Materiały źródłowe

• #1 Diagnosis and Staging of Lymphedema

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5891654/

  Lymphedema often is confused with other causes of extremity edema and enlargement. Understanding the risk factors and physical examination signs of lymphedema can enable the health care practitioner to accurately diagnose patients 90% of the time. Confirmatory diagnosis of the disease is made using lymphoscintigraphy. It is important to correctly diagnose patients with lymphedema so that they can be managed appropriately. […] Although 90% of patients with lymphedema can be diagnosed by history and physical examination, confirmation requires lymphoscintigraphy. […] The definitive diagnostic test for lymphedema is lymphoscintigraphy. This study involves the injection of a tracer protein (99m Tc-sulfur colloid) into the hand or foot, after which the tracer is preferentially taken up by the lymphatic vasculature. A gamma camera positioned over the patient then detects the 99m Tc-sulfur colloid signal (gamma emissions), with sequential images showing the migration of tracer via the lymphatic system proximally to the inguinal or axillary lymph nodes. Abnormal findings include delayed transit time of the radiolabeled colloid to the regional lymph nodes, dermal backflow (accumulation of tracer in cutaneous lymphatics), asymmetric node uptake, and/or formation of collateral lymphatic channels. The test gives qualitative information (i.e., normal or abnormal lymphatic function) that is 96% sensitive and 100% specific for lymphedema.

• #1 Clinical features, diagnosis, and staging of peripheral lymphedema – UpToDate

  https://www.uptodate.com/contents/clinical-features-diagnosis-and-staging-of-peripheral-lymphedema/print

  Clinical features, diagnosis, and staging of peripheral lymphedema […] The clinical features, diagnosis, evaluation, and differential diagnosis of lymphedema are reviewed. […] A careful medical history is important in the evaluation of the patient with suspected lymphedema. […] Following treatment for cancer, the onset of lymphedema is usually insidious and typically characterized by slowly progressive swelling of an arm following axillary node dissection or a leg following inguinal node dissection. […] Among patients being treated for malignancy, methods for early identification have been suggested to identify and treat patients to minimize the progression of lymphedema.

• #1 Understanding your Lymphoedema Diagnosis | JOBST UK

  https://www.jobst.co.uk/living-with-your-condition/diagnoses/diagnosing-your-condition/diagnosis-of-lymphoedema

  Recognising lymphoedema, particularly primary lymphoedema, can be challenging, and late diagnosis is not uncommon. Your medical history and a complete physical exam are the main elements in the diagnosis of lymphoedema. […] There is no specific test or tool to diagnose lymphoedema. This makes the diagnosis difficult, and some patients struggle without a correct diagnosis for a long time. […] A complete physical exam and your medical history are important in determining the type of your lymphoedema. […] After that, your Healthcare Professional may refer you to a specialist in lymphoedema to confirm the diagnosis and to develop a holistic treatment plan with you. […] Your medical history and the physical exam of your body are the main elements in the diagnosis of lymphoedema. […] Your Healthcare Professional will examine your affected limb as well.

• #1 Primary lymphedema French National Diagnosis and Care Protocol (PNDS; Protocole National de Diagnostic et de Soins) | Orphanet Journal of Rare Diseases | Full Text

  https://ojrd.biomedcentral.com/articles/10.1186/s13023-020-01652-w

  Primary lymphedema is a rare chronic pathology associated with constitutional abnormalities of the lymphatic system. […] The diagnosis is clinical, associating mild or non-pitting edema and skin thickening, as confirmed by the Stemmer’s sign (impossibility to pinch the skin on the dorsal side or the base of the second toe), which is pathognomonic of lymphedema. Limb lymphoscintigraphy is useful to confirm the diagnosis. […] Primary lymphedema is often diagnosed late (>10 years between lymphedema onset and the first clinical assessment in a specialized center), because it is confused with other diagnoses (venous insufficiency, lipedema, etc.). […] A diagnosis of primary lymphedema may be advanced by a family physician, pediatrician, vascular or other medical specialist (dermatologist, cardiologist, internist, geneticist, etc.) and confirmed by a trained physician in liaison with a referral or specialized center.

• #1 Diagnosis — National Lymphedema Network

  https://lymphnet.org/diagnosis

  Lymphedema is typically diagnosed based on the presenting symptoms, including: […] Swelling in the limb or body region where lymph nodes were removed or damaged. […] Slow progressive onset of swelling. […] Visible asymmetry of the limbs. […] Swelling comes and goes in early stages but becomes more persistent in time. […] Tissue changes that include thickening, firmness, and pitting. […] Sensation of heaviness or aching in the limb or body region. […] Diffused light tingling symptoms in the limb or body region. […] Clothing or shoes that no longer fit the limb or feel tighter on the body region. […] Jewelry that used to fit comfortable is now difficult to get on/off or to wear. […] Tissue swelling that was present but now seems to have gone away. […] Swelling in the tissue that comes and goes regularly.

