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Review

Quantitative Assessment of Upper-Limb Volume: Implications for Lymphedema Rehabilitation?

by
Lorenzo Lippi
1,2,
Alessio Turco
1,
Stefano Moalli
1,
Mauro Nascimben
1,3,
Claudio Curci
4,
Alessandro de Sire
5,6,
Lia Rimondini
1,7 and
Marco Invernizzi
1,2,*
1
Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, 28100 Novara, Italy
2
Translational Medicine, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
3
Enginsoft SpA, 35129 Padua, Italy
4
Physical Medicine and Rehabilitation Unit, Department of Neurosciences, ASST Carlo Poma, 46100 Mantova, Italy
5
Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
6
Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
7
Center for Translational Research on Autoimmune and Allergic Diseases-CAAD, Università del Piemonte Orientale, 28100 Novara, Italy
*
Author to whom correspondence should be addressed.
Appl. Sci. 2023, 13(17), 9810; https://doi.org/10.3390/app13179810
Submission received: 6 July 2023 / Revised: 24 August 2023 / Accepted: 28 August 2023 / Published: 30 August 2023
(This article belongs to the Special Issue Feature Review Papers in Section Applied Biosciences and Bioengineering)
Browse Figure
Versions Notes

Abstract

:
Upper-limb lymphedema is a chronic condition characterized by the accumulation of lymphatic fluid in the arm or hand, resulting in swelling and functional impairment. The accurate and reliable volumetric assessment of limb volume is crucial for the correct management of lymphedema. This narrative review provides an overview of the different methods proposed in the literature for the volumetric assessment of upper-limb lymphedema. In more detail, several methods of volumetric assessment have been proposed in recent years, including water displacement, the centimetric method, perometry, bioimpedance spectroscopy, dual-energy X-ray absorptiometry, magnetic resonance imaging, computed tomography, and three-dimensional laser scanning techniques. On the other hand, each method is characterized by specific strengths and limitations in terms of accuracy, reliability, practicality, and cost-effectiveness. Moreover, factors including operator experience, equipment availability, and patient population characteristics might have several implications in the optimal assessment of upper-limb volume. In this context, a precise volumetric assessment is crucial to improving the rehabilitation framework, patient education, and research outcomes. As a result, the integration of emerging technologies is needed to improve the tailored management of patients with upper-limb lymphedema. In conclusion, volumetric assessment methods provide valuable insights in the management of upper-limb lymphedema, improving patient care, treatment outcomes, and research advancements. Future research should focus on testing these innovative solutions on larger samples of patients to enhance the reproducibility, accuracy, accessibility, and clinical utility of volumetric assessment methods in the complex treatment framework of upper-limb lymphedema.

1. Introduction

Upper-limb lymphedema is a chronic and disabling condition characterized by the accumulation of excessive interstitial fluid and swelling in the affected arm [1]. It commonly arises as a result of impaired lymphatic drainage, often due to surgical interventions such as lymph node dissection or radiation therapy for cancer treatment [2,3]. This condition significantly impacts the quality of life (QoL) of affected individuals and might lead to functional limitations, axillary web syndrome, and psychological distress [4].
The accurate and reliable assessment of upper-limb lymphedema is crucial to diagnosing, staging, and monitoring treatment outcomes [5,6]. Traditionally, circumferential measurements have been widely employed as a primary method for evaluating limb volume changes at each 4 cm interval from the ulnar styloid to the axilla, with a discriminant increase of 2 cm [7]. However, such measurements only provide an indirect estimation of the extent of edema and may not accurately reflect the true volumetric changes occurring within the affected limb [7,8]. In recent years, several alternative methods for volumetric assessment have been proposed in the literature, aiming to overcome the limitations of circumferential measurements [9,10,11,12]. These novel techniques utilize advanced technologies and innovative approaches to provide more precise and comprehensive limb volume measurements [9,10,11,12]. By quantifying the extent of swelling and detecting subtle changes over time, these methods offer valuable insights into the early detection and progression of upper-limb lymphedema, aiding treatment decision making [1,13,14].
Despite these considerations, the significance of an accurate volumetric assessment in the management of upper-limb lymphedema is still underestimated and the optimal volumetric assessment method is still debated [15].
Thus, the present narrative review provides an overview of the different methods currently proposed in the literature for the volumetric assessment of upper-limb lymphedema, discussing potential clinical applications and implications to improve the complex rehabilitation framework of upper-limb lymphedema.

