Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan.
Plastic and Reconstructive Surgery, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy.
Ann Surg. 2018 Sep;268(3):513-525. doi: 10.1097/SLA.0000000000002917.
The aim was to validate the new Taiwan Lymphoscintigraphy Staging, correlate it with Cheng Lymphedema Grading (CLG) and evaluate the treatment outcomes of unilateral extremity lymphedema.
No consensus has been reached for diagnosis and staging for patients with lymphedema among medical specialties.
We included 285 patients with unilateral extremity lymphedema using lymphoscintigraphy. Lymphoscintigraphy was correlated to clinical symptoms and signs, and classified into normal lymphatic drainage, partial obstruction, and total obstruction. Inter- and intraobserver reliability of Taiwan Lymphoscintigraphy Staging, correlation between Taiwan Lymphoscintigraphy Staging and clinical findings were conducted. Patients were categorized in "surgical" (n = 154) or "nonsurgical" (n = 131) groups for outcome evaluation.
Lymphoscintigraphy found 11 patients (3.9%) with normal lymphatic drainage, 128 (44.9%) with partial obstruction, and 146 (51.2%) with total obstruction. Taiwan Lymphoscintigraphy Staging showed high interobserver agreement [intraclass correlation coefficient: 0.89 (95% confidence interval, 0.82-0.94)], and significantly correlated to computed tomography volumetric difference (r = 0.66, P < 0.001) and CLG [intraclass correlation coefficient: 0.79 (95% confidence interval 0.72-0.84)]. At a mean follow-up of 31.2 ± 2.9 months, significant improvement in the circumferential difference (from 23.9% ± 17.6% to 14.6% ± 11.1%; P = 0.03) with a mean circumferential reduction rate of 40.4% ± 4.5% was found in surgical group. At a mean follow-up of 26.6 ± 8.7 months, the nonsurgical group had increase of mean circumferential difference from 24.0% ± 17.2% to 25.3% ± 19.0% (P = 0.09), with a mean circumferential reduction rate was -1.9% ± 13.0%.
The Taiwan Lymphoscintigraphy Staging is a reliable diagnostic tool, correlated with clinical findings and CLG, aiding in the selection of the appropriate treatment to achieve favorable long-term outcomes in unilateral extremity lymphedema.
验证新的台湾淋巴闪烁分期，并将其与 Cheng 淋巴水肿分级（CLG）相关联，评估单侧肢体淋巴水肿的治疗效果。
医学专业领域对淋巴水肿患者的诊断和分期尚未达成共识。
我们纳入了 285 例单侧肢体淋巴水肿患者，使用淋巴闪烁显像进行检查。将淋巴闪烁显像与临床症状和体征相关联，并分为正常淋巴引流、部分梗阻和完全梗阻。对台湾淋巴闪烁分期的观察者内和观察者间可靠性、台湾淋巴闪烁分期与临床发现之间的相关性进行了评估。将患者分为“手术”（n=154）或“非手术”（n=131）组进行疗效评估。
淋巴闪烁显像发现 11 例（3.9%）患者存在正常淋巴引流，128 例（44.9%）患者存在部分梗阻，146 例（51.2%）患者存在完全梗阻。台湾淋巴闪烁分期显示出较高的观察者间一致性[组内相关系数：0.89（95%置信区间，0.82-0.94）]，并与 CT 容积差异（r=0.66，P<0.001）和 CLG 显著相关[组内相关系数：0.79（95%置信区间 0.72-0.84）]。在平均 31.2±2.9 个月的随访中，手术组的周长差异（从 23.9%±17.6%降至 14.6%±11.1%；P=0.03）和平均周长缩小率（40.4%±4.5%）均有显著改善。在平均 26.6±8.7 个月的随访中，非手术组的平均周长差异从 24.0%±17.2%增加到 25.3%±19.0%（P=0.09），平均周长缩小率为-1.9%±13.0%。
台湾淋巴闪烁分期是一种可靠的诊断工具，与临床发现和 CLG 相关联，有助于选择合适的治疗方法，以实现单侧肢体淋巴水肿的长期良好效果。
