Zeynep Erdogan Iyigun1, Filiz Agacayak2, Ahmet Serkan Ilgun3, Filiz Elbuken Celebi2, Cetin Ordu4, Gul Alco5, Alper Ozturk6, Tomris Duymaz7, Fatma Aktepe8, Vahit Ozmen9. 1. 1 Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Istanbul Bilim University, Istanbul, Turkey. 2. 2 Department of Radiology, Istanbul Florence Nightingale Hospital, Istanbul, Turkey. 3. 3 Department of General Surgery, Gaziosmanpaşa Taksim Education and Research Hospital, Istanbul, Turkey. 4. 4 Department of Oncology and Gayrettepe Florence Nightingale Hospital, Istanbul, Turkey. 5. 5 Department of Radiation Oncology, Gayrettepe Florence Nightingale Hospital, Istanbul, Turkey. 6. 6 Department of General Surgery, Biruni University Hospital, Istanbul, Turkey. 7. 7 Physiotheraphy and Rehabilitation School, Istanbul Bilgi University, Istanbul, Turkey. 8. 8 Department of Pathology, Gayrettepe Florence Nightingale Hospital, Istanbul, Turkey. 9. 9 Department of Breast Surgery, Istanbul Florence Nightingale Hospital, Istanbul, Turkey.
Abstract
Background: Early detection of lymphedema gives an opportunity for effective and successful treatment of lymphedema. However, the current diagnosis methods, except the bioimpedance analysis, perometry, and indocyanine green lymphography, have limitations in detecting early stage lymphedema. Sonoelastography is a diagnostic ultrasound technique that provides an opportunity to estimate soft tissue stiffness. Shear wave elastography (SWE) is a brand new elastography technique. Unlike strain elastography, this method is conducted automatically, that is, independently of user's manual tissue compression. The aim of this study is to establish the role of sonoelastography in diagnosis and staging of lymphedema by using the SWE technique in lymphedema patients. Methods and Results: A total of 36 female lymphedema patients were included in the study. There was no significant difference between patients with stages 1 (n = 17) and 2 (n = 19) lymphedema in terms of age, duration after surgery, and body mass index (p > 0.05). But, differences in terms of circumference measurements for forearm and arm, L-DEX values, and duration of lymphedema were found to be statistically significant (p = 0.002-0.000-0.000-0.001). Elastography measurements between normal forearm and forearm with lymphedema showed a statistically significant difference (p = 0.012). Correlation was found between circumference measurements and elastography values of forearms (p = 0.004, r = 0.471) and L-DEX scores and elastography measurements (p = 0.041, r = 0.352). When circumferential measurements of the forearms with lymphedema were compared with those with normal forearms, stage 1 patients showed no significant difference (p = 0.850), whereas a significant difference was detected in stage 2 patients (p = 0.003). Conclusion: SWE should be a useful tool in diagnosis and distinguishing early and late stages of lymphedema.
Background: Early detection of lymphedema gives an opportunity for effective and successful treatment of lymphedema. However, the current diagnosis methods, except the bioimpedance analysis, perometry, and indocyanine green lymphography, have limitations in detecting early stage lymphedema. Sonoelastography is a diagnostic ultrasound technique that provides an opportunity to estimate soft tissue stiffness. Shear wave elastography (SWE) is a brand new elastography technique. Unlike strain elastography, this method is conducted automatically, that is, independently of user's manual tissue compression. The aim of this study is to establish the role of sonoelastography in diagnosis and staging of lymphedema by using the SWE technique in lymphedemapatients. Methods and Results: A total of 36 female lymphedemapatients were included in the study. There was no significant difference between patients with stages 1 (n = 17) and 2 (n = 19) lymphedema in terms of age, duration after surgery, and body mass index (p > 0.05). But, differences in terms of circumference measurements for forearm and arm, L-DEX values, and duration of lymphedema were found to be statistically significant (p = 0.002-0.000-0.000-0.001). Elastography measurements between normal forearm and forearm with lymphedema showed a statistically significant difference (p = 0.012). Correlation was found between circumference measurements and elastography values of forearms (p = 0.004, r = 0.471) and L-DEX scores and elastography measurements (p = 0.041, r = 0.352). When circumferential measurements of the forearms with lymphedema were compared with those with normal forearms, stage 1 patients showed no significant difference (p = 0.850), whereas a significant difference was detected in stage 2 patients (p = 0.003). Conclusion: SWE should be a useful tool in diagnosis and distinguishing early and late stages of lymphedema.
Authors: Antonio J Forte; Maria T Huayllani; Daniel Boczar; Gabriela Cinotto; Pedro Ciudad; Oscar J Manrique; Xiaona Lu; Sarah A McLaughlin Journal: Gland Surg Date: 2020-04