2. Research Methodology

This narrative review followed the SANRA quality criteria [16]. A comprehensive literature search was conducted on PubMed/MEDLINE, Web of Science (WoS), and Scopus using MESH terms including “Lymphedema”, “Breast Cancer”, “Upper Limb Lymphedema”, “Limb Volume”, “Water Displacement”, “Centimetric Method”, “Tape Measures”, “Perometry”, “Bioimpedance Spectroscopy”, “Dual-Energy X-ray Absorptiometry”, “Magnetic Resonance Imaging”, “Computed Tomography”, “Three-Dimensional (3D) Scanning Techniques”, “3D Volume Measurement”, and “Rehabilitation”. Table 1 summarizes the SPIDER tool search strategy [17].
The literature search was performed from January 2023 to June 2023 by two independent reviewers (L.L. and A.T.). These reviewers then independently screened the studies for eligibility. In cases where a consensus was not reached, a third reviewer (M.I.) was consulted. Eligible articles addressed the research question: “What are the optimal volume assessment methods for the rehabilitation of upper limb lymphedema?”. Specifically, the inclusion criteria were (i) studies involving human subjects with upper-limb lymphedema, (ii) studies addressing upper-limb volume measurement, and (iii) studies assessing the rehabilitation implications of lymphedema volumetric assessment. The exclusion criteria encompassed (i) studies in languages other than English, (ii) studies without full-text availability, (iii) studies involving animals, and (iv) conference abstracts, medical degrees, master’s and doctoral theses.
Data extraction and synthesis were performed using a qualitative method. The reviewers (L.L. and A.T.) independently extracted and synthesized information on quantitative assessment of upper-limb volume in lymphedema. In cases of disagreement, a third reviewer (A.d.S.) was asked. Given the heterogeneity of the included studies and in accordance with the narrative review design, a qualitative synthesis approach was employed, and all outcome data were presented in a narrative approach.

