Dylke ES, Schembri GP, Bailey DL, Bailey E, Ward LC, Refshauge K, Beith J, Black D, Kilbreath SL, et al.
Acta oncologica (Stockholm, Sweden). Date of publication 2016 Dec 1;volume 55(12):1477-1483.
1. Acta Oncol. 2016 Dec;55(12):1477-1483. Epub 2016 Jun 22.
Diagnosis of upper limb lymphedema: development of an evidence-based approach.
Dylke ES(1), Schembri GP(2), Bailey DL(1), Bailey E(2), Ward LC(3), Refshauge
K(1), Beith J(4), Black D(1), Kilbreath SL(1).
Author information:
(1)a Faculty of Health Sciences , University of Sydney , Sydney , New South Wales
, Australia.
(2)b Nuclear Medicine Department , Royal North Shore Hospital , Sydney , New
South Wales , Australia.
(3)c School of Chemistry and Molecular Biosciences, the University of Queensland
, Brisbane , Queensland , Australia.
(4)d Chris O'Brien Lifehouse , Camperdown , New South Wales , Australia.
BACKGROUND: The diagnosis of secondary upper limb lymphedema (LE) is complicated
by the lack of an agreed-upon measurement tool and diagnostic threshold. The aim
of this study was to determine which of the many commonly used and normatively
determined clinical diagnostic thresholds has the best diagnostic accuracy of
secondary upper limb LE, when compared to diagnosis by an appropriate reference
standard, lymphoscintigraphy.
MATERIAL AND METHODS: The arms of women treated for breast cancer with and
without a previous diagnosis of LE, as well as healthy controls, were assessed
using lymphoscintigraphy, bioimpedance spectroscopy (BIS) and perometry. Dermal
backflow score determined from lymphoscintigraphy imaging assessment (reference
standard) was compared with diagnosis by both commonly used and normatively
determined diagnostic thresholds for volume and circumference measurements as
well as BIS.
RESULTS: For those with established dermal backflow, all commonly used and
normatively determined diagnostic thresholds accurately identified presence of LE
compared with lymphoscintigraphy diagnosis. In participants with mild to moderate
changes in dermal backflow, only a normatively determined diagnostic threshold,
set at two standard deviations above the norm, for arm circumference and full arm
BIS were found to have both high sensitivity (81% and 76%, respectively) and
specificity (96% and 93%, respectively). For this group, strong, and clinically
useful, positive (23 and 10, respectively) and negative likelihood (0.2 and 0.3)
ratios were found for both the circumference and bioimpedance diagnostic
thresholds.
CONCLUSION: For the first time, evidence-based clinical diagnostic thresholds
have been established for secondary LE. With mild LE, normatively determined
circumference and BIS thresholds are superior to the commonly used thresholds.
DOI: 10.1080/0284186X.2016.1191668
PMID: 27333213 [Indexed for MEDLINE]
