Preoperative assessment of upper extremity secondary lymphedema Journal Article
| Authors: | Wiser, I.; Mehrara, B. J.; Coriddi, M.; Kenworthy, E.; Cavalli, M.; Encarnacion, E.; Dayan, J. H. |
| Article Title: | Preoperative assessment of upper extremity secondary lymphedema |
| Abstract: | Introduction: The purpose of this study was to evaluate the most commonly used preoperative assessment tools for patients undergoing surgical treatment for secondary upper extremity lymphedema. Methods: This was a prospective cohort study performed at a tertiary cancer center specializing in the treatment of secondary lymphedema. Lymphedema evaluation included limb volume measurements, bio-impedance, indocyanine green lymphography, lymphoscintigraphy, magnetic resonance angiography, lymphedema life impact scale (LLIS) and upper limb lymphedema 27 (ULL-27) questionnaires. Results: 118 patients were evaluated. Limb circumference underestimated lymphedema compared to limb volume. Bioimpedance (L-Dex) scores highly correlated with limb volume excess (r2 = 0.714, p < 0.001). L-Dex scores were highly sensitive and had a high positive predictive value for diagnosing lymphedema in patients with a volume excess of 10% or more. ICG was highly sensitive in identifying lymphedema. Lymphoscintigraphy had an overall low sensitivity and specificity for the diagnosis of lymphedema. MRA was highly sensitive in diagnosing lymphedema and adipose hypertrophy as well as useful in identifying axillary vein obstruction and occult metastasis. Patients with minimal limb volume difference still demonstrated significantly impaired quality of life. Conclusion: Preoperative assessment of lymphedema is complex and requires multimodal assessment. MRA, L-Dex, ICG, and PROMs are all valuable components of preoperative assessment. © 2020 by the authors. Licensee MDPI, Basel, Switzerland. |
| Keywords: | adult; controlled study; major clinical study; lymphoscintigraphy; preoperative evaluation; prospective study; sensitivity and specificity; metastasis; quality of life; cohort analysis; lymphedema; cancer center; predictive value; adipose tissue; magnetic resonance angiography; impedance; vein occlusion; lymphography; patient reported outcomes; limb disease; preoperative assessment; indocyanine green; upper limb; arm circumference; human; male; female; article; l-dex; limb volumes; llis; mra; ull-27; axillary vein |
| Journal Title: | Cancers |
| Volume: | 12 |
| Issue: | 1 |
| ISSN: | 2072-6694 |
| Publisher: | MDPI |
| Date Published: | 2020-01-01 |
| Start Page: | 135 |
| Language: | English |
| DOI: | 10.3390/cancers12010135 |
| PROVIDER: | scopus |
| PUBMED: | 31935796 |
| PMCID: | PMC7016742 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 2 March 2020 -- Source: Scopus |
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