3. Anatomy and Pathophysiology of Upper-Limb Lymphedema

To understand the implications of volumetric assessment in upper-limb lymphedema, it is essential to focus on the underlying anatomy and pathophysiology of the lymphatic system and how it relates to the development of this condition.
The lymphatic system plays a crucial role in maintaining fluid balance and immune function. It consists of a network of lymphatic vessels that collect and transport lymph (a clear fluid containing proteins), cellular components, and waste products throughout the body [18]. Lymphatic vessels progressively converge into larger vessels called lymphatic trunks, which ultimately drain into the venous system [3]. In the upper limb, lymphatic drainage is predominantly facilitated by the superficial and deep lymphatic vessels. The superficial vessels are located within the subcutaneous tissue, while the deep vessels accompany the deep veins. Lymph nodes act as filters and sites of immune cell activity and are strategically positioned along the lymphatic pathways [3,19].
Upper-limb lymphedema occurs when there is an impairment or disruption of the lymphatic system’s normal functioning, leading to the inadequate drainage of lymphatic fluid [3,19]. This deficiency can be the result of various factors, most commonly associated with surgical interventions and radiation therapy for the treatment of breast cancer or other malignancies [20]. For instance, axillary lymph node dissection or radiation therapy in breast cancer patients can damage or result in the removal of lymph nodes, compromising the lymphatic flow from the upper limb [21]. In turn, this disruption leads to an accumulation of lymphatic fluid in the interstitial spaces of the affected arm, causing swelling and subsequent lymphedema [20].
The pathophysiological mechanisms underlying upper-limb lymphedema are multifactorial [2]. Lymphatic obstruction or insufficiency leads to an imbalance between lymphatic fluid production and clearance, increasing interstitial fluid accumulation. This accumulation leads to tissue fibrosis, inflammation, and impaired immune function, further exacerbating lymphatic dysfunction [22]. Over time, the persistent accumulation of interstitial fluid leads to the characteristic swelling and chronic changes observed in upper-limb lymphedema [22,23].
Upper-limb lymphedema leads to relevant disabling consequences for individuals affected by this condition. The chronic accumulation of interstitial fluid causes swelling, heaviness, and discomfort in the affected arm. It can lead to functional impairments, such as reduced range of motion and strength, making daily activities challenging. Additionally, the altered lymphatic flow and impaired immune function increase the risk of infections, including cellulitis and lymphangitis [24,25]. The psychosocial impact of upper-limb lymphedema should not be overlooked, as it can cause body image issues, emotional distress, and reduced QoL [26].
Understanding the anatomy and pathophysiology of upper-limb lymphedema is crucial to assessing the rationale behind volumetric assessment methods. By accurately measuring limb volume, these assessment techniques provide quantitative information regarding the extent of fluid accumulation, allowing for a more comprehensive evaluation and a tailored rehabilitation intervention [27,28,29].
The accurate and reliable assessment of upper-limb lymphedema is crucial to the effective diagnosis, staging, and monitoring of treatment outcomes [30]. While traditional methods such as circumferential measurements have been widely used, they provide only an indirect estimation of limb volume changes and may not accurately reflect the true extent of edema [31,32]. In contrast, volumetric assessment techniques offer a more precise and comprehensive measurement of limb volume, providing valuable information about the severity and progression of lymphedema [33]. One of the key advantages of volumetric assessment is its ability to quantify changes in limb volume over time. By obtaining precise measurements, healthcare professionals can monitor the effectiveness of interventions and accurately track the treatment response [34]. It could have relevant implications in clinical practice, where objective data on volume changes can aid in treatment decision making and facilitate personalized care for individuals with upper-limb lymphedema [1].
Furthermore, the volumetric assessment detects subtle changes in limb volume that may not be apparent through visual inspection alone. Lymphedema progression can occur gradually, and early identification of volume changes is essential for timely interventions and preventive measures [21]. Volumetric measurements provide quantitative data that can aid in the early detection of lymphedema exacerbations, helping to prevent further complications and optimize patient outcomes [9,10].
Moreover, volumetric assessment methods enable a more comprehensive evaluation of the entire limb, considering both localized and diffuse swelling. This approach allows for a more accurate assessment of the asymmetry and distribution of lymphedema, providing clinicians with detailed information about the affected areas. Such information can guide an adequate treatment plan [21,35].
Altogether, this evidence underlines the crucial need to implement a precise volumetric limb assessment in the rehabilitation clinical practice of lymphedema. However, although several methods are available, the optimal assessment tool for the volumetric assessment of lymphedema remains controversial.

4. Methods for Volumetric Assessment

4.1. Water Displacement Method

The water displacement method is currently considered the gold standard for the volumetric assessment of lymphedema [7]. It is based on Archimedes’ principle, which states that the volume of an object can be determined by measuring the amount of water it displaces when immersed [36].
In the volumetric assessment of lymphedema, the water displacement method involves submerging the affected limb in a water-filled container and measuring the amount of water displaced. The volume change can be determined by subtracting the initial water volume from the final volume after immersing the limb, providing an estimation of limb volume [36].
The water displacement method offers several advantages in the assessment of upper-limb lymphedema. First, it is a relatively simple and cost-effective technique that does not require sophisticated equipment. It can be easily performed in a clinical or research setting with readily available materials. Additionally, if performed correctly, the water displacement method provides accurate measurements, allowing for the reliable tracking of limb volume changes over time [7,37].
However, it is important to acknowledge several limitations. In particular, water displacement requires complete limb immersion, which may be challenging for patients with mobility limitations or wounds [7,38]. Additionally, the method relies on the accurate measurement of the water volume, which can be subject to human error [7,38].
Several studies have investigated the utility of the water displacement method in assessing limb volume in lymphedema, supporting its effectiveness in quantifying edema and monitoring the response to treatment interventions [8,37]. However, it is worth noting that technological advancements have introduced alternative volumetric assessment methods that offer greater precision and convenience [9,10,38,39,40].

