The objective of this systematic review is to describe imaging measurement methods used to assess breast cancer-related lymphedema (BCRL).
An original search was conducted in seven databases, and screening of studies was performed independently by two reviewers based on eligibility criteria using Covidence. Disagreement between reviewers was discussed and, if relevant, a third reviewer was involved to resolve. Data from included studies was extracted into predefined data fields. Data extraction factors included study design, participant selection criteria, setting, country, measurement methods evaluated, number of and time between measurements. Participant information includes: number of participants, age, sex and lymphemeda status (at risk for or diagnosed with lymphedema), stage/severity and disease duration.
Abstract screening included n=2815 articles, and n=121 articles were selected for full text extraction. Of these articles, n=15 included some form of imaging, including MRI, CT, 3D full body scanning, ultrasonography and other forms of novel scanning systems. Study designs varied, including: feasibility study (n=3), quasi-experimental design (n=1), cross-sectional (n=10) and prospective longitudinal cohort study (n=1). Thirteen (87%) studies included participants with BCRL, while two studies included individuals with or at risk of BCRL. The most common comparators for validity included lymphoscintigraphy, indocyanine green (ICG), lymphography (n=5), perometry (n=4), circumferential measuring methods (n=5) and water displacement strategies (n=2). Additionally, multiple studies assessed inter and intra rater reliability (n=3). Nearly all (87%) of the studies reported strong validity and reliability of imaging methods when compared with traditional measurement methods.
Imaging measurement methods including MRI, CT, 3D full body scanning and ultrasonography are reliable methods to assess breast cancer-related lymphedema compared to traditional measurement methods.
Imaging may provide a more specific and precise measurement of arm lymphedema compared to other external measurement methods. Further analysis on the accuracy and diagnostic validity of imaging versus traditional measurements of arm lymphedema will lend to future development of best practice guidelines for assessment of lymphedema.
Lymphedema
