Next Article in Journal
Proline-Dependent Induction of Apoptosis in Oral Squamous Cell Carcinoma (OSCC)—The Effect of Celecoxib
Previous Article in Journal
Mu Opioid Receptor 1 (MOR-1) Expression in Colorectal Cancer and Oncological Long-Term Outcomes: A Five-Year Retrospective Longitudinal Cohort Study
Previous Article in Special Issue
Lower Extremity Lymphedema in Gynecologic Cancer Patients: Propensity Score Matching Analysis of External Beam Radiation versus Brachytherapy
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
Author to whom correspondence should be addressed.
Cancers 2020, 12(1), 135;
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
Show Figures

Figure 1

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.

Show more citation formats Show less citations formats
Note that from the first issue of 2016, MDPI journals use article numbers instead of page numbers. See further details here.

Article Access Map by Country/Region

Back to TopTop