Agreement of Breast Cancer-Related Lymphedema Diagnosis Across Commonly Utilized Diagnostic Criteria: A Cross-Sectional Observational Cohort Study

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Background: This cross-sectional cohort study analyzes diagnostic agreement among commonly utilized diagnostic thresholds for breast cancer-related lymphedema (BCRL) . Methods: Sixty participants were measured using 4 methods: tape measure (every 4 cm [Q4] and National Lymphedema Network [NLN] methods) converted to volume, optoelectronic limb volumetry, and bioimpedance spectroscopy (BIS). Diagnostic thresholds compared included relative volume change (RVC) ≥ 10%, absolute volume difference ≥ 10%, and L-Dex scores > 6.5 or > 10 with and without preoperative baseline, respectively. Results: Data from 57 participants was analyzed; 21 participants (36.8%) were diagnosed with BCRL (RVC ≥ 10%). When BCRL diagnosis incorporated preoperative baseline (RVC ≥ 10%, L-Dex increase ≥ 6.5), diagnostic agreement between these methods was poor and insignificant (Cohen’s kappa –0.083; 95% confidence interval [CI], –0.227 to 0.062; P = .619). Diagnostic agreement was fair between diagnosis with (RVC and BIS) and without preoperative baseline (NLN, Q4, volumeter, BIS without baseline), respectively (range Cohen’s kappa 0.233 [95% CI, 0.0005-0.461], P = .045; Cohen’s kappa 0.308 [95% CI, 0.120-0.496], P = .001], except moderate agreement for diagnosis via RVC vs volumeter (Cohen’s kappa 0.531, 95% CI 0.349-0.713; P < .001). For the cohort with BIS baseline (n = 21), there was no diagnostic agreement between L-Dex increase ≥6.5 from baseline and measures without preoperative baseline (NLN, Q4, volumeter). Conclusion: The proportion of women diagnosed with BCRL after breast cancer treatment varies greatly depending on the measurement tool and diagnostic criteria utilized.

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