The Clinical Usefulness of Lymphedema Measurement Technique Using Ultrasound

Abstract

Background: We previously invented a new technique to measure the cross-sectional area of soft tissue of a limb (DCSA) with lymphedema using ultrasonography. The measurement correlated strongly with both circumference and volumetry in normal subjects. The purpose of this study was to measure the reliability and accuracy of the method in patients with lymphedema. Methods and Results: Ultrasonography was performed on both arms of 69 female patients diagnosed with stage ‡1 lymphedema related to advanced breast cancer. At 10 cm above elbow (AE) and below elbow (BE), softtissue thicknesses at various locations were measured by two examiners. Subcutaneous tissue stiffness was also obtained by measuring thickness differences of soft tissue when applying minimal and maximal pressure to the skin (compliance) and its ratio to the initial thickness (compliance ratio). DCSA showed a strong positive correlation with circumference (r = 0.758 to 0.951), and a moderate negative correlation with Z at 5 Hz (r = -0.326 to -0.486). Intra-and interclass coefficients of all ultrasonography measurements were moderate to excellent (0.623-0.990). Compliance measured at 10 cm BE on the lesion side was significantly higher than on the normal side ( p < 0.001), and compliance measured at 10 cm AE showed no difference between the two sides ( p = 0.653). Conversely, compliance ratios measured at 10 cm AE and BE on the lesion side were significantly lower than on the normal side ( p < 0.001). Conclusion: Thus, DCSA using ultrasonography could be a particularly viable option for determining status in lymphedema patients.

Upper limb sensory evaluations and ultrasonographic skin measurements in breast cancer–related lymphedema receiving complex decongestive physiotherapy

“…Epidermis, dermis, and subcutaneous fat thicknesses were measured using plenty of gel and with minimum probe compression using the automatic calculation feature of the US device. Intra-and inter-rater ICC values were found to be excellent (0.95 and 0.99, respectively) for US measurements of the forearm in patients with BCRL [19].…”

Ultrasonography as an instrument to evaluate lymphedema secondary to breast cancer: systematic review

“…The process of lymphedema formation involves increased activity of neutrophils, macrophages, and fibroblasts and inflammation and collagen deposition (fibrosis). According to Suehiro et al, 30 DUS can be used to capture the increase in collagen and the increase in subcutaneous inflammation, while Kim et al 33 showed that it is also possible to detect histological changes in addition to structural ones. Finally, Han et al 18 describe fibrosis as a highly valuable ultrasonographic finding, in addition to the extent of edema.…”

Case reports of primary lymphedema tarda in South Korea: Two case reports of unilateral primary lymphedema tarda in lower extremities

“…The amount of soft tissue in the cross-sectional area was calculated from a designed formula using the mean thicknesses on 16 sites. [13] According to Lee et al, the ratio of the cross-sectional area was calculated to be 1.93 for 15cm AK and 2.53 for 15cm BK. Bioelectrical impedance analysis (BIA) using single-frequency-BIA (InBody S10; Biospace, Seoul, Republic of Korea) and isokinetic muscle strength test using an isokinetic dynamometer (System 4 Pro TM ; Biodex Medical Systems, Inc., NY) were also performed to measure the lymphedema amount and muscle amount, respectively.…”

“…The state of lymphedema was evaluated using ultrasonographic techniques. [13] Ultrasonography was used to measure the distance between the skin and the muscle fascia 3 times each at the superior, medial, inferior, and lateral aspects of the bilateral leg, at 15 cm AK and BK (Fig. 3).…”

“…The amount of soft tissue in the cross-sectional area was calculated from a designed formula using the mean thicknesses on 16 sites. [13] According to Lee et al, the ratio of the cross-sectional area was calculated to be 1.93 for 15cm AK and 2.53 for 15cm BK.…”