4.2. Centimetric Method

The centimetric measurement of upper-limb volume is the most common and simple tool in assessing and monitoring lymphedema [7]. The centimetric method typically calculates limb volume using geometric formulas based on the shape of the limb. In particular, the truncated cone formula assumes that the limb shape can be approximated as a series of connected cones of varying diameters along the limb’s length [31,32].
One significant advantage of the centimetric method is its simplicity and accessibility [41,42]. Additionally, the centimetric method allows for repeated measurements, enabling the accurate tracking of lymphedema progression and response to treatment interventions over time [10].
Compared to other tools used to assess upper-limb volume in lymphedema, such as water displacement and perometry, the centimetric method offers ease of use and immediate availability [7]. However, several limitations might characterize the centimetric method. While it provides a quantitative assessment of volume changes, it does not account for changes in tissue composition. In lymphedema, alterations in tissue quality, such as fibrosis or adipose deposition, can contribute to limb enlargement. Therefore, the centimetric method may not capture these specific tissue changes, limiting its ability to provide a comprehensive evaluation of lymphedema [7,43]. In addition, quantitative data about the limb volume result from a formula approximating limb morphology and might result in potential systematic errors [7,43].
In conclusion, while the centimetric measurement of upper-limb volume offers simplicity, accessibility, and the ability to track changes over time, it does have limitations in capturing precise limb volume and tissue composition changes. Thus, the optimal choice of assessment tool should consider these limitations and should be based on the specific clinical or research requirements and the availability of resources in each setting.

4.3. Perometry

Perometry is a modern volumetric assessment technique that utilizes infrared light scanning to measure limb volume in individuals with lymphedema. This non-invasive method offers a more advanced and comprehensive approach compared to traditional circumferential measurements, providing detailed information about limb size and shape [39]. The principle of perometry involves projecting infrared light onto the limb and capturing the reflected light using sensors. The system can generate a three-dimensional limb representation by analyzing the light patterns, allowing for accurate volume measurements [44].
One of the primary advantages of perometry is its ability to provide precise and objective volumetric measurements. Unlike circumferential measurements, perometry accounts for variations in limb shape and contour, providing a more accurate representation of volume changes [44]. The technique also allows for the assessment of both the affected and unaffected limbs, facilitating side-to-side comparisons and aiding in the identification of asymmetry.
Perometry offers additional benefits in terms of convenience and patient comfort. The scanning process is quick and can be performed without direct contact with the limb, reducing discomfort for individuals with sensitive or fragile skin. Furthermore, perometry can be easily repeated at regular intervals, enabling regular monitoring of limb volume changes and treatment progress [45].
Several studies have demonstrated the effectiveness of perometry in assessing limb volume in lymphedema [8,39,46]. The technique has shown good agreement with other established volumetric assessment methods, such as water displacement, and has been validated in clinical practice. Its accuracy, ease of use, and reliability make perometry a valuable tool for clinicians in the diagnosis, staging, and monitoring of upper-limb lymphedema [8,39,46].
While perometry has numerous advantages, it is important to consider certain limitations. The availability and cost of perometry systems may be a barrier to its widespread use, particularly in resource-limited settings. Additionally, the technique requires proper training and standardization to ensure consistent and accurate measurements [47]. Further research and validation studies are needed to establish standardized protocols and guidelines for its implementation in rehabilitation clinical practice.