• #1 Diagnosis and Treatments of Limb Lymphedema: Review

  https://www.jstage.jst.go.jp/article/avd/17/2/17_ra.24-00011/_article

  Lymphedema is caused by dysfunction of the lymphatic system. It is divided into primary edema with no apparent cause and secondary edema with an exogenous cause. The main symptoms are edema and heaviness, skin changes such as skin hardening, lymphocysts, lymphorrhoea, papillomas, and recurrent cellulitis. They are often irreversible and progressive, thus greatly reducing quality of life of the patients. Diagnosis is made by image examinations that can evaluate lymphatic flow and functions such as lymphoscintigraphy and indocyanine green fluorescence lymphangiography. Linear pattern and dermal backflow are the main findings. […] Although CPT has become the gold standard of treatment, with evidence of efficacy reported in terms of volume reduction, maintenance, and prevention of cellulitis, it is a symptomatic treatment and does not improve impaired lymphatic flow. On the other hand, surgical treatment, such as lymphaticovenous anastomosis and vascularized lymph node transplantation, can create new lymphatic flow and improve lymphatic dysfunctions. […] In Japan, lymphedema is treated with a combination of conservative and surgical therapies, but lymphedema is intractable and few cases are completely cured. Therefore, how to improve the outcome of treatment is an important issue to be addressed in the future.

• #1 Lymphedema and Cancer – Side Effects – NCI

  https://www.cancer.gov/about-cancer/treatment/side-effects/lymphedema

  How is lymphedema diagnosed? […] You should watch for lymphedema signs and symptoms, such as tightness or swelling in an arm or leg, during and after cancer treatment. If you alert your doctor to swelling or other changes you have noticed, your doctor will examine the swollen part of your body. If swelling is affecting an arm or leg, they will compare the size of your swollen arm or leg with that of the other limb. […] You may also have one or more of the following tests to help your doctor better understand the cause of swelling and what is disrupting the flow of lymph fluid: […] Ultrasound uses high-energy sound waves to examine how fluid, such as blood and lymph, is moving through the body. Doctors can use ultrasound to find a blood clot that might be the cause of swelling. […] Magnetic resonance imaging (MRI) uses a dye, magnet, radio waves, and computer to make a series of detailed pictures of areas inside the body. Magnetic resonance lymphangiography (MRL) is like an MRI, but it makes pictures of the lymph system. Doctors can use MRI and MRL to identify what might be blocking the flow of lymph.

• #1 Lymphedema (PDQ®) – NCI

  https://www.cancer.gov/about-cancer/treatment/side-effects/lymphedema/lymphedema-hp-pdq

  Lymphedema is typically evident by clinical findings such as unilateral, nonpitting edema, usually with involvement of the digits, in a patient with known risk factors (e.g., a breast cancer patient with previous axillary dissection). […] Other causes of limb swelling, including deep venous thrombosis, malignancy, and infection, should be considered in the differential diagnosis and excluded with appropriate studies, if indicated. […] The wide variety of methods for evaluating limb volume and lack of standardization make it difficult for the clinician to assess the at-risk limb. Options include water displacement, tape measurement, infrared scanning, and bioelectrical impedance measures. […] The most common method for diagnosing upper-extremity lymphedema is circumferential upper-extremity measurement using specific anatomical landmarks.

• #1 Lymphedema: Diagnosis, prevention, and management – Oncology Nurse Advisor

  https://www.oncologynurseadvisor.com/features/lymphedema-diagnosis-prevention-and-management/

  Lymphedema is usually defined as increases in limb circumference or volume exceeding 2 cm or 10%, respectively, as determined by comparison of affected and unaffected limbs, or pre-onset affected limb measurements compared with swollen limb measurements. […] After other conditions that may cause lymphedema symptoms are excluded (such as recurrent or secondary cancers, deep-vein thrombosis, diabetes, or heart, kidney, or liver disease), lymphedema of the limb measurements are taken for comparison with quantitative criteria used in lymphedema diagnosis. […] Limb volume can be reliably measured using water displacement, tape measurement, infrared perometry, or electrical impedance measurement. […] Electrical bioimpedance allows early lymphedema detection and involves the use of electrical currents to measure fluid volumes, which correlate strongly with physical limb and perometric measurements.

• #1 Center for Lymphatic Disease | UC Davis Plastic and Reconstructive Surgery

  https://health.ucdavis.edu/plasticsurgery/procedures/lymphatic-diagnosing.html

  Comparing this volume to the other side (in patients with one-sided swelling) can help evaluate for lymphedema. […] Bioimpedance spectroscopy analysis is a non-invasive technology that allows for a quick and easy measurement of the volume of fluid in parts of the body by measuring a very low electrical current. It has been shown to detect very early lymphedema that cannot always be detected with tape measurements.

• #1 Diagnosis | Stanford Health Care

  https://stanfordhealthcare.org/medical-conditions/blood-heart-circulation/lymphedema/diagnosis.html

  Lymphedema is a painful, chronic condition that causes parts of the body to swell with fluid. […] At Stanford, our experienced, compassionate doctors and other care providers help you manage lymphedema and avoid complications. […] We offer leading-edge therapies, clinical trials, and surgical options to help you live your best quality of life. […] Our specialists will tailor a plan to your needs. Although there is no cure for lymphedema, treatment to manage the condition improves symptoms. […] Your personalized plan may consist of one or a combination of treatments including massage therapy, medication, clinical trials, and surgery. […] We pass a safe, low-level electrical current through the limb and compare the amount of fluid to other areas of the body to determine if lymphedema is present.

