exclusion criteria.

Inclusion criteria

  1. Biopsy proven cases of infiltrating ductal carcinoma
  2. Age >30 years and <60 years
  3. Has given informed consent
  4. Has not been treated prior for malignancy
  5. Not suffering from diseases like diabetes, hypertension, electrolyte imbalance, cirrhosis, hepatitis, HIV etc.


Exclusion criteria

  1. Any prior surgical, chemotherapy or radiotherapy
  2. Over hydrated or dehydrated
  3. Pregnancy
  4. Heart disease with pacemakers
  5. H/O alcohol or drug abuse
  6. Patients on diuretics or any other drug known to cause water and electrolyte imbalance.


Height was measured on a parallel plane stadiometer without shoes with a correction of 0.5 cm. Weight was taken with minimal clothing on with correction of 0.1 kg respectively. Hip circumference was measured at maximum posterior extension of buttocks whereas waist circumference was measured at a plane across iliac crest in standing position at end expiration. Two measurements were made at each site in rotational order with a 3 rd measurement if the first two differed by more than 1 cm. Subjects were instructed not to consume alcohol, coffee or do exercise 24 hours prior to test. They had to come with fasting of at least 4 hours. Following standard precautions were taken like subjects not wearing any metallic thing, no other electronic devices within 50 cm of BIA etc. Subject lied supine on a non-conducting couch with arms 30 degree apart from trunk and ankles at least 20 cm away from each other. The parts where electrodes were to be placed were cleaned with spirit swab. Bioelectric Impedance Analyzer BODY STAT QUAD SCAN 4000 was used. Red electrode was placed on the knuckles and black on the wrist next to ulna head in the right upper limb. In the right lower limb, red lead was placed behind the toes and black in between the medial and lateral malleoli. BIA was done at 50, 100 and 200 kHz. All the readings were taken within 5 minutes of lying down. The Impedance of the body was determined. Impedance has two components: Resistance (R) and Reactance (Xc). Resistance is the restriction to flow of an electric current whereas reactance causes current to lag behind the voltage creating a phase shift, which is quantified geometrically as the angular transformation of the ratio of resistance to reactance or the phase angle. [6] Phase Angle was calculated using following equation:

Phase Angle = (Resistance)/(reactance) × 180/π

All the patients proven to be cases of infiltrating ductal carcinoma breast were staged according to American Joint Cancer Committee recommendations on malignancy breast staging.

Phase angles of different stages were grouped accordingly. We analyzed the data with Graph pad prism software version 6.03 and Microsoft excel.

Phase angle of test group was compared with that of control group by applying unpaired t test. One way ANOVA was applied to compare the mean phase angle of different stages.

All breast cancer patients were assessed for phase angle preoperatively but the cases that were included in the study were proven to suffer from infiltrating ductal breast carcinoma on biopsy postoperatively.


  Results Top


All the patients were staged according to American Joint Cancer Committee recommendations on malignancy breast staging [Table 1].
Table 1: Clinical staging with TNM classification of patients


Click here to view


We had 7 patients of Stage IIa (T2NoM0) contributing to 20.58% whereas 11 patients were diagnosed to have Stage IIb (T2N1M0 and T3N0M0). Out of these patients, 7 patients belonged to T2N1M0 and 4 patients to T3N0M0. Stage IIIa (T2N2M0, T3N1M0, T3N2M0) had a total of 13 cases contributing to 38.2% of total. Stage IV (Any T, Any N, M1) had minimum number of cases amounting to just 3 cases thus contributing 8.8% of total cases [Figure 1].
Figure 1: TNM staging and cases distribution

