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Open AccessArticle

Preoperative Assessment of Upper Extremity Secondary Lymphedema

Division of Plastic and Reconstructive Surgery, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
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Author to whom correspondence should be addressed.
Cancers 2020, 12(1), 135; https://doi.org/10.3390/cancers12010135
Received: 4 November 2019 / Revised: 4 December 2019 / Accepted: 18 December 2019 / Published: 6 January 2020
(This article belongs to the Special Issue Cancer Related Lymphedema)
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. View Full-Text
Keywords: lymphedema; preoperative assessment; indocyanine green; L-DEX; ULL-27; LLIS; patient reported outcomes; limb volumes; MRA lymphedema; preoperative assessment; indocyanine green; L-DEX; ULL-27; LLIS; patient reported outcomes; limb volumes; MRA
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MDPI and ACS Style

Wiser, I.; Mehrara, B.J.; Coriddi, M.; Kenworthy, E.; Cavalli, M.; Encarnacion, E.; Dayan, J.H. Preoperative Assessment of Upper Extremity Secondary Lymphedema. Cancers 2020, 12, 135.

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