• #1 Lymphedema – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/lymphedema/diagnosis-treatment/drc-20374687

  If you’re at risk of lymphedema for instance, if you’ve recently had cancer surgery involving your lymph nodes your doctor may diagnose lymphedema based on your signs and symptoms. […] If the cause of your lymphedema isn’t as obvious, your doctor may order imaging tests to get a look at your lymph system. Tests may include: […] MRI scan. Using a magnetic field and radio waves, an MRI produces 3D, high-resolution images of the involved tissue. […] CT scan. This X-ray technique produces detailed, cross-sectional images of the body’s structures. CT scans can reveal blockages in the lymphatic system. […] Ultrasound. This test uses sound waves to produce images of internal structures. It can help find obstructions within the lymphatic system and vascular system. […] Lymphoscintigraphy. During this test, the person is injected with a radioactive dye and then scanned by a machine. The resulting images show the dye moving through the lymph vessels, highlighting blockages. […] For lymphedema, some basic questions to ask the doctor include: […] What tests do I need? Do these tests require special preparation? […] What’s the treatment for lymphedema? […] Are there medications to ease the swelling?

• #1 Diagnosis and treatment of lymphoedema – Senocore

  https://senocore.com/education/surgical-treatment-for-lymphedema/diagnosis-and-treatment-of-lymphoedema/?lang=en

  Indocyanine green (ICG) lymphography using indocyanine green dye for near-infrared fluorescence labeling in lymphaticovenular anastomoses, helps define lymphatic dysfunction and delineate individualized lymphedema treatment. […] It is the primary test used to determine eligibility for surgical treatment of lymphedema. It allows to select patients eligible for surgical treatment, to choose the appropriate surgical technique and to choose the location of surgical incisions. […] Lymphoscintigraphy is a special type of nuclear medicine imaging that provides special pictures of the lymphatic system, which transports fluid throughout your immune system. It allows us to assess the capacity of the lymphatic system. […] Computed tomography angiography (CTA) uses an injection of contrast material into your blood vessels and CT scanning to help diagnose and locate blood vessels that is places which will be anastomosed to lymphatic vessels (LVA) or place of collection and lymph nodes transfer (LNT). […] A Doppler ultrasound is a noninvasive test that can be used to estimate the blood flow through your blood vessels by bouncing high-frequency sound waves (ultrasound) off circulating red blood cells. It is useful in both preoperative planning of the surgery and intraoperative verification.

• #1 Lymphedema: Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/8353-lymphedema

  Lymphedema is swelling that happens when something affects your lymphatic system. […] Healthcare providers cant cure lymphedema, but they do have treatments to reduce swelling and discomfort. […] If you have swelling that may be due to lymphedema, your healthcare provider may do several tests to determine if lymphedema is causing the swelling. Those tests may include: Doppler ultrasound, Magnetic resonance imaging (MRI), Computed tomography (CT) scan. […] Yes, healthcare providers use the following staging system: Stage 0: The affected area may feel swollen, tight and heavy but without outside signs of swelling. Stage I: There may be occasional swelling that goes away when you elevate the affected area. Stage II: The affected area is almost always swollen and your skin in the area may feel firmer than the surrounding area. Stage III: The affected area has significant swelling with changes in your skin such as changes in its color and texture.

• #1 Lymphedema Diagnosis After Breast Cancer: 4 Tests You Can Do At Home

  https://torontophysiotherapy.ca/lymphedema-diagnosis-after-breast-cancer-4-tests/

  If after performing these tests you believe that you may have lymphedema, you should pursue a professional diagnosis and advice from a qualified healthcare practitioner. […] An early lymphedema diagnosis can help simplify self-management, prevent disease progression, increase treatment effectiveness, and improve outcomes. […] The importance of self-screening in at-risk populations is underrecognized, and patient tools for self-diagnosing lymphedema have been lacking. […] You cannot formally self-diagnose lymphedema using this test; lymphedema diagnosis can only be made by a qualified healthcare practitioner. […] You cannot formally self-diagnose lymphedema using these tests; lymphedema diagnosis can only be made by a qualified health professional. […] You cannot formally self-diagnose lymphedema using this tool; lymphedema diagnosis can only be made by a qualified healthcare professional.

• #1

  https://www.nhs.uk/conditions/lymphoedema/

  Lymphoedema is a long-term (chronic) condition that causes swelling in the body’s tissues. […] It’s important that lymphoedema is identified and treated as soon as possible. If it is not treated, it can get worse. […] See a GP if you experience the typical symptoms of lymphoedema, such as swelling in your arms and legs. They may refer you to a specialist lymphoedema treatment centre for further assessment. […] In many cases, lymphoedema can be diagnosed from your symptoms and medical history, and by examining the affected body part and measuring the distance around it to see if it’s enlarged. […] Occasionally, further tests may be necessary to assess and monitor your condition. […] If you’re being treated for cancer and are at risk of developing lymphoedema, you’ll be monitored for it afterwards.

• #1 Diagnosis | Stanford Health Care

  https://stanfordhealthcare.org/medical-conditions/blood-heart-circulation/lymphedema/diagnosis.html

  Your doctor can usually diagnose lymphedema by evaluating your symptoms, and we may use diagnostic tests to confirm it. […] These tests include: L-Dex: This noninvasive diagnostic test measures the amount of fluid in tissue to determine if lymphedema is present. […] Lymphoscintigraphy: We inject a small, safe amount of a radioactive sugar substance is into the web space of your hand or foot. […] A special imaging device can detect the gamma rays created by the substance, which helps us identify lymphedema in its earliest stage. […] Venous duplex: An ultrasound of the veins can rule out blood clots and check the function of the blood vessel valves. […] Blood clots and venous reflux can be mistaken for lymphedema because they cause swelling. […] Lympho-MRI: This detailed imaging study provides a look at the entire lymphatic system. […] Lymphatic mapping using fluorescent angiography: We inject a fluorescent dye into the webspace of your hand or foot. […] Fluorescent imaging using the SPY Elite or Photodynamic Eye allows us to visualize your superficial lymphatic system in real time.

