Diagnostic Accuracy of Dermal Thickness in Lymphedema
Condition: Lymphedema of Upper Arm; Breast Cancer
MeSH terms: Breast Neoplasms; Lymphedema
Study type: Observational

Summary: 
      Ultrasound is an easily feasible noninvasive technique which is widely used in rehabilitation
      settings. Measurement of dermal thickness via ultrasound can be less time consuming than
      volume measurements with water displacement and circumference measurements. Measurement of
      subcutaneous tissue thickness were used for both assessment and treatment outcome. Recently
      reliability of ultrasound examination of thickness of the skin and subcutaneous tissue were
      studied by Han et al. However, diagnostic accuracy of this method has not been studied
      before. Early identification of breast cancer related lymphedema to start treatment earlier
      is critical. Consequently, reliability and diagnostic accuracy of the assessment techniques
      of lymphedema is crucial to evaluate both severity at the time of diagnosis, and later
      effectiveness of treatment. The aim of this study was to establish diagnostic accuracy of
      between side differences of ultrasonographic dermal thickness measurements in breast cancer
      related arm lymphedema.
    

Detailed description: 
      Breast cancer related arm lymphedema is a potential sequalae from the treatment of breast
      cancer which is characterized by the accumulation of protein-rich lymphatic fluid in the
      extracellular spaces. It may occur in almost 40% of the patients who have undergone breast
      cancer surgery or radiation therapy. Breast cancer related lymphedema may appear in the upper
      extremity, as well as in the ipsilateral upper quadrant and remaining breast tissue.
      Clinically, the diagnosis of lymphedema is based mainly on patient history and self-report of
      symptoms, visual inspection and skin palpation, and the determination of volume differences
      between both limbs. The most widely accepted measure of lymphedema is limb volume compared
      with that of the unaffected limb or compared with that of the same limb. Sequential
      circumference measurements along designated measure points are widely used in clinical
      practice. Limb volumes can be calculated or estimated based on a truncated cone formula.
      Volumetry by means of water displacement is considered the golden standard. The most common
      criterion for lymphedema diagnosis is a volume difference of 200 mL. Circumference
      measurements and the estimated volume were found to be reliable and highly correlated with
      each other. However, these volume measurements are not only influenced by fluid changes but
      also by compositional changes of muscle mass, bone, or fat. Also, water displacement is too
      cumbersome and messy to be used in routine clinical practice.

      Ultrasound is an easily feasible noninvasive technique which is widely used in rehabilitation
      settings. Measurement of dermal thickness via ultrasound can be less time consuming than
      volume measurements with water displacement and circumference measurements. Measurement of
      subcutaneous tissue thickness were used for both assessment and treatment outcome. Recently
      reliability of ultrasound examination of thickness of the skin and subcutaneous tissue were
      studied by Han et al. However, diagnostic accuracy of this method has not been studied
      before. Early identification of breast cancer related lymphedema to start treatment earlier
      is critical. Consequently, reliability and diagnostic accuracy of the assessment techniques
      of lymphedema is crucial to evaluate both severity at the time of diagnosis, and later
      effectiveness of treatment. The aim of this study was to establish diagnostic accuracy of
      between side differences of ultrasonographic dermal thickness measurements in breast cancer
      related arm lymphedema. Patients with breast cancer related lymphedema will be included.
      Lymphedema of the limbs will be assessed using the circumferential method. The
      circumferential upper limb measurementswill be carried out with the arm abducted at 30°,
      starting at the level of the carpometacarpal joint, every 5 cm proximal to this point along
      both limbs. Then, a computer program (limb volumes professional version 5.0) will be used to
      convert these values into limb volumes in milliliters. Differences in volume of affected and
      unaffected sides was defined as edema (volume difference). The criterion for lymphedema
      diagnosis is volume difference of 200 mL. Ultrasonographic dermal thickness measurements will
      be performed from medial forearm. Differences of the affected and unaffected sides will be
      calculated. The circumference measurement method and the thickness of the skin of the
      edematous limb by using the ultrasound and the truncated cone method by using circumference
      measurements will be compared to evaluate the diagnostic accuracy of between side differences
      of ultrasonographic dermal thickness measurements in breast cancer related arm lymphedema.
    

Intervention name(s): ultrasonographic dermal thickness measurements
Intervention type(s): Other
Intervention description(s): ultrasonographic dermal thickness measurements
Observational model: Other
Time perspective: Cross-Sectional
Sampling method: Probability Sample
Study population: 
        Patients with breast cancer related lymphedema
      
Keywords: assessment; breast cancer; diagnosis; lymphedema; measurement; ultrasound