Diagnosis of Upper Quadrant Lymphedema Secondary to Cancer: Clinical Practice Guideline From the Oncology Section of the American Physical Therapy Association.
Kimberly Levenhagen, Claire Davies, Marisa Perdomo and 2 others
PMID 28838217WHAT IT FOUND
No single test diagnoses upper quadrant lymphedema after cancer.
Use symptoms, volume measures, and bioimpedance for early cases; use ultrasound for late tissue changes. Cluster findings and keep the same method over time.
Key findings
01No single diagnostic tool can definitively diagnose secondary upper quadrant lymphedema, so clinicians should cluster findings from history, examination, and measurements.
02For early or at-risk upper extremity lymphedema, bioimpedance analysis is recommended, and an L-Dex score over 7.1 can be diagnostic when preoperative baseline is unavailable.
03For established upper extremity lymphedema, calculated volume from circumferential measurements is recommended, with a side-to-side difference of at least 200 ml or ratio over 1.04 helping rule in lymphedema.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The search covered January 1, 2000 through July 5, 2015, so newer evidence may be missing. Only English-language papers were included. The evidence was not uniformly high quality, and many diagnostic methods lacked accuracy studies. The guideline was written by physical therapists, was not piloted in practice, and did not include patient perspectives during development. Different studies used different diagnostic criteria and patient groups, so cutpoints may not apply equally to every cancer-related lymphedema site or stage. No single quality rating tool covers all psychometric properties of diagnostic measures, so several appraisal tools were used.
The easy way to misread this
Do not assume any single test can confirm upper quadrant lymphedema in every cancer patient. The guideline found no definitive diagnostic tool, and most evidence is for breast cancer upper extremity lymphedema, with little research for hand, trunk, and head and neck sites.