Diagnostic Accuracy of Clinical Measures Considering Segmental Tissue Composition and Volume Changes of Breast Cancer-Related Lymphedema.

Eun Joo Yang,Seoung Yeon Kim,Jaebong Lee,Woo Hyung Lee,Jae-Young Lim

doi:10.1089/lrb.2017.0047

Abstract

Background: If we use only volumetry for measuring lymphedema, we could underdiagnose lymphedema with characteristics of biomechanical changes without definite volume change, especially in the medial forearm.Methods and Results: In total, 158 breast cancer patients participated in this study. Arm volume was measured by water displacement volumetry, and segmental volumes were calculated from circumferences by using the truncated cone method. Subcutaneous ultrasound echogenicities were assessed on the medial side of the upper arm and forearm of both arms and graded by subcutaneous echogenicity grade (SEG) and revised SEG (rSEG). The standards for diagnosing secondary lymphedema were according to the volume change and clinical stage. Sensitivity, specificity, receiver-operating characteristic (ROC) curve, and area under the curve (AUC) were used. Analysis of ROC curves yielded AUCs of 0.875–0.933 (p < 0.001). Volume differences in each segment were significantly different among the grades by SEG. The highest AUC was found for volume difference (AUC = 0.919, 95% confidence interval [CI] = 0.860–0.978) in the upper arm near the elbow; however, in the medial forearm, the highest AUC was found for rSEG (AUC = 0.948, 95% CI = 0.923–0.965 in the proximal forearm; AUC = 0.940, 95% CI = 0.923–0.965 in the distal forearm).Conclusions: Our findings support the use of SEG by ultrasound in the assessment of lymphedema, especially in the medial region of the forearm. Subcutaneous ultrasound echogenicities may improve the accuracy of diagnosis of lymphedema in the forearm.

Highlights

Breast cancer-related lymphedema (BCRL) is a chronic, debilitating condition with a variety of causes that restricts the flow of lymphatic fluid.[1,2] During the initial stages of lymphedema, the edema may be soft with pitting, and the severity of the condition is reflected by limb volume change
We explored the relationships between arm volume, bioimpedance spectroscopy (BIS) measurement of extracellular fluid (ECF) levels, and ultrasound data on skin and subcutaneous tissue of patients with secondary lymphedema in the upper extremities
The purpose of this study was to evaluate the role of subcutaneous echogenicity grade (SEG) for lymphedema assessment and to compare values obtained with this method with volume difference and clinical stage in each part of the arm

Summary

Introduction

Breast cancer-related lymphedema (BCRL) is a chronic, debilitating condition with a variety of causes that restricts the flow of lymphatic fluid.[1,2] During the initial stages of lymphedema, the edema may be soft with pitting, and the severity of the condition is reflected by limb volume change. Rarely identified as such, the frequency of use of different measures of limb volume or circumference would suggest that these measures are considered de facto gold standards for diagnosing secondary lymphedema. The accepted gold standards for measuring limb volume change in the clinical environment are water displacement volumetry and circumferential limb measures. If we use only volumetry for measuring lymphedema, we could underdiagnose lymphedema with characteristics of biomechanical changes without definite volume change, especially in the medial forearm. Arm volume was measured by water displacement volumetry, and segmental volumes were calculated from circumferences by using the truncated cone method. Conclusions: Our findings support the use of SEG by ultrasound in the assessment of lymphedema, especially in the medial region of the forearm. Subcutaneous ultrasound echogenicities may improve the accuracy of diagnosis of lymphedema in the forearm

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Conclusion