Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea.
Department of Physical Therapy, Youngsan University, Yangsan, Republic of Korea.
Lymphat Res Biol. 2024 Feb;22(1):37-42. doi: 10.1089/lrb.2023.0005. Epub 2023 Nov 16.
We previously devised an ultrasonographic evaluation to calculate subcutaneous tissue cross-sectional area (△CSA). The reliability and accuracy of this method were demonstrated in healthy individuals and in patients with lymphedema. The purpose of this study was to estimate the optimal cut-off value of the ratio of the △CSA of the involved side (lesion side) to the contralateral side for detecting breast cancer-related lymphedema (BCRL) using ultrasonography. Ultrasonographic measurements were performed 290 times in 150 patients. BCRL was defined as a confirmed difference of >2 cm in arm circumference. BCRL confirmed by a clinician (BCRL) was defined as the patient group that included not only BCRL but also patients with subcutaneous thickening and abnormal findings on lymphoscintigraphy, even if the difference in arm circumference was <2 cm. The △CSAs of both upper arms and forearms were calculated by measuring the thickness of the subcutaneous tissue at four locations using ultrasonography (superior, medial, inferior, lateral) at 10 cm above the elbow and 10 cm below the elbow. With a 1.35 △CSA ratio as the cut-off value for detecting BCRL, the sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) were 0.88, 0.87, and 0.95, respectively. With a 1.20 △CSA ratio as the cut-off value for detecting BCRL, the sensitivity, specificity, and AUC were 0.92, 0.89, and 0.97, respectively. Our findings suggest that a 1.20 △CSA ratio as determined using ultrasonography, corresponding to a tape measurement of 1.05 cm, can be considered as a diagnostic criterion for lymphedema.
我们之前设计了一种超声评估方法来计算皮下组织横截面积（△CSA）。该方法在健康个体和淋巴水肿患者中的可靠性和准确性已经得到证实。本研究旨在通过超声检查来评估患侧（病变侧）与对侧△CSA 比值来诊断乳腺癌相关淋巴水肿（BCRL）的最佳截断值。对 150 例患者的 290 次超声测量进行了研究。BCRL 通过临床医生确认（BCRL）定义为不仅包括 BCRL 患者，还包括手臂周长差异>2cm 且淋巴闪烁扫描显示皮下增厚和异常的患者。使用超声在肘上 10cm 和肘下 10cm 处的四个位置（上、内、下、外）测量皮下组织厚度来计算双侧上臂和前臂的△CSA。当 1.35 △CSA 比值作为检测 BCRL 的截断值时，灵敏度、特异性和受试者工作特征曲线下面积（AUC）分别为 0.88、0.87 和 0.95。当 1.20 △CSA 比值作为检测 BCRL 的截断值时，灵敏度、特异性和 AUC 分别为 0.92、0.89 和 0.97。我们的研究结果表明，超声检查确定的 1.20 △CSA 比值（相当于 1.05cm 的胶带测量值）可作为淋巴水肿的诊断标准。