• #1 Lymphedema – Wikipedia

  https://en.wikipedia.org/wiki/Lymphedema

  No generally accepted criterion is definitively diagnostic, although a volume difference of 200 ml between limbs or a 4 cm (1.6 in) difference (at a single measurement site or set intervals along the limb) is often used. […] Bioimpedance measurement (which measures the amount of fluid in a limb) offers greater sensitivity than other methods. […] Devices like SOZO utilize Bioimpedence Analysis (BIA) by sending a current through the body and measuring the resultant impedance. […] Another approach involves Tissue Dielectric Constant (TDC) measurement, used by devices such as Delfin Technology’s MoistureMeterD and LymphScanner, which employ microwaves to detect changes in the dielectric properties of tissue. […] These innovative techniques have become integral to official protocols for lymphedema detection.

• #1 Blood test accurately predicts lymphedema, study shows | News Center

  https://med.stanford.edu/news/all-news/2012/12/blood-test-accurately-predicts-lymphedema-study-shows.html

  Scientists have identified a set of proteins circulating in blood whose levels accurately flag the presence of lymphedema, an often-painful condition that can afflict cancer patients. […] The only known way to diagnose lymphedema now is via physical inspection, and all too often it is misdiagnosed or overlooked altogether. […] By the time the main symptom – swelling of one or more limbs – is detectable, the condition may have gotten such a foothold that it becomes difficult or impossible to reverse, at least given current treatment options, Rockson said. […] Statistical modeling indicated a panel of tests that measured six separate proteins’ levels in study subjects’ blood was able to distinguish the lymphedematous patients from control subjects who did not have lymphedema. […] To determine their six-protein biomarker-panel’s validity, Rockson’s group collected blood from a new cohort of 36 lymphedematous and 15 healthy adults, extracted blood samples and tested them with the panel.

• #1

  https://www.nhs.uk/conditions/lymphoedema/diagnosis/

  See a GP if you have symptoms of lymphoedema. If you’re being treated for cancer and are at risk of developing lymphoedema, you’ll be monitored for the condition afterwards. […] In many cases, it’s possible to diagnose lymphoedema by: asking about your symptoms and medical history, examining the affected limb and measuring the distance around it to see if it’s enlarged. […] The GP may refer you to a specialist lymphoedema treatment centre for further assessment. […] Early diagnosis and treatment can help prevent the condition from getting worse. […] Imaging tests may also be used if there’s uncertainty around the diagnosis or to rule out other causes of swelling.

• #1 Understanding your Lymphedema Diagnosis | JOBST

  https://www.jobstcanada.com/patients/lymphcare/what-is-lymphedema/diagnosis-of-lymphedema.html

  Recognizing lymphedema, particularly primary lymphedema, can be challenging, and late diagnosis is not uncommon. Your medical history and a complete physical exam are the main elements in the diagnosis of lymphedema. […] There is no specific test or tool to diagnose lymphedema. This makes the diagnosis difficult, and some patients struggle without a correct diagnosis for a long time. […] A complete physical exam and your medical history are important in determining the type of your lymphedema. […] After that, your Healthcare Professional should refer you to a specialist for lymphedema to confirm the diagnosis and to develop a holistic treatment plan with you. […] Your medical history and the physical exam of your body are the main elements in the diagnosis of lymphedema. […] Your Healthcare Professional may need further information, for example when you have other diseases that can cause swelling or in the very early stages of lymphedema. Several diagnostic tools can be useful in such a case: […] An early diagnosis of lymphedema is important for effective treatment and to prevent progression. Be aware of your body and stay in contact with your Healthcare Professional when you notice any changes or new signs and symptoms.

• #1 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Lymphedema-Diagnosis.aspx

  The diagnosis of lymphedema can be difficult because early signs of the condition can be subtle and patients may not be aware of them worsening. […] Diagnosis should be made based on a history of symptoms and medical conditions, in addition to a physical examination. There are also several diagnostic tests that are sometimes used. […] A physical examination is important to establish changes to the affected body part and the involvement and severity of lymphedema. […] Further diagnostic tests are not required in most cases but are occasionally used to assess the condition and monitor changes. These tests include: […] These testing methods can be used to diagnose lymphedema and monitor changes in the condition as treatment commences. […] Patients that have undergone cancer therapy recently or in the past have an increased risk of lymphedema and should be monitored for signs of the condition regularly. […] It is important that these individuals are aware of the early signs and symptoms of lymphedema, such that they can recognize the condition earlier if it presents.

• #1 Lymphedema Diagnosis After Breast Cancer: 4 Tests You Can Do At Home

  https://torontophysiotherapy.ca/lymphedema-diagnosis-after-breast-cancer-4-tests/

  Do you think that you might be showing early signs of the chronic swelling condition known as lymphedema? Assessment by a qualified healthcare practitioner is vital for an accurate diagnosis, but learning the basics of how to self-diagnose lymphedema can help you monitor yourself more effectively and discover your symptoms sooner – which can lead to earlier diagnosis, easier self-management, and better outcomes. […] In our experience, and that of our patients, this advice is often inadequate. Most patients first learn of their condition only after experiencing obvious swelling, and by the time many receive a formal diagnosis of lymphedema, significant swelling and permanent tissue changes have already begun to take pace. […] We believe at-risk patients should be taught better methods to monitor and self-diagnose lymphedema, this will help them seek out a professional diagnosis earlier, and receive appropriate care faster.

