Sensitivity and specificity of combined perimetric and volumetric evaluations in the diagnosis of arm lymphedema.

The objective of the current study was to evaluate the sensitivity and the specificity of perimetry combined with volumetry in the treatment of lymphedema. Ninety women, who had been submitted to breast cancer surgery, were randomly selected in the Government Healthcare Clinic for this study. Only patients who underwent surgical treatment of breast cancer with some degree of lymphadenectomy were included in the study cohort. Individuals with active disease, whether local or otherwise, functional alterations of the upper limbs before breast cancer surgery were not included. The following possibilities were considered: 1--the perimetry evaluation was considered positive when the difference between the affected and unaffected sides was > or =2 cm for any one of the seven measurements and volumetry was > or = 100 mL; 2--perimetry > or =2 cm and volumetry > or =200 mL; 3--a difference > 10% between the two limbs in volumetry and perimetry. Prevalence, sensitivity, specificity, positive predictive value, negative predictive value and accuracy were evaluated statistically with an alpha error of 5% considered acceptable (p-value < 0.05). The mean age of the women was 54.8 +/- 11.7 years. The sensitivity, negative predictive value and accuracy were higher using perimetry when a volume > or =2 cm were considered. The specificity and positive predictive values were better when the difference was greater than 10% between the two limbs by both perimetry and volumetry. Perimetry is a reliable method in the diagnosis of lymphedema when differences > or =2 cm between the two limbs should be considered.