Various tests, ranging from a tape measure to sophisticated imaging technology, show low to moderate agreement in diagnosing breast cancer–related lymphedema, according to a recent study published by Brunelle et al in Rehabilitation Oncology.
Background
Breast cancer–related lymphedema is characterized by uncomfortable swelling in the trunk, breast, or arm on the side of surgery. Early and accurate diagnosis is needed to enable effective treatments for the condition.
Although various tests and diagnostic criteria have been used, there is currently no gold standard test for identifying patients with lymphedema. “For years, the lack of a standardized assessment for [breast cancer–related lymphedema] has been recognized as an impediment to research and clinical practice,” explained lead study author Cheryl L. Brunelle, PT, MS, CCS, CLT, of Massachusetts General Hospital. “Our findings highlight the unacceptably low levels of agreement between different tests for recognizing this complication and the urgent need to establish standardized diagnostic criteria,” she added.
Study Methods and Results
In this study, researchers compared the performance of different tests and diagnostic criteria for lymphedema among 57 patients. The tests included relative and absolute differences in arm volume—assessed using a tape measure—and comparison of the treated and untreated sides. The researchers also used optoelectronic limb volumetry with infrared light as well as bioimpedance spectroscopy with very low–strength electrical currents designed to determine extracellular fluid levels.
The researchers identified 21 patients with breast cancer–related lymphedema on the basis of a 10% increase in relative volume change from prior breast surgery. Whether preoperative baseline measures were integrated into the diagnosis of breast cancer–related lymphedema, diagnostic agreement was found to be poor and insignificant. In other comparisons evaluating relative volume change vs optoelectronic limb volumetry or varying diagnostic cutoff points, agreement was statistically moderate.
“Clinically, this is unacceptable, as it would result in 40% to 60% diagnostic disagreement utilizing different diagnostic thresholds,” the study authors emphasized.
In addition, test performance varied based on the presence of physical signs and symptoms of lymphedema, specifically swelling or a feeling of heaviness in the arm. The researchers suggested the diagnosis of breast cancer–related lymphedema should incorporate patient-reported symptoms and a clinical examination of the findings.
“[E]very participant reporting heaviness or swelling met the diagnostic criteria for [breast cancer–related lymphedema],” the study authors indicated.
Conclusions
The findings revealed the critical need for rigorously designed studies to develop standardized guidelines for breast cancer–related lymphedema diagnosis such as the integration of preoperative baseline measurements.
“The proportion of women diagnosed with [breast cancer–related lymphedema] after breast cancer treatment varies greatly depending on the measurement tool and the diagnostic criteria utilized,” the study authors concluded.
Disclosure: For full disclosures of the study authors, visit journals.lww.com.
