Department of Physical Medicine and Rehabilitation, MetroHealth Rehabilitation Institute, Case Western Reserve University, Cleveland, OH, USA.
Center for Molecular Imaging, UTHealth, Houston, TX, USA.
Med Oncol. 2024 Sep 5;41(10):241. doi: 10.1007/s12032-024-02472-9.
Lymphedema evaluation entails multifaceted considerations for which options continue to evolve and emerge. This paper provides a critical review of the current status of diagnostic and quantitative measures for lymphedema, from traditional and novel bedside assessment tools for volumetric and fluid assessment, to advanced imaging modalities. Modalities are contrasted with regard to empirical support and feasibility of clinical implementation. The manuscript proposes a grid framework for comparing the ability of each modality to quantify specific lymphedema characteristics, including distribution, dysmorphism, tissue composition and fluid content, lymphatic anatomy and function, metaplasia, clinical symptoms, and quality of life and function. This review additionally applies a similar framework approach to consider how well assessment tools support important clinical needs, including: (1) screening, (2) diagnosis and differential diagnosis, (3) individualization of treatment, and (4) monitoring treatment response. The framework highlights which clinical needs are served by an abundance of assessment tools and identifies others that have problematically few. The framework clarifies which tools have greater or lesser empirical support. The framework is designed to assist stakeholders in selecting appropriate diagnostic and surveillance modalities, gauging levels of confidence when applying tools to specific clinical needs, elucidating overarching patterns of diagnostic and quantitative strengths and weaknesses, and informing future investigation.
淋巴水肿的评估需要多方面的考虑，其选择也在不断发展和出现。本文批判性地回顾了淋巴水肿的诊断和定量测量的现状，从传统和新颖的床边评估工具，到体积和流体评估的先进成像方式。本文对比了各种方式的实证支持和临床实施的可行性。本文提出了一个网格框架，用于比较每种方式量化特定淋巴水肿特征的能力，包括分布、畸形、组织成分和液体含量、淋巴解剖和功能、化生、临床症状以及生活质量和功能。此外，本文还应用类似的框架方法来考虑评估工具在满足以下重要临床需求方面的表现：（1）筛查，（2）诊断和鉴别诊断，（3）治疗个体化，以及（4）监测治疗反应。该框架突出了哪些临床需求有大量的评估工具可以满足，哪些临床需求则明显缺乏合适的工具。该框架还明确了哪些工具具有更多或更少的实证支持。该框架旨在帮助利益相关者选择合适的诊断和监测方式，在将工具应用于特定临床需求时评估其置信度水平，阐明诊断和定量优势和劣势的总体模式，并为未来的研究提供信息。