• #1

  https://journals.lww.com/rehabonc/fulltext/2017/07000/diagnosis_of_upper_quadrant_lymphedema_secondary.11.aspx

  Overall, on the basis of the evidence in this CPG, there is no one diagnostic tool that can be used definitively to diagnose SUQL, but using these recommendations can facilitate early identification and should lead to an examination of activity and participation restrictions and appropriate interventions.

• #1 Lymphedema: Symptoms & Treatment | University of Utah Health | University of Utah Health

  https://healthcare.utah.edu/lymphedema

  Lymphedema is swelling in a part of your body where lymphatic fluid builds up more than normal. It can develop when lymph nodes are removed or when lymph vessels that carry lymphatic fluid are missing, damaged, or not developed. […] A medical professional, such as a doctor, certified lymphedema therapist, or physical therapist, diagnoses lymphedema. Unfortunately, doctors often overlook lymphedema and the patient receives treatment at very late stages. […] To diagnose lymphedema you will have a clinical exam and imaging. The imaging uses indocyanine green (IcG) dye to show the structure and functioning of the lymphatic system. […] Early stage lymphedema can be difficult to diagnose. Patients usually complain of a feeling of heaviness, tingling, and swelling. If you can catch lymphedema early, you can prevent it from being a chronic and debilitating condition. […] It is very important to adequately diagnose this condition and start treatment early.

• #1

  https://link.springer.com/article/10.1007/s12032-024-02472-9

  Lymphedema diagnostic methods comprise an area of vigorous current research, with multifaceted priorities including early detection, establishing diagnosis and pathophysiology, localization, guiding intervention, and surveillance of severity and response to therapy. […] Most of the existing diagnostic literature for lymphedema emphasizes breast cancer-related and upper quadrant lymphedema, especially regarding traditional or common measures such as tape measurement, water displacement and bioimpedance spectroscopy. […] Given the importance of lymphedema in the vascular space, three American vascular societies collectively published an expert opinion consensus on lymphedema diagnosis and treatment which suggests agreement from the experts with diagnostic work-up and risk factors for lymphedema, though highlights the high degree of variability regarding lymphedema treatment and practice patterns necessitating further investigation.

• #1

  https://link.springer.com/article/10.1007/s12032-024-02472-9

  This paper explores the spectrum of traditional through emerging modalities, with the goal of evaluating practicable strategies by type of clinical scenario. […] The emphasis is on peripheral lymphedema, especially cancer-related lymphedema. […] Aims include (1) facilitation of best decision-making for modality choice in clinical and research applications, and (2) allowing overarching patterns to be identified, including strengths and gaps in current literature with regard to identified lymphedema assessment priorities. […] The framework clarifies which tools have greater or lesser empirical support. […] The framework is designed to assist stakeholders in selecting appropriate diagnostic and surveillance modalities, gauging levels of confidence when applying tools to specific clinical needs, elucidating overarching patterns of diagnostic and quantitative strengths and weaknesses, and informing future investigation.

• #1 New diagnostic modalities in lymphedema – Servier – PhlebolymphologyServier – Phlebolymphology

  https://www.phlebolymphology.org/new-diagnostic-modalities-in-lymphedema/

  In most cases, the diagnosis of lymphedema can be made by obtaining the patients history and conducting a good clinical examination, which consists of age of onset, medication, travel to tropical countries, all causes of secondary lymphedema, family history, etc. […] Lymphoscintigraphy has replaced lymphangiography as the standard for the diagnosis of lymphedema; however, other promising techniques have recently been developed. […] The most commonly used diagnostic tool for examining extremity lymphedema is lymphoscintigraphy. This technique, first described by Sherman and Ter-Pogossian in 1953, directly images the lymphatic system. […] Lymphoscintigraphy can be used to diagnose lymphedema and estimate the severity of the lymphedema. […] Near-infrared fluorescence imaging seems a good tool to visualize the superficial lymphatic architecture, to assess the severity of lymphedema according to the different images, and to use it as a guide for manual lymphatic drainage. Compared with lymphoscintigraphy, this technique does not use a radionuclide, has a lower cost, and shows a benefit for an early detection of lymphedema.

• #1 .Lymphedema Diagnosis – Laboratory of Lymphatic Biology and Bioengineering

  https://llbb.gatech.edu/lymphedema-diagnosis/

  One of the most feared side effect of breast cancer treatment is developing lymphedema. It is often diagnosed too late and therefore, requires a lifetime of maintenance. Current lymphedema detection employs various techniques to assess global limb volume change over time or differences between both limbs. New technologies like infrared sensors are more accessible and can output 3D reconstructions of limbs. Therefore, this system provides the platform to explore other (more local) metrics along the limb of interest that may be indicative of lymphedema potentially earlier on in its progression. […] To be clinically relevant, these systems must easily integrate into the clinics workflow. Collaborating with LymphaTech, our lab has undergone iterations of infrared sensor systems that have the capacity to calculate traditional volume measurements but also allows us to explore new metrics. More importantly, these systems have the potential to be implemented in clinics, having small footprints, being affordable, and working quickly.

