BACKGROUND: Patient-reported signs and symptoms are often the first indication of clinically relevant lymphedema. OBJECTIVE: The purpose of this study was to develop and assess the diagnostic accuracy of a screening questionnaire to detect lower-extremity lymphedema (LEL) among normal-weight women and women with obesity. DESIGN: This was a cross-sectional survey study. METHODS: The authors reviewed existing questionnaires assessing upper-extremity lymphedema (UEL) for potential questions and worked with content experts to generate new items. A draft questionnaire with 59 items was reviewed by 5 physicians and 5 physical therapists who specialized in lymphedema management and 5 female patients with clinically confirmed secondary LEL. A revised questionnaire with 45 items was administered by mail to 186 women with clinically confirmed LEL (n=116) or UEL (n=70). A total of 99 women (53.2% of 186) completed the mailed survey, and 28 women with lymphedema who were recruited directly in a lymphedema clinic waiting area also completed the survey. A parsimonious subset of items that best discriminated patients with and without LEL was identified using chi-square tests and logistic regression. Sensitivity and specificity for detecting LEL and positive and negative likelihood ratios (LR+, LR-) were estimated for the entire sample and for subsamples defined by obesity (body mass index ≥30 versus <30 kg/m(2)), which may confound the accurate diagnosis of LEL. RESULTS: Questionnaires were completed by 127 women (LEL group, n=88; UEL group, n=39). A sum of 13 items (score range=0-52) was the most discriminating. Using a cutoff score of ≥5 points, the sensitivity and specificity for detecting LEL among all participants were 95.5% and 86.5%, respectively (LR+=7.1, LR-=0.05), and 94.8% and 76.5%, respectively (LR+=4.0, LR-=0.07), for participants who were obese. LIMITATIONS: By enumerating a sample with a high prevalence of LEL, a spectrum bias may have been introduced, which may have affected the accuracy of the screening questionnaire. CONCLUSIONS: The brief, 13-item self-report questionnaire is a sensitive and specific tool for detecting clinically relevant LEL among women, including those with a body mass index of ≥30 kg/m(2).
BACKGROUND:Patient-reported signs and symptoms are often the first indication of clinically relevant lymphedema. OBJECTIVE: The purpose of this study was to develop and assess the diagnostic accuracy of a screening questionnaire to detect lower-extremity lymphedema (LEL) among normal-weight women and women with obesity. DESIGN: This was a cross-sectional survey study. METHODS: The authors reviewed existing questionnaires assessing upper-extremity lymphedema (UEL) for potential questions and worked with content experts to generate new items. A draft questionnaire with 59 items was reviewed by 5 physicians and 5 physical therapists who specialized in lymphedema management and 5 female patients with clinically confirmed secondary LEL. A revised questionnaire with 45 items was administered by mail to 186 women with clinically confirmed LEL (n=116) or UEL (n=70). A total of 99 women (53.2% of 186) completed the mailed survey, and 28 women with lymphedema who were recruited directly in a lymphedema clinic waiting area also completed the survey. A parsimonious subset of items that best discriminated patients with and without LEL was identified using chi-square tests and logistic regression. Sensitivity and specificity for detecting LEL and positive and negative likelihood ratios (LR+, LR-) were estimated for the entire sample and for subsamples defined by obesity (body mass index ≥30 versus <30 kg/m(2)), which may confound the accurate diagnosis of LEL. RESULTS: Questionnaires were completed by 127 women (LEL group, n=88; UEL group, n=39). A sum of 13 items (score range=0-52) was the most discriminating. Using a cutoff score of ≥5 points, the sensitivity and specificity for detecting LEL among all participants were 95.5% and 86.5%, respectively (LR+=7.1, LR-=0.05), and 94.8% and 76.5%, respectively (LR+=4.0, LR-=0.07), for participants who were obese. LIMITATIONS: By enumerating a sample with a high prevalence of LEL, a spectrum bias may have been introduced, which may have affected the accuracy of the screening questionnaire. CONCLUSIONS: The brief, 13-item self-report questionnaire is a sensitive and specific tool for detecting clinically relevant LEL among women, including those with a body mass index of ≥30 kg/m(2).
Authors: Electra D Paskett; Bette J Caan; Lisa Johnson; Brittany M Bernardo; Gregory S Young; Michael L Pennell; Roberta M Ray; Candyce H Kroenke; Peggy L Porter; Garnet L Anderson Journal: Cancer Epidemiol Biomarkers Prev Date: 2018-01-29 Impact factor: 4.254
Authors: Mario M Leitao; Qin C Zhou; Natalia R Gomez-Hidalgo; Alexia Iasonos; Ray Baser; Marissa Mezzancello; Kaity Chang; Jae Ward; Dennis S Chi; Kara Long Roche; Yukio Sonoda; Carol L Brown; Jennifer J Mueller; Ginger J Gardner; Elizabeth L Jewell; Vance Broach; Oliver Zivanovic; Sean C Dowdy; Andrea Mariani; Nadeem R Abu-Rustum Journal: Gynecol Oncol Date: 2019-11-25 Impact factor: 5.482
Authors: Xiaochen Zhang; Eric M McLaughlin; Jessica L Krok-Schoen; Michelle Naughton; Brittany M Bernardo; Andrea Cheville; Matthew Allison; Marcia Stefanick; Jennifer W Bea; Electra D Paskett Journal: JAMA Netw Open Date: 2022-03-01
Authors: Sandra Russo; Joan L Walker; Jay W Carlson; Jeanne Carter; Leigh C Ward; Allan Covens; Edward J Tanner; Jane M Armer; Sheila Ridner; Sandi Hayes; Alphonse G Taghian; Cheryl Brunelle; Micael Lopez-Acevedo; Brittany A Davidson; Mark V Schaverien; Sharad A Ghamande; Michael Bernas; Andrea L Cheville; Kathleen J Yost; Kathryn Schmitz; Barbara Coyle; Jeannette Zucker; Danielle Enserro; Stephanie Pugh; Electra D Paskett; Leslie Ford; Worta McCaskill-Stevens Journal: Gynecol Oncol Date: 2020-11-04 Impact factor: 5.482