Diagnosis of upper limb lymphedema: development of an evidence-based approach

Dylke, E. S., Schembri, G. P., Bailey, D. L., Bailey, E., Ward, L. C., Refshauge, K., Beith, J., Black, D. and Kilbreath, S. L. (2016) Diagnosis of upper limb lymphedema: development of an evidence-based approach. Acta Oncologica, 1-7. doi:10.1080/0284186X.2016.1191668

Author Dylke, E. S.
Schembri, G. P.
Bailey, D. L.
Bailey, E.
Ward, L. C.
Refshauge, K.
Beith, J.
Black, D.
Kilbreath, S. L.
Title Diagnosis of upper limb lymphedema: development of an evidence-based approach
Journal name Acta Oncologica   Check publisher's open access policy
ISSN 1651-226X
Publication date 2016-06-22
Year available 2016
Sub-type Article (original research)
DOI 10.1080/0284186X.2016.1191668
Open Access Status Not Open Access
Start page 1
End page 7
Total pages 7
Place of publication Abingdon, Oxfordshire United Kingdom
Publisher Taylor & Francis
Language eng
Formatted abstract
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.
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: HERDC Pre-Audit
School of Chemistry and Molecular Biosciences
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Created: Tue, 28 Jun 2016, 21:00:49 EST by Mrs Louise Nimwegen on behalf of School of Chemistry & Molecular Biosciences