• #1 Diagnosis and management of secondary lymphedema – Journal of Skin and Sexually Transmitted Diseases

  https://jsstd.org/diagnosis-and-management-of-secondary-lymphedema/

  Measurements of affected area can aid in diagnosis, as well as in monitoring the response to therapy. […] In situations where diagnosis of lymphedema is not clear cut or differentiation from non-lymphatic causes of edema is not possible from the history and physical examination, imaging studies can be invaluable. Imaging is also indicated to assess the extent of involvement before deciding the appropriate therapeutic intervention, especially the surgical approach. […] A complete blood count should be done if possibility of infection exists. Analysis of blood parameters such as serum urea, creatinine, liver function tests, and albumin levels are indicated to assess hepatic and renal causes of extremity swelling. […] The objectives of lymphedema treatment are alleviation of the symptoms, reduction of the morbidity, and improvement in the quality of life. Earlier, the treatment is instituted, better the outcome. Education and training of the patient form the cornerstone of treatment.

• #1 New diagnostic modalities in lymphedema – Servier – PhlebolymphologyServier – Phlebolymphology

  https://www.phlebolymphology.org/new-diagnostic-modalities-in-lymphedema/

  Lymphedema is a chronic, progressive, and debilitating disease. An early and accurate diagnosis and treatment is very important to alter the normal progression of the disease. […] Until recently, lymphoscintigraphy was considered the gold-standard diagnostic technique; however, other new and renewed diagnostic tools have emerged. This article provides an overview of the available diagnostic tools based on the findings from a literature search. […] Diagnostic tools can be divided into noninvasive and invasive techniques. Ultrasonography is a noninvasive technique that can identify lymphedema by looking at the thickness of the skin and echogenicity. […] A good clinical examination and history is a critical first step. Ultrasonography is a noninvasive and inexpensive technique that can be used to diagnose lymphedema based on tissue changes. Lymphoscintigraphy and near-infrared fluorescence imaging can diagnose lymphedema and visualize the lymphatic architecture.

• #1 Lymphoedema Diagnosis | Cancer Council NSW

  https://www.cancercouncil.com.au/cancer-information/managing-cancer-side-effects/lymphoedema/diagnosis/

  Your lymphoedema practitioner or another health professional will ask about your medical history, and check the level of swelling and any pitting, thickening or damage to the skin. […] The size of the affected limb will be compared to the other limb, and any differences will be assessed. This is done in different ways: […] If lymphoedema is diagnosed, it will be staged from 0 (least severe) to 3 (most severe). All stages of lymphoedema need ongoing treatment and care. […] Lymphoedema usually requires care from a range of health professionals including a qualified lymphoedema practitioner, doctors and allied health professionals (e.g. dietitian, exercise physiologist). […] Lymphoedema practitioners assess people with lymphoedema, develop treatment plans, prescribe compression garments, and provide ongoing treatment and care. […] Your general practitioner (GP), surgeon or oncologist may diagnose the condition, coordinate your treatment plan and refer you to a lymphoedema practitioner.

• #2 New diagnostic modalities in lymphedema – Servier – PhlebolymphologyServier – Phlebolymphology

  https://www.phlebolymphology.org/new-diagnostic-modalities-in-lymphedema/

  Lymphedema is a chronic, progressive, and debilitating disease. An early and accurate diagnosis and treatment is very important to alter the normal progression of the disease. […] Until recently, lymphoscintigraphy was considered the gold-standard diagnostic technique; however, other new and renewed diagnostic tools have emerged. This article provides an overview of the available diagnostic tools based on the findings from a literature search. […] Diagnostic tools can be divided into noninvasive and invasive techniques. Ultrasonography is a noninvasive technique that can identify lymphedema by looking at the thickness of the skin and echogenicity. […] A good clinical examination and history is a critical first step. Ultrasonography is a noninvasive and inexpensive technique that can be used to diagnose lymphedema based on tissue changes. Lymphoscintigraphy and near-infrared fluorescence imaging can diagnose lymphedema and visualize the lymphatic architecture.

• #2

  https://www.nhs.uk/conditions/lymphoedema/diagnosis/

  See a GP if you have symptoms of lymphoedema. If you’re being treated for cancer and are at risk of developing lymphoedema, you’ll be monitored for the condition afterwards. […] In many cases, it’s possible to diagnose lymphoedema by: asking about your symptoms and medical history, examining the affected limb and measuring the distance around it to see if it’s enlarged. […] The GP may refer you to a specialist lymphoedema treatment centre for further assessment. […] Early diagnosis and treatment can help prevent the condition from getting worse. […] Imaging tests may also be used if there’s uncertainty around the diagnosis or to rule out other causes of swelling.

• #2 Diagnosis – LIVE Today Foundation

  https://www.live-today.org/diagnosis/

  Most experts rely on a good history and physical exam to diagnosis lymphedema. […] A positive Stemmers sign is diagnostic of lymphedema. […] If you cannot gently pinch and tent the tissue, this is because the protein rich lymph fluid in the tissues prevents you from bringing the skin folds together and the Stemmers sign is positive. […] A positive Stemmers sign is diagnostic of lymphedema.

• #2 Lymphedema and Cancer – Side Effects – NCI

  https://www.cancer.gov/about-cancer/treatment/side-effects/lymphedema

  CT scan uses a computer linked to an x-ray machine to make a series of detailed pictures of areas inside the body from different angles. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. […] Lymphoscintigraphy uses a small amount of radioactive glucose to allow doctors to trace the flow of lymph fluid and identify blockages. […] Perometry and water displacement are noninvasive techniques used to estimate the volume of a limb in people at risk of lymphedema. […] Bioimpedance spectroscopy is a noninvasive technique used to measure the amount of fluid in the body. It can help determine whether a person who does not have symptoms is in the beginning stages of lymphedema. This tool is sometimes used to help prevent lymphedema in people who are at risk.