Click here to view


Mean value of control and test group was calculated using unpaired t test. The mean value (±SEM) of control group was 5.479 (±0.0558) whereas that of test group was 4.726 (±0.0804). The two differed significantly from each other with a P < 0.0001, which showed the significance of ****. In Stage IIa, the range of phase angle varied from 5.4 to 4.7. The mean value ±SD was 5.071. (0.228) Stage IIb had a maximum value of phase angle 5.5 whereas the minimum value was 4.1 with a mean value ±SD of 4.891 (0.378). The values of phase angle in Stage IIIa varied from 5.1 to 4.1. The mean ±SD calculated was 4.631 (0.317) for this stage. Stage IV had highest value of 3.9 whereas least value of 3.5 with a mean value ±SD of 3.733 (0.208) [Table 2] and [Figure 2].
Figure 2: Staging and mean phase angle

Click here to view
Table 2: Mean phase angle of case and control


Click here to view


One-way ANOVA was applied and the differences among means of all stages was statistically significant (****) with an f value of 13.85 and a P < 0.0001 [Table 3].
Table 3: Mean phase angles in various stages of infiltrating ductal carcinoma breast


Click here to view



  Discussion Top


This prospective case control study included comparison of a control group (n = 34) and a test group (n = 34) diagnosed as cases of infiltrating ductal carcinoma breast based on triple assessment of breast and postoperative biopsy report.

In this study, we found that the phase angle differed significantly between the two groups and also showed a decreasing trend as the staging of infiltrating ductal carcinoma breast advances. When compared to stage IIa, the phase angle in groups related to Stage III and IV showed a significant decreasing trend. Hence phase angle could be a prognostic indicator in infiltrating ductal carcinoma breast.

The phase angle reflects the status of cell and cell membrane. It can be considered as a global marker of health. [6] The probable reason for the reduced phase angle in test group could be the altered and impaired cell structure and function. The neoplastic cells have impaired and reduced cell junctions, lost or new antigens, shift in ion ratios (Na, K, and Ca), abnormal plasma membrane transport, high aerobic lactate production and insertion of new proteins in cell membrane. [15] Any change in tissue physiology should produce changes in the tissue electrical properties. BIA-derived impedance and phase angle detect changes in electrical properties. [16] Reduced phase angle indicates a decreased ionic conduction with loss of dielectric mass. The observed impedance pattern, which is reflected in form of phase angle is determined by dielectric properties of the cancer cells which appear even before the appearance of overt signs of cachexia. [3] The standardized phase angle is an independent predictor for impaired functional and nutritional statuses and a better indicator of six month mortality than are malnutrition and disease severity in cancer. [14]

There are few studies which support the role of phase angle in malignancy e.g., Gupta D et al., Implications for prognosis in advanced colorectal cancer and Davis MP et al. Phase angle changes during hydration and prognosis in advanced cancer. [17],[18]

We conclude that if a lady presents with breast lump and reduced phase angle compared for her age strongly suggest breast malignancy after applying above mentioned exclusion criteria.

This study suggests that a reduced value of phase angle gives a clue for further investigation and could also be used as a prognostic indicator (for assessing staging) in patients of carcinoma breast.


  Acknowledgment Top


We are thankful to the medical superintendent of CSSH Hospital attached to Subharti Medical College, Meerut for granting us the permission to publish this material. We declare that this is our work, except where it is acknowledged specifically as the published or unpublished work of others. We are grateful to all the patients and controls for their cooperation during the study.

 
  References Top

1.Ferlay J, Bray F, Pisani P, Parkin DM. GLOBOCAN 2000: Cancer Incidence, Mortality and Prevalence Worldwide IARC Cancer Base No 5, Lyon: IARC; 2001.  Back to cited text no. 1
    
2.Roses DF. Breast Cancer. Churchill-Livingstone; 1999. p. 511.  Back to cited text no. 2
    
3.Toso S, Piccoli A, Gusella M, Menon D, Crepaldi G, Bononi A, et al. Bioimpedance vector pattern in cancer patients without disease versus locally advanced or disseminated disease. Nutrition 2003;19:510-4.  Back to cited text no. 3
    
4.Simons JP, Schols AM, Westerterp KR, ten Velde GP, Wouters EF. The use of bioelectrical impedance analysis to predict total body water in patients with cancer cachexia. Am J Clin Nutr 1995;61:741-5.  Back to cited text no. 4
    
