Cheng MH, Pappalardo M, Lin C, Kuo CF, Lin CY, Chung KC, et al.
Annals of surgery. Date of publication 2018 Sep 1;volume 268(3):513-525.
1. Ann Surg. 2018 Sep;268(3):513-525. doi: 10.1097/SLA.0000000000002917.
Validity of the Novel Taiwan Lymphoscintigraphy Staging and Correlation of Cheng
Lymphedema Grading for Unilateral Extremity Lymphedema.
Cheng MH(1), Pappalardo M(1)(2), Lin C(3), Kuo CF(4)(5), Lin CY(1), Chung KC(6).
Author information:
(1)Division of Reconstructive Microsurgery, Department of Plastic and
Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University,
College of Medicine, Taoyuan, Taiwan.
(2)Plastic and Reconstructive Surgery, Department of Surgical, Oncological and
Oral Sciences, University of Palermo, Palermo, Italy.
(3)Department of Nuclear Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
(4)Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital,
Taoyuan, Taiwan.
(5)Division of Rheumatology, Allergy, and Immunology, Chang Gung Memorial
Hospital, Taoyuan, Taiwan.
(6)Section of Plastic Surgery, Department of Surgery, Michigan Medicine, Ann
Arbor, MI.
OBJECTIVE: The aim was to validate the new Taiwan Lymphoscintigraphy Staging,
correlate it with Cheng Lymphedema Grading (CLG) and evaluate the treatment
outcomes of unilateral extremity lymphedema.
BACKGROUND: No consensus has been reached for diagnosis and staging for patients
with lymphedema among medical specialties.
METHODS: We included 285 patients with unilateral extremity lymphedema using
lymphoscintigraphy. Lymphoscintigraphy was correlated to clinical symptoms and
signs, and classified into normal lymphatic drainage, partial obstruction, and
total obstruction. Inter- and intraobserver reliability of Taiwan
Lymphoscintigraphy Staging, correlation between Taiwan Lymphoscintigraphy Staging
and clinical findings were conducted. Patients were categorized in "surgical" (n
= 154) or "nonsurgical" (n = 131) groups for outcome evaluation.
RESULTS: Lymphoscintigraphy found 11 patients (3.9%) with normal lymphatic
drainage, 128 (44.9%) with partial obstruction, and 146 (51.2%) with total
obstruction. Taiwan Lymphoscintigraphy Staging showed high interobserver
agreement [intraclass correlation coefficient: 0.89 (95% confidence interval,
0.82-0.94)], and significantly correlated to computed tomography volumetric
difference (r = 0.66, P < 0.001) and CLG [intraclass correlation coefficient:
0.79 (95% confidence interval 0.72-0.84)]. At a mean follow-up of 31.2 ± 2.9
months, significant improvement in the circumferential difference (from
23.9% ± 17.6% to 14.6% ± 11.1%; P = 0.03) with a mean circumferential reduction
rate of 40.4% ± 4.5% was found in surgical group. At a mean follow-up of
26.6 ± 8.7 months, the nonsurgical group had increase of mean circumferential
difference from 24.0% ± 17.2% to 25.3% ± 19.0% (P = 0.09), with a mean
circumferential reduction rate was -1.9% ± 13.0%.
CONCLUSIONS: The Taiwan Lymphoscintigraphy Staging is a reliable diagnostic tool,
correlated with clinical findings and CLG, aiding in the selection of the
appropriate treatment to achieve favorable long-term outcomes in unilateral
extremity lymphedema.
DOI: 10.1097/SLA.0000000000002917
PMID: 30004927
