What is the assessment for a patient with lymphedema?

From the Guidelines

Assessment for Lymphedema

Lymphedema assessment typically involves a comprehensive evaluation of the affected limb, including measurement of circumference and volume, as well as evaluation of skin and soft tissue integrity 1.

• The patient's medical history, including any prior surgeries, radiation therapy, or infections, should also be thoroughly reviewed.
• Clinical examination using the Modified Head and Neck External Lymphedema and Fibrosis assessment criteria may be used in conjunction with circumferential measurement for diagnostic purposes 1.
• Self-reported symptoms such as swelling, heaviness, and numbness should be investigated to facilitate early diagnosis 1.
• Bioimpedance analysis may be used to detect lymphatic transport impairments and diagnose subclinical and early stage lymphedema in patients at risk for breast cancer–related lymphedema (Stage 0 and 1) 1.
• Ultrasound, Magnetic Resonance Imaging, and Computed Tomography may be used as diagnostic tools to identify tissue changes and detect lymphatic system impairment 1.
• Lymphoscintigraphy and Lymphography may also be used to detect lymphatic system impairment 1.
• The Norman Questionnaire and Morbidity Screening Tool are examples of questionnaires that can assist in the diagnosis of secondary upper quadrant lymphedema 1.
• Water displacement and perometry may be used to diagnose lymphedema with volumetry >200 mL when compared to the contralateral arm and with volumes >10% interlimb difference 1.
• Tissue Dielectric Constant and Dual-energy X-Ray Absorptiometry may be used for assessment but not as diagnostic tools 1.
• According to the American Cancer Society/American Society of Clinical Oncology breast cancer survivorship care guideline, primary care clinicians should counsel survivors on how to prevent/reduce the risk of lymphedema and refer patients with clinical symptoms or swelling suggestive of lymphedema to a therapist knowledgeable about the diagnosis and treatment of lymphedema 1.
• A systematic review of rehabilitation and exercise recommendations in oncology guidelines also recommends using clinical objective and patient-reported subjective measures to screen and assess limb and tissue changes over time 1.

From the Research

Assessment of Lymphedema

The assessment of lymphedema involves a comprehensive evaluation of the patient's condition, including:

• Patient-reported outcomes 2
• Palpation 2
• Visual assessment 2
• Assessment of limb size using circumference measurements 2, 3
• Assessment of extracellular fluid using bioimpedance spectroscopy 2
• Limb volume measurement, with a difference of >10% in the affected limb compared to the unaffected limb confirming a lymphedema diagnosis 4

Factors to Consider

When assessing a patient with lymphedema, the following factors should be considered:

• Prior surgical or radiation therapy for malignancy 5
• Other risk factors for lymphedema, such as prior trauma to or infection of the affected limb 5
• Duration of lymphedema, with longer durations potentially indicating more advanced stages of the condition 6
• Presence of peripheral arterial disease, which may impact treatment outcomes 6

Diagnostic Tools

The following diagnostic tools may be used to confirm a diagnosis of lymphedema:

• Lymphoscintigraphy 5
• CT or MRI scans 5
• Bioimpedance spectroscopy 2

Comprehensive Assessment

A comprehensive assessment of lymphedema should include a thorough medical, psychological, and physical examination, as recommended by guidelines 4. This assessment should inform the development of a personalized treatment plan, which may include Complex Decongestive Therapy (CDT), self-management strategies, and other interventions as needed.