Godoy J M P, Silva S H, Godoy M F G
Medicine School, São José do Rio Preto, São Paulo, Brazil.
Prague Med Rep. 2007;108(3):243-7.
The objective of the current study was to evaluate the sensitivity and the specificity of perimetry combined with volumetry in the treatment of lymphedema. Ninety women, who had been submitted to breast cancer surgery, were randomly selected in the Government Healthcare Clinic for this study. Only patients who underwent surgical treatment of breast cancer with some degree of lymphadenectomy were included in the study cohort. Individuals with active disease, whether local or otherwise, functional alterations of the upper limbs before breast cancer surgery were not included. The following possibilities were considered: 1--the perimetry evaluation was considered positive when the difference between the affected and unaffected sides was > or =2 cm for any one of the seven measurements and volumetry was > or = 100 mL; 2--perimetry > or =2 cm and volumetry > or =200 mL; 3--a difference > 10% between the two limbs in volumetry and perimetry. Prevalence, sensitivity, specificity, positive predictive value, negative predictive value and accuracy were evaluated statistically with an alpha error of 5% considered acceptable (p-value < 0.05). The mean age of the women was 54.8 +/- 11.7 years. The sensitivity, negative predictive value and accuracy were higher using perimetry when a volume > or =2 cm were considered. The specificity and positive predictive values were better when the difference was greater than 10% between the two limbs by both perimetry and volumetry. Perimetry is a reliable method in the diagnosis of lymphedema when differences > or =2 cm between the two limbs should be considered.
本研究的目的是评估视野检查联合容积测量法在淋巴水肿治疗中的敏感性和特异性。在政府医疗诊所随机挑选了90名接受过乳腺癌手术的女性参与本研究。研究队列仅纳入接受过一定程度淋巴结清扫的乳腺癌手术患者。不包括患有活动性疾病（无论局部或其他情况）以及乳腺癌手术前上肢有功能改变的个体。考虑了以下几种情况：1——当七项测量中的任何一项患侧与未患侧的差异≥2 cm且容积测量≥100 mL时，视野检查评估为阳性；2——视野检查≥2 cm且容积测量≥200 mL；3——两侧肢体在容积测量和视野检查方面的差异>10%。以5%的α错误率（p值<0.05）作为可接受标准，对患病率、敏感性、特异性、阳性预测值、阴性预测值和准确性进行了统计学评估。这些女性的平均年龄为54.8±11.7岁。当考虑容积≥2 cm时，使用视野检查法的敏感性、阴性预测值和准确性更高。当两侧肢体通过视野检查和容积测量的差异均大于10%时，特异性和阳性预测值更好。当考虑两侧肢体差异≥2 cm时，视野检查是诊断淋巴水肿的可靠方法。
