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proposed in literature. This article provides a systematic review of the literature concerning the different methods and technologies used to detect the entity of the lymphedema. Aim of this work is to understand which the best method is in term of accuracy, reliability and suitability for use in clinical practice.
MATERIALS AND METHODS
The methodological approach used in this review is represented in the workflow in Fig. 2.
Some electronic databases, including Pubmed and ISI Web of Knowledge, were used.
The publications were restricted between 1998 and 2013 and the following keywords were used together with lymphedema term: water displacement, circumference method, perometry, laser scanning and bioimpedance.
This search yielded a total of 684 articles using Pubmed ad 469 articles using ISI Web of Knowledge (indicated below in brackets) divided as follows:
– lymphedema and water displacement method: 64 (88) papers; – lymphedema and circumference method: 48 (123) papers;
– lymphedema and perometry: 21 (20);
– lymphedema and bioimpedance: 73 (97) papers;
– lymphedema and laser scanning: 478 (141) papers.
Fig. 2 - Workflow followed during the review process.
RESUL TS
After a first general query, new keywords were used for limiting the research to papers on the quantitative evaluation of upper limb lymphedema volume. This search yielded to 50 papers. Further research was conducted for other references and clinical guidelines. At the end a bibliography of a 51 total of works on upper limb lymphedema volume assessment (1-51) was created.
All results were grouped according to the techniques and clustered in five groups. The results are shown in Fig. 3.
The highest percentage of the articles is on water displacement method (29%) and circumferential techniques (29%) that represent more than 50% of the total. Bioimpedance and Perometry methods are also quite good treated in literature and the percentage of article on these methods are respectively 23% and 15%; the smallest percentage is on the laser scanning (4%). Several works
Fig. 3 - Percentage of reviewed articles grouped by volumetric method.
tackle an issue of evaluate which volumetric measure techniques can be considered most proper, simple to use and suitable for clinical requirements. The goodness of the technique is related to the quality of the measure. It is evaluated, first of all, by the accuracy and repeatability of the instrument. These parameters are compared with the gold standard, represented by water displacement method, in order to highlight vantages and disadvantages of all methods analyzed.
1. Water Displacement Method (W) (1, 6, 8, 10, 11, 15, 16, 18, 19, 23, 24, 26-31, 33, 34, 39, 40, 43, 46, 50)
A total of 16 papers on water displacement method has been
reviewed. This method has been widely used to provide a direct
measurement of arm and leg volumes. Water displacement
is considered the gold standard for the limb volume
measurement (27,31,39). The principle is simple and easy; it is
based on the well-known Archimedes principle for which the
water volume moved by an object is equal to the same object
volume. Thus, the affected extremity is submerged in a tank of
water and its displacement is measured to determine the volume
ofthelimb(9). Apparatusforthemeasurementofarmhasbeen
described in detail in several works (1,27,39). The main limit of
this method is related to accuracy, which is strictly dependent
on the size of the water tank. A small limb in a large tank will
have a greater margin of error; small changes in angulation of
the limb can also lead to error (29). Beside this classical method,
other authors suggest to use a variant called “inverse water
volumetry”. This technique has been validate by Damstra et al
(39) and seems to be more suitable for hand and finger volume
measurement. This technique has shown a quite good results
with respect to intra and interobserver variability with an
Interclass Correlation Coefficient equal to (ICC) [2,1]=0.89-
0.91. However, this method has some disadvantages. First, it
is laborious and difficult to use in a clinical setting; then, the
water displacement method is not suitable for patients with
breaks in the skin because the risk of infections (1). Several
papers reported the reliability (1,11,18,19,23,26,29,31,39,40,46), and the accuracy (1,23,26,29,39,40,46) of the method.
THE EUROPEAN JOURNAL OF LYMPHOLOGY - Vol. XXIX - Nr. 75 - 2017
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