Can a practicing surgeon detect early lymphedema reliably?

Background: Lymphedema may be identified by simpler circumference changes as compared with changes in limb volume. Methods: Ninety breast cancer patients were prospectively enrolled in an academic trial, and seven upper extremity circumferences were measured quarterly for 3 years. A 10% volume increase or greater than I cm increase in arm circumference identified lymphedema with verification by a lymphedema specialist. Sensitivity and specificity of several different criteria for detecting lymphedema were compared using the academic trial as the standard. Results: Thirty-nine cases of lymphedema were identified by the academic trial. Using a 10% increase in circumference at two sites as the criterion, half the lymphedema cases were detected (sensitivity 37%). When using a 10% increase in circumference at any site, 74.4% of cases were detected (sensitivity 49%). Detection by a 5% increase in circumference at any site was 91% sensitive. Conclusions: An increase of 5% in circumference measurements identified the most potential lymphedema cases compared with an academic trial. (C) 2003 Excerpta Medica, Inc. All rights reserved.