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Semin Plast Surg 2018; 32(01): 012-016
DOI: 10.1055/s-0038-1635117
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Diagnosis and Staging of Lymphedema

Arin K. Greene
1   Department of Plastic and Oral Surgery, Lymphedema Program, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
,
Jeremy A. Goss
1   Department of Plastic and Oral Surgery, Lymphedema Program, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
› Author Affiliations
Further Information

Publication History

Publication Date:
09 April 2018 (online)

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Abstract

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.

Keywords

extremity - lymphedema - lymphoscintigraphy - diagnosis - staging

Note

The authors have no financial interest in this manuscript.


 

  • References

  • 1 Smeltzer DM, Stickler GB, Schirger A. Primary lymphedema in children and adolescents: a follow-up study and review. Pediatrics 1985; 76 (02) 206-218
    PubMedGoogle Scholar
  • 2 Schook CC, Mulliken JB, Fishman SJ, Grant FD, Zurakowski D, Greene AK. Primary lymphedema: clinical features and management in 138 pediatric patients. Plast Reconstr Surg 2011; 127 (06) 2419-2431
    CrossrefPubMedGoogle Scholar
  • 3 Schook CC, Mulliken JB, Fishman SJ, Alomari AI, Grant FD, Greene AK. Differential diagnosis of lower extremity enlargement in pediatric patients referred with a diagnosis of lymphedema. Plast Reconstr Surg 2011; 127 (04) 1571-1581
    CrossrefPubMedGoogle Scholar
  • 4 Maclellan RA, Couto RA, Sullivan JE, Grant FD, Slavin SA, Greene AK. Management of primary and secondary lymphedema: analysis of 225 referrals to a center. Ann Plast Surg 2015; 75 (02) 197-200
    CrossrefPubMedGoogle Scholar
  • 5 Brorson H, Svensson H. Liposuction combined with controlled compression therapy reduces arm lymphedema more effectively than controlled compression therapy alone. Plast Reconstr Surg 1998; 102 (04) 1058-1067 , discussion 1068
    CrossrefPubMedGoogle Scholar
  • 6 Brorson H, Ohlin K, Olsson G, Karlsson MK. Breast cancer-related chronic arm lymphedema is associated with excess adipose and muscle tissue. Lymphat Res Biol 2009; 7 (01) 3-10
    CrossrefPubMedGoogle Scholar
  • 7 International Society of Lymphology. The diagnosis and treatment of peripheral lymphedema: 2013 Consensus Document of the International Society of Lymphology. Lymphology 2013; 46 (01) 1-11
    PubMedGoogle Scholar
  • 8 Petrek JA, Senie RT, Peters M, Rosen PP. Lymphedema in a cohort of breast carcinoma survivors 20 years after diagnosis. Cancer 2001; 92 (06) 1368-1377
    CrossrefPubMedGoogle Scholar
  • 9 Gärtner R, Mejdahl MK, Andersen KG, Ewertz M, Kroman N. Development in self-reported arm-lymphedema in Danish women treated for early-stage breast cancer in 2005 and 2006--a nationwide follow-up study. Breast 2014; 23 (04) 445-452
    CrossrefPubMedGoogle Scholar
  • 10 Mendoza N, Li A, Gill A, Tyring S. Filariasis: diagnosis and treatment. Dermatol Ther (Heidelb) 2009; 22 (06) 475-490
    CrossrefPubMedGoogle Scholar
  • 11 Greene AK, Grant FD, Slavin SA. Lower-extremity lymphedema and elevated body-mass index. N Engl J Med 2012; 366 (22) 2136-2137
    PubMedGoogle Scholar
  • 12 Greene AK, Grant FD, Slavin SA, Maclellan RA. Obesity-induced lymphedema: clinical and lymphoscintigraphic features. Plast Reconstr Surg 2015; 135 (06) 1715-1719
    CrossrefPubMedGoogle Scholar
  • 13 Bagheri S, Ohlin K, Olsson G, Brorson H. Tissue tonometry before and after liposuction of arm lymphedema following breast cancer. Lymphat Res Biol 2005; 3 (02) 66-80
    CrossrefPubMedGoogle Scholar
  • 14 Stemmer R. Ein klinisches Zeichen zur Früh- und Differential- diagnose des Lymphödems [A clinical symptom for the early and differential diagnosis of lymphedema]. Vasa 1976; 5 (03) 261-262
    PubMedGoogle Scholar
  • 15 Brouillard P, Boon L, Vikkula M. Genetics of lymphatic anomalies. J Clin Invest 2014; 124 (03) 898-904
    CrossrefPubMedGoogle Scholar
  • 16 Shaw AC, Kalidas K, Crosby AH, Jeffery S, Patton MA. The natural history of Noonan syndrome: a long-term follow-up study. Arch Dis Child 2007; 92 (02) 128-132
    PubMedGoogle Scholar
  • 17 Welsh J, Todd M. Incidence and characteristics of lymphedema in Turner's syndrome. Lymphology 2006; 39 (03) 152-153
    PubMedGoogle Scholar
  • 18 Gloviczki P, Calcagno D, Schirger A. , et al. Noninvasive evaluation of the swollen extremity: experiences with 190 lymphoscintigraphic examinations. J Vasc Surg 1989; 9 (05) 683-689 , discussion 690
    CrossrefPubMedGoogle Scholar
  • 19 Szuba A, Shin WS, Strauss HW, Rockson S. The third circulation: radionuclide lymphoscintigraphy in the evaluation of lymphedema. J Nucl Med 2003; 44 (01) 43-57
    PubMedGoogle Scholar
  • 20 Hassanein AH, Maclellan RA, Grant FD, Greene AK. Diagnostic accuracy of lymphoscintigraphy for lymphedema and analysis of false-negative tests. Plast Reconstr Surg Glob Open 2017; 5 (07) e1396
    PubMedGoogle Scholar
  • 21 Maclellan RA, Zurakowski D, Voss S, Greene AK. Correlation between lymphedema disease severity and lymphoscintigraphic findings: a clinical-radiologic study. J Am Coll Surg 2017; 225 (03) 366-370
    CrossrefPubMedGoogle Scholar
  • 22 Maclellan RA, Greene AK. Lymphedema. Semin Pediatr Surg 2014; 23 (04) 191-197
    CrossrefPubMedGoogle Scholar
  • 23 Chang DW, Masia J, Garza III R, Skoracki R, Neligan PC. Lymphedema: surgical and medical therapy. Plast Reconstr Surg 2016; 138 (3, Suppl): 209S-218S
    CrossrefPubMedGoogle Scholar
  • 24 Weiss M, Burgard C, Baumeister R. , et al. Magnetic resonance imaging versus lymphoscintigraphy for the assessment of focal lymphatic transport disorders of the lower limb: first experiences. Nucl Med (Stuttg) 2014; 53 (05) 190-196
    PubMedGoogle Scholar
  • 25 Akita S, Mitsukawa N, Kazama T. , et al. Comparison of lymphoscintigraphy and indocyanine green lymphography for the diagnosis of extremity lymphoedema. J Plast Reconstr Aesthet Surg 2013; 66 (06) 792-798
    CrossrefPubMedGoogle Scholar