Yang Eun Joo, Kim Seoung Yeon, Lee Woo Hyung, Lim Jae-Young, Lee Jaebong
1 Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital , Seongnam-si, Korea.
2 Department of Rehabilitation Medicine, Seoul National University Hospital , Jongno-gu, Korea.
Lymphat Res Biol. 2018 Aug;16(4):368-376. doi: 10.1089/lrb.2017.0047. Epub 2018 Jan 17.
If we use only volumetry for measuring lymphedema, we could underdiagnose lymphedema with characteristics of biomechanical changes without definite volume change, especially in the medial forearm.
In total, 158 breast cancer patients participated in this study. Arm volume was measured by water displacement volumetry, and segmental volumes were calculated from circumferences by using the truncated cone method. Subcutaneous ultrasound echogenicities were assessed on the medial side of the upper arm and forearm of both arms and graded by subcutaneous echogenicity grade (SEG) and revised SEG (rSEG). The standards for diagnosing secondary lymphedema were according to the volume change and clinical stage. Sensitivity, specificity, receiver-operating characteristic (ROC) curve, and area under the curve (AUC) were used. Analysis of ROC curves yielded AUCs of 0.875-0.933 (p < 0.001). Volume differences in each segment were significantly different among the grades by SEG. The highest AUC was found for volume difference (AUC = 0.919, 95% confidence interval [CI] = 0.860-0.978) in the upper arm near the elbow; however, in the medial forearm, the highest AUC was found for rSEG (AUC = 0.948, 95% CI = 0.923-0.965 in the proximal forearm; AUC = 0.940, 95% CI = 0.923-0.965 in the distal forearm).
Our findings support the use of SEG by ultrasound in the assessment of lymphedema, especially in the medial region of the forearm. Subcutaneous ultrasound echogenicities may improve the accuracy of diagnosis of lymphedema in the forearm.
如果仅使用体积测量法来评估淋巴水肿，对于那些具有生物力学变化特征但无明确体积变化的淋巴水肿，尤其是前臂内侧的淋巴水肿，我们可能会漏诊。
共有158名乳腺癌患者参与了本研究。通过水置换体积测量法测量手臂体积，并使用截头圆锥体法根据周长计算各节段体积。在双臂上臂和前臂内侧评估皮下超声回声，并根据皮下回声分级（SEG）和修订后的SEG（rSEG）进行分级。继发性淋巴水肿的诊断标准依据体积变化和临床分期。采用敏感性、特异性、受试者操作特征（ROC）曲线及曲线下面积（AUC）进行分析。ROC曲线分析得出AUC为0.875 - 0.933（p < 0.001）。各节段的体积差异在不同SEG分级之间存在显著差异。在上臂靠近肘部处，体积差异的AUC最高（AUC = 0.919，95%置信区间[CI] = 0.860 - 0.978）；然而，在前臂内侧，近端前臂rSEG的AUC最高（AUC = 0.948，95% CI = 0.923 - 0.965），远端前臂rSEG的AUC为0.940，95% CI = 0.923 - 0.965。
我们的研究结果支持在淋巴水肿评估中使用超声SEG，尤其是在前臂内侧区域。皮下超声回声可能会提高前臂淋巴水肿诊断的准确性。