• #2 Diagnosis | Stanford Health Care

  https://stanfordhealthcare.org/medical-conditions/blood-heart-circulation/lymphedema/diagnosis.html

  Your doctor can usually diagnose lymphedema by evaluating your symptoms, and we may use diagnostic tests to confirm it. […] These tests include: L-Dex: This noninvasive diagnostic test measures the amount of fluid in tissue to determine if lymphedema is present. […] Lymphoscintigraphy: We inject a small, safe amount of a radioactive sugar substance is into the web space of your hand or foot. […] A special imaging device can detect the gamma rays created by the substance, which helps us identify lymphedema in its earliest stage. […] Venous duplex: An ultrasound of the veins can rule out blood clots and check the function of the blood vessel valves. […] Blood clots and venous reflux can be mistaken for lymphedema because they cause swelling. […] Lympho-MRI: This detailed imaging study provides a look at the entire lymphatic system. […] Lymphatic mapping using fluorescent angiography: We inject a fluorescent dye into the webspace of your hand or foot. […] Fluorescent imaging using the SPY Elite or Photodynamic Eye allows us to visualize your superficial lymphatic system in real time.

• #2 Diagnostic workup of lymphedema

  https://www.oaepublish.com/articles/2347-9264.2019.33

  Its widely accepted that lymphedema progresses through 4 stages. […] Lymphoscintigraphy has been regarded as the gold standard for the diagnosis of lymphedema since its first introduction. […] Lymphoscintigraphy demonstrates the lymphatic vessels efferent from the injected sites and lymph nodes along the pathway. […] Dermal backflow, accumulation of tracer outside the main lymph routes and in cutaneous lymphatices, and lymphangiectasia are considered major diagnostic findings for lymphedema. […] ICG lymphography can be used for early recognition of lymphedema, as some patients without symptoms can still show abnormal images. […] MRL allows for early recognition, full assessment of lymphedema status and surgical planning especially LVA. […] Since each diagnostic technique has its own pros and cons, there’s no consensus on how to properly diagnose lymphedema.

• #2 Lymphedema (PDQ®) – NCI

  https://www.cancer.gov/about-cancer/treatment/side-effects/lymphedema/lymphedema-hp-pdq

  The staging system of the ISL reflects likely changes over time based on the pathophysiology of lymphedema. […] The severity of lymphedema may be evaluated using the Common Terminology Criteria for Adverse Events (CTCAE), which was developed for grading adverse events in the context of clinical trials.

• #2 Lymphedema: Symptoms & Treatment | University of Utah Health | University of Utah Health

  https://healthcare.utah.edu/lymphedema

  Lymphedema is swelling in a part of your body where lymphatic fluid builds up more than normal. It can develop when lymph nodes are removed or when lymph vessels that carry lymphatic fluid are missing, damaged, or not developed. […] A medical professional, such as a doctor, certified lymphedema therapist, or physical therapist, diagnoses lymphedema. Unfortunately, doctors often overlook lymphedema and the patient receives treatment at very late stages. […] To diagnose lymphedema you will have a clinical exam and imaging. The imaging uses indocyanine green (IcG) dye to show the structure and functioning of the lymphatic system. […] Early stage lymphedema can be difficult to diagnose. Patients usually complain of a feeling of heaviness, tingling, and swelling. If you can catch lymphedema early, you can prevent it from being a chronic and debilitating condition. […] It is very important to adequately diagnose this condition and start treatment early.

• #2

  https://journals.lww.com/rehabonc/fulltext/2017/07000/diagnosis_of_upper_quadrant_lymphedema_secondary.11.aspx

  Early detection of lymphatic insufficiency, coupled with appropriate intervention, may be important to prevent progression of the condition and may provide a cost-effective approach. […] Providing timely and appropriate care to patients with SUQL requires that physical therapists and other health care professionals have access to guidelines that assist in directing their assessment and management. […] This document reflects the work of this group in developing recommendations for the detection and diagnosis of SUQL. […] For subclinical/early-stage lymphedema, BIA should be used to assist in the diagnosis of SUQL. […] In the moderate and late stages, circumferential measurement should be used, and water displacement may be used in some cases, for the diagnosis of upper-extremity lymphedema.

• #2 Blood test accurately predicts lymphedema, study shows | News Center

  https://med.stanford.edu/news/all-news/2012/12/blood-test-accurately-predicts-lymphedema-study-shows.html

  Because levels of the six proteins begin to climb early in the course of the disease, such a test should be valuable in determining risk for, or the onset of, lymphedema long before symptoms occur – which in turn would mean earlier, appropriate therapeutic intervention, perhaps in time to spare patients from the condition’s most-damaging effects or even reverse its course. […] „In addition,” Rockson said, „a standardized, accurate bioassay for lymphedema could help to pave the road for future human clinical trials of drugs to treat it.”

• #2 Lymphoedema Diagnosis | Cancer Council NSW

  https://www.cancercouncil.com.au/cancer-information/managing-cancer-side-effects/lymphoedema/diagnosis/

  Your lymphoedema practitioner or another health professional will ask about your medical history, and check the level of swelling and any pitting, thickening or damage to the skin. […] The size of the affected limb will be compared to the other limb, and any differences will be assessed. This is done in different ways: […] If lymphoedema is diagnosed, it will be staged from 0 (least severe) to 3 (most severe). All stages of lymphoedema need ongoing treatment and care. […] Lymphoedema usually requires care from a range of health professionals including a qualified lymphoedema practitioner, doctors and allied health professionals (e.g. dietitian, exercise physiologist). […] Lymphoedema practitioners assess people with lymphoedema, develop treatment plans, prescribe compression garments, and provide ongoing treatment and care. […] Your general practitioner (GP), surgeon or oncologist may diagnose the condition, coordinate your treatment plan and refer you to a lymphoedema practitioner.

