Comparison of Diagnostic Accuracy of Clinical Measures of Breast Cancer–Related Lymphedema: Area Under the Curve

Abstract

Objective To compare diagnostic accuracy of measures of breast cancer–related lymphedema (BCRL). Design Cross-sectional design comparing clinical measures with the criterion standard of previous diagnosis of BCRL. Setting University of California San Francisco Translational Science Clinical Research Center. Participants Women older than 18 years and more than 6 months posttreatment for breast cancer (n=141; 70 with BCRL, 71 without BCRL). Interventions Not applicable. Main Outcome Measures Sensitivity, specificity, receiver operator characteristic curve, and area under the curve (AUC) were used to evaluate accuracy. Results A total of 141 women were categorized as having (n=70) or not having (n=71) BCRL based on past diagnosis by a health care provider, which was used as the reference standard. Analyses of ROC curves for the continuous outcomes yielded AUC of .68 to .88 (P<.001); of the physical measures bioimpedance spectroscopy yielded the highest accuracy with an AUC of .88 (95% confidence interval, .80–.96) for women whose dominant arm was the affected arm. The lowest accuracy was found using the 2-cm diagnostic cutoff score to identify previously diagnosed BCRL (AUC, .54–.65). Conclusions Our findings support the use of bioimpedance spectroscopy in the assessment of existing BCRL. Refining diagnostic cutoff values may improve accuracy of diagnosis and warrant further investigation.

Diagnosis of upper limb lymphedema: development of an evidence-based approach

“…Previous attempts to determine appropriate diagnostic thresholds have used questionable reference standards. For example, a prior diagnosis of BCRL has been previously used as a reference standard [16]. The authors noted that some participants did not have clinically evident LE, despite a previous diagnosis.…”

Normative Volume Difference Between the Dominant and Nondominant Upper Limbs in Healthy Older Women

“…where V is the volume of the segment, C avg (1,2) is the average of the circumference at each end of the segment, and h is the distance between the two circumference, 10 cm.…”

“…1 Measurements of limb volume or circumferences can be used to monitor the onset or progression of conditions, as well as the response to treatment. 2 Clinical detection of lymphedema is typically based on measurements of arm circumference or measurements of volumes that are derived from the circumferences. Circumferential measurements, obtained with a tape measure, are clinically the most frequently used technique.…”

Breast Cancer-Related Lymphedema (BCRL)

“…There are an estimated 2.3 million US survivors of breast cancer who are affected by LE; of those, approximately 19-33 % develop LE following axillary lymph node dissection (ALND) and radiation therapy (RT), and 3.5-24 % develop LE following sentinel node (SLN) biopsy and RT. The reported incidence of lymphedema after breast cancer treatment varies from 6 % to 63 %, depending on the study [1][2][3]. The incidence of LE ranges from 7 % to 77 % of patients who undergo ALND.…”

“…Foreign substances such as bacteria and toxins are filtered and destroyed in the nodes. The lymph vessels finally open into large ducts-the thoracic duct and right lymphatic duct-and then drain into the neck veins [1][2][3][4].…”