Starmer Heather, Cherry Mary Gemma, Patterson Joanne, Young Bridget, Fleming Jason
Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, USA.
Institution of Population Health, University of Liverpool, Liverpool, United Kingdom.
Lymphat Res Biol. 2023 Feb;21(1):42-51. doi: 10.1089/lrb.2021.0100. Epub 2022 Jun 9.
Head and neck lymphedema is a common condition following head and neck cancer (HNC) treatment, with substantial functional morbidity. This systematic review aimed to (1) identify tools used to assess head and neck lymphedema in HNC patients and (2) determine their validity and reliability. Electronic and hand searches of Prospero, MEDLINE, Cochrane Library, and Embase were searched from their inception until April 2021, and hand searches were independently screened by two reviewers. Studies were included if they were available in English and measured lymphedema in adult HNC patients (aged ≥18 years). Data including psychometric characteristics were extracted and synthesized narratively, with the Quality Assessment of Diagnostic Accuracy Studies-2 and the COnsensus-based Standards for the selection of health Measurement INstruments checklists used to assess risk of bias. Thirty-three studies, reporting 38 assessment tools, were included. Assessments included clinician rating scales, symptom inventories, size measures, measures of internal edema, radiographic and ultrasonographic measures, and quality-of-life measures. Of the 38 measures cited, only 11 had any degree of validation and reliability testing. Risk of bias varied among the different assessment tools. While many tools are used in the assessment of head and neck lymphedema, the majority of these tools lack validation and reliability data. Only one tool, the Head and Neck Lymphedema and Fibrosis Symptom Inventory, met criteria for strong quality assessment. Further efforts to establish a core set of metrics for this complex condition are warranted.
头颈部淋巴水肿是头颈部癌症（HNC）治疗后常见的病症，会导致严重的功能障碍。本系统评价旨在：（1）识别用于评估HNC患者头颈部淋巴水肿的工具；（2）确定这些工具的有效性和可靠性。对Prospero、MEDLINE、Cochrane图书馆和Embase进行了电子检索和手工检索，检索时间从各数据库创建之初至2021年4月，两名评审员独立对手工检索结果进行筛选。纳入的研究需为英文发表，且测量成年HNC患者（年龄≥18岁）的淋巴水肿情况。提取包括心理测量特征在内的数据，并进行叙述性综合分析，使用诊断准确性研究质量评估-2和基于共识的健康测量工具选择标准清单来评估偏倚风险。共纳入33项研究，报告了38种评估工具。评估包括临床医生评定量表、症状清单、尺寸测量、内部水肿测量、放射学和超声测量以及生活质量测量。在引用的38种测量方法中，只有11种进行了一定程度的效度和信度测试。不同评估工具的偏倚风险各不相同。虽然有许多工具用于评估头颈部淋巴水肿，但这些工具大多缺乏效度和信度数据。只有一种工具，即头颈部淋巴水肿和纤维化症状清单，符合高质量评估标准。有必要进一步努力为这种复杂病症建立一套核心指标。