• #2 Diagnosing lymphoedema | Coping with cancer | Cancer Research UK

  https://www.cancerresearchuk.org/about-cancer/coping/physically/lymphoedema-and-cancer/diagnosing-assessing/diagnosing-tests

  Your hospital doctor or nurse will arrange for you to see a lymphoedema specialist if you have swelling that may be caused by your cancer treatment. […] Diagnosing lymphoedema early is important, so you can start treatment to reduce and control the swelling as soon as possible. […] Speak to your doctor or specialist nurse if you have swelling that could be caused by cancer or its treatment. They can check whether you have lymphoedema. […] For many people, an examination and your medical history may be all thats needed to confirm a diagnosis of lymphoedema. […] Your doctor will refer you to a lymphoedema specialist if they think you have lymphoedema. […] The lymphoedema specialist will assess your swelling. They will work out which treatment you need. […] You might have some tests if your doctors are not sure what is causing your swelling. […] Doctors don’t normally use these scans to diagnose lymphoedema. They might use it to check that cancer is not causing your swelling. […] Your lymphoedema specialist will do a full assessment of your swelling. They will work out a treatment plan specifically for you.

• #2 Diagnosis and management of secondary lymphedema – Journal of Skin and Sexually Transmitted Diseases

  https://jsstd.org/diagnosis-and-management-of-secondary-lymphedema/

  The therapeutic options are divided into conservative (non-surgical) and surgical measures. A combined approach may be necessary in some cases. […] In carefully chosen patients, surgical measures can be either an adjunct to CDT (after the fluid component has been removed) or indicated when CDT fails. Recent research shows that operative interventions can also have a preventive role in avoiding complications of chronic disease. […] Secondary lymphedema is a complex condition in terms of etiology, clinical presentation, evolution, and treatment. A comprehensive approach is required in tackling the same because progressive disease leads to irreversible changes and puts severe psychosocial and economic burden on the patients.

• #3 Diagnosis and Staging of Lymphedema

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5891654/

  Lymphedema often is confused with other causes of extremity edema and enlargement. Understanding the risk factors and physical examination signs of lymphedema can enable the health care practitioner to accurately diagnose patients 90% of the time. Confirmatory diagnosis of the disease is made using lymphoscintigraphy. It is important to correctly diagnose patients with lymphedema so that they can be managed appropriately. […] Although 90% of patients with lymphedema can be diagnosed by history and physical examination, confirmation requires lymphoscintigraphy. […] The definitive diagnostic test for lymphedema is lymphoscintigraphy. This study involves the injection of a tracer protein (99m Tc-sulfur colloid) into the hand or foot, after which the tracer is preferentially taken up by the lymphatic vasculature. A gamma camera positioned over the patient then detects the 99m Tc-sulfur colloid signal (gamma emissions), with sequential images showing the migration of tracer via the lymphatic system proximally to the inguinal or axillary lymph nodes. Abnormal findings include delayed transit time of the radiolabeled colloid to the regional lymph nodes, dermal backflow (accumulation of tracer in cutaneous lymphatics), asymmetric node uptake, and/or formation of collateral lymphatic channels. The test gives qualitative information (i.e., normal or abnormal lymphatic function) that is 96% sensitive and 100% specific for lymphedema.

• #4 Lymphoscintigraphic Indications in the Diagnosis, Management and Prevention of Secondary Lymphedema

  https://www.mdpi.com/2673-592X/3/1/4

  Diagnosis of lymphedema is not easy, because the pathology can also be confused with other clinical manifestations (for example, edema due to venous insufficiency). […] To confirm the diagnosis, lymphoscintigraphy is confirmed as the “gold standard” procedure for the diagnosis of lymphedema, particularly in secondary type. […] To confirm the diagnosis, it is often necessary to resort to specialist imaging tests for an anatomo-functional definition of the pathology. Among these, lymphoscintigraphy is confirmed as the “gold standard” procedure for the diagnosis of lymphedema. […] The diagnosis of lymphedema is not easy, because the disease can also be confused with other clinical manifestations (for example, venous insufficiency edema), but an experienced Lymphologist is usually able to diagnose it with good accuracy.

• #5 Lymphoscintigraphic Indications in the Diagnosis, Management and Prevention of Secondary Lymphedema

  https://www.mdpi.com/2673-592X/3/1/4

  Lymphoscintigraphy is therefore an essential examination to establish the exact origin of the lymphatic block; this can be useful (often, indispensable) to establish the right therapy for the patient, and to agree together on a long-term maintenance path. […] Lymphoscintigraphy has been shown to be an effective and objective method of evaluating response to treatment, as regards microsurgical therapy, but also for lymphatic drainage and physical therapies in patients with secondary lymphedema. […] In conclusion, the possibility offered to nuclear medicine to be a primary protagonist in the development of the diagnosis and therapy of complex pathologies, including a series of rare diseases, must be considered. In this field, lymphoscintigraphy proves to be a useful, if not indispensable, diagnostic tool for the prevention of secondary lymphedema. […] It is so useful that lymphoscintigraphy has been included in the Italian Guidelines by the Ministry of Health.

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