5.Zarowitz BJ, Pilla AM. Bioelectrical impedance in clinical practice. DICP 1989;23:548-55.  Back to cited text no. 5
    
6.Barbosa-Silva MC, Barros AJ. Bioelectrical impedance analysis in clinical practice: A new perspective on its use beyond body composition equations. Curr Opin Clin Nutr Metab Care 2000;8:311-7.  Back to cited text no. 6
    
7.Baumgartner RN, Chumlea WC, Roche AF. Bioelectric impedance phase angle and body composition. Am J Clin Nutr 1988;48:16-23.  Back to cited text no. 7
    
8.Selberg O, Selberg D. Norms and correlates of bioimpedance phase angle in healthy human subjects, hospitalized patients, and patients with liver cirrhosis. Eur J Appl Physiol 2002;86:509-16.  Back to cited text no. 8
    
9.Faisy C, Rabbat A, Kouchakji B, Laaban JP. Bioelectrical impedance analysis in estimating nutritional status and outcome of patients with chronic obstructive pulmonary disease and acute respiratory failure. Intensive Care Med 2000;26:518-25.  Back to cited text no. 9
    
10.Maggiore Q, Nigrelli S, Ciccarelli C, Grimaldi C, Rossi GA, Michelassi C. Nutritional and prognostic correlates of bioimpedance indexes in hemodialysis patients. Kidney Int 1996;50:2103-8.  Back to cited text no. 10
    
11.Ott M, Fischer H, Polat H, Helm EB, Frenz M, Caspary WF, et al. Bioelectrical impedance analysis as a predictor of survival in patients with human immunodeficiency virus infection. J Acquir Immune Defic Syndr Hum Retrovirol 1995;9:20-5.  Back to cited text no. 11
    
12.Schwenk A, Ward LC, Elia M, Scott GM. Bioelectrical impedance analysis predicts outcome in patients with suspected bacteraemia. Infection 1998;26:277-82.  Back to cited text no. 12
    
13.Schwenk A, Beisenherz A, Romer K, Kremer G, Salzberger B, Elia M. Phase angle from bioelectrical impedance analysis remains an independent predictive marker in HIV-infected patients in the era of highly active antiretroviral treatment. Am J Clin Nutr 2000;72:496-501.  Back to cited text no. 13
    
14.Norman K, Stobäus N, Zocher D, Bosy-Westphal A, Szramek A, Scheufele R, et al. Cutoff percentiles of bioelectrical phase angle predict functionality, quality of life and mortality in patients with cancer. Am J Clin Nutr 2010;92:612-9.  Back to cited text no. 14
    
15.Trump BF, Heatfield BM, Phelps PC, Sanefuji H, Shamsuddin AK. Cell surface changes in preneoplastic and neoplastic epithelium. Scan Electron Microsc 1980:43-60.  Back to cited text no. 15
[PUBMED]    
16.Malecka-Massalka T, Smolen A, Zubryzycki J, Lupa-Zatwarnica K, Morshed K. Bioimpedance vector pattern in head and neck squamous cell carcinoma. J Physiol Pharmacol 2012;63:101-4.  Back to cited text no. 16
    
17.Gupta D, Lammersfeld CA, Burrows JL, Dahlk SL, Vashi PG, Grutsch JF, et al. Bioelectrical impedance phase angle in clinical practice: Implications for prognosis in advanced colorectal cancer. Am J Clin Nutr 2004;80:1634-8.  Back to cited text no. 17
    
18.Davis MP, Yavuzsen T, Khoshknabi D, Kirkova J, Walsh D, Lasheen W, et al. Bioelectric impedance phase angle changes during hydration and prognosis in advanced cancer. Am J Hosp Palliat Care 2009;26:180-7.  Back to cited text no. 18
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Materials and Me...
Results
Discussion
Acknowledgment
References
Article Figures
Article Tables

 Article Access Statistics
    Viewed2245    
    Printed26    
    Emailed0    
    PDF Downloaded218    
    Comments [Add]    

Recommend this journal