Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Department of Epidemiology-Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Ann Surg Oncol. 2022 Jan;29(1):438-445. doi: 10.1245/s10434-021-10469-1. Epub 2021 Jul 15.
Breast cancer-related lymphedema occurs in up to 30% of women following axillary lymph node dissection (ALND) and less commonly following sentinel lymph node biopsy. To quantify disability in these patients, patient-reported outcome measures (PROMs) have proven useful; however, given the overlap of symptoms between ALND and lymphedema, examination of their accuracy, sensitivity, and specificity in detecting lymphedema in breast cancer patients undergoing ALND is needed.
The Lymphedema Life Impact Scale (LLIS) and the Upper Limb Lymphedema 27 scale (ULL27) were administered to patients who had undergone ALND at least 2 years prior and either did or did not develop lymphedema. Survey responses and the degree of disability were compared to generate receiver operator characteristic (ROC) curves, and the sensitivity and specificity of PROMs to diagnose lymphedema were analyzed.
Both PROMs were highly accurate, sensitive, and specific for detecting lymphedema. The LLIS had an accuracy of 97%, sensitivity of 100%, and specificity of 84.8% at a cutoff of ≥ 5.88 overall percent impairment score (higher scores indicate worse disability). The ULL27 had an accuracy of 93%, sensitivity of 88.6%, and specificity of 90.9% at a cutoff of ≤ 83.3 global score (lower scores indicate worse disability).
The LLIS and the ULL27 appear to be highly specific for lymphedema and capable of differentiating it from symptoms resulting from ALND alone. Our findings suggest that use of these questionnaires with a threshold may be effective for diagnosing lymphedema, potentially reducing the need for frequent clinic visits and time-consuming measurements.
乳腺癌相关淋巴水肿在接受腋窝淋巴结清扫术（ALND）的女性中发生率高达 30%，在接受前哨淋巴结活检的女性中较少见。为了量化这些患者的残疾程度，患者报告的结局测量（PROM）已被证明是有用的；然而，鉴于 ALND 和淋巴水肿之间的症状重叠，需要检查它们在检测接受 ALND 的乳腺癌患者淋巴水肿中的准确性、敏感性和特异性。
在至少 2 年前接受 ALND 且未发生或发生淋巴水肿的患者中，使用淋巴水肿生活影响量表（LLIS）和上肢淋巴水肿 27 量表（ULL27）进行评估。比较调查回复和残疾程度，以生成接收者操作特征（ROC）曲线，并分析 PROM 诊断淋巴水肿的敏感性和特异性。
两种 PROM 对检测淋巴水肿均具有高度准确性、敏感性和特异性。LLIS 的总损伤百分比得分（较高的分数表示更严重的残疾）≥5.88 时，准确性为 97%，敏感性为 100%，特异性为 84.8%；ULL27 的准确性为 93%，敏感性为 88.6%，特异性为 90.9%，当总分为≤83.3 时（较低的分数表示更严重的残疾）。
LLIS 和 ULL27 似乎对淋巴水肿具有高度特异性，并能够将其与仅由 ALND 引起的症状区分开来。我们的研究结果表明，使用这些问卷并设置阈值可能对诊断淋巴水肿有效，可能减少对频繁就诊和耗时测量的需求。
