Can a practicing surgeon detect early lymphedema reliably?

Lymphedema may be identified by simpler circumference changes as compared with changes in limb volume. Ninety breast cancer patients were prospectively enrolled in an academic trial, and seven upper extremity circumferences were measured quarterly for 3 years. A 10% volume increase or greater than 1...

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Bibliographic Details
Published in:	The American journal of surgery Vol. 186; no. 5; pp. 509 - 513
Main Authors:	Bland, Keiva L, Perczyk, Rebecca, Du, Wei, Rymal, Christine, Koppolu, Prathima, McCrary, Ruthie, Carolin, Kathryn A, Kosir, Mary Ann
Format:	Journal Article
Language:	English
Published:	New York, NY Elsevier Inc 01-11-2003 Elsevier Elsevier Limited
Subjects:	Arm - anatomy & histology Biological and medical sciences Blood and lymphatic vessels Breast cancer Breast Neoplasms - radiotherapy Breast Neoplasms - surgery Cancer therapies Cardiology. Vascular system Circumference Diseases of the lymphatic vessels Early Diagnosis Elbow Female Follow-Up Studies Humans Lumpectomy Lymphatic system Lymphedema Lymphedema - diagnosis Mastectomy Measurements Medical sciences Methods Middle Aged NMR Nuclear magnetic resonance Postoperative Complications - diagnosis Prospective Studies Radiation therapy Radiotherapy, Adjuvant Sensitivity and Specificity Surgery Time Factors Lymphedema Measurements Circumference Human Health staff Cardiovascular disease Early Diagnosis Surgeon Lymphatic vessel disease
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Summary:	Lymphedema may be identified by simpler circumference changes as compared with changes in limb volume. Ninety breast cancer patients were prospectively enrolled in an academic trial, and seven upper extremity circumferences were measured quarterly for 3 years. A 10% volume increase or greater than 1 cm increase in arm circumference identified lymphedema with verification by a lymphedema specialist. Sensitivity and specificity of several different criteria for detecting lymphedema were compared using the academic trial as the standard. Thirty-nine cases of lymphedema were identified by the academic trial. Using a 10% increase in circumference at two sites as the criterion, half the lymphedema cases were detected (sensitivity 37%). When using a 10% increase in circumference at any site, 74.4% of cases were detected (sensitivity 49%). Detection by a 5% increase in circumference at any site was 91% sensitive. An increase of 5% in circumference measurements identified the most potential lymphedema cases compared with an academic trial.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23
ISSN:	0002-9610 1879-1883
DOI:	10.1016/j.amjsurg.2003.07.003