4.4. Bioimpedance Spectroscopy (BIS)

Bioimpedance spectroscopy (BIS) is a non-invasive technique that has gained recognition for its application in the volumetric assessment of upper-limb lymphedema [48]. This method utilizes electrical impedance measurements to estimate limb fluid content and volume. By analyzing the impedance response to varying frequencies of electrical current, BIS provides valuable information about tissue composition and fluid distribution within the limb [49].
The principle behind BIS lies in the fact that different tissues, such as muscle, fat, and fluid, have different electrical conductivities. When an electrical current is applied to the limb, the impedance to the current flow can be measured. By analyzing the impedance spectrum across multiple frequencies, BIS algorithms can separate out the contribution of different tissue types and estimate the volume of extracellular fluid, a key component of lymphedema [50].
One of the key advantages of BIS is its ability to assess both the fluid content and the volume of the affected limb [51]. Traditional methods, such as circumferential measurements, provide limited information about tissue composition and may not capture subtle changes in fluid accumulation. On the other hand, BIS offers a more comprehensive evaluation of the limb’s fluid status, enabling clinicians to monitor the overall volume, tissue hydration, and fluid distribution within the limb [52]. BIS has demonstrated good reliability and accuracy in assessing upper-limb lymphedema [43,52,53]. It allows for repeated measurements over time, facilitating the longitudinal monitoring of edema progression and response to treatment interventions. Additionally, BIS can provide valuable insights into the early detection of subclinical lymphedema, enabling early intervention and preventive measures [50].
However, it is important to note certain considerations when using BIS for volumetric assessment. The technique relies on proper electrode placement and ensuring consistent contact with the skin to obtain accurate impedance measurements [43]. Factors such as limb positioning, hydration status, and electrode quality can affect the reliability of the results. The standardization of measurement protocols and training of operators are necessary to ensure consistent and reproducible outcomes [49,50].
Several studies have demonstrated the effectiveness of BIS in assessing limb volume in lymphedema, both in research and clinical settings. BIS has shown good agreement with other established methods, such as water displacement and perometry, and has been validated in various patient populations [39,54].
Altogether, this evidence underlines that BIS could be considered a promising tool in lymphedema volume assessment. Beyond its volume assessment capabilities, BIS offers the unique advantage of evaluating tissue composition and facilitating longitudinal monitoring, thus cementing its role as a cutting-edge and indispensable tool for the comprehensive evaluation of upper-limb lymphedema.

4.5. Dual-Energy X-ray Absorptiometry (DXA)

Dual-energy X-ray absorptiometry (DXA) is a commonly used imaging technique for assessing body composition, including fat, lean tissue, and bone mineral density. While DXA is primarily utilized for assessing overall body composition, it can also be employed in the evaluation of upper-limb lymphedema [55].
In particular, DXA provides quantitative measurements of tissue composition, providing regional analysis of the upper limb, allowing for the differentiation of fat and lean tissue distribution across specific regions of interest [56]. Moreover, it can help identify localized changes in tissue composition and assess the extent and severity of lymphedema in different limb areas [56].
Interestingly, by comparing the two sides, DXA can help quantify and monitor the asymmetry of tissue composition and assess the progression or response to treatment of upper-limb lymphedema [57]. On the other hand, DXA involves relatively low levels of radiation exposure compared to other imaging modalities, such as computed tomography (CT). The radiation dose associated with DXA is considered minimal and well within acceptable limits for diagnostic imaging purposes [58].
While DXA offers advantages in assessing upper-limb lymphedema, it is essential to consider its limitations. DXA does not directly visualize the lymphatic system or provide information on lymphatic flow dynamics. Therefore, it is typically used in conjunction with other imaging techniques, such as lymphoscintigraphy or magnetic resonance lymphography, to provide a comprehensive evaluation of lymphedema [59]. Additionally, DXA may only be readily available in specific healthcare settings, and its use in lymphedema assessment may require specific protocols and expertise [55].

4.6. Magnetic Resonance Imaging (MRI)

Magnetic resonance imaging (MRI) is a powerful imaging technique that might be a valuable tool for volumetric assessment in upper-limb lymphedema. This non-invasive method utilizes a magnetic field and radio waves to generate detailed images of the affected limb, allowing for the accurate measurement and visualization of tissue volumes [60].
The principle behind MRI involves the interaction of hydrogen atoms within the body with the applied magnetic field. By manipulating the magnetic field and detecting the radiofrequency signals emitted by the hydrogen atoms, MRI scanners can construct high-resolution images that provide insights into tissue composition and fluid distribution [61].
MRI offers several advantages in the volumetric assessment of upper-limb lymphedema. According to BIS, MRI allows for the precise and comprehensive evaluation of the limb’s volume and the different tissue types within the limb, further characterizing muscle, fat, and edematous tissue [62]. This capability enables clinicians to assess the extent and distribution of edema, providing valuable information for treatment planning and monitoring [63].
In recent years, non-contrast magnetic resonance lymphography (NC-MRL) has been introduced as a non-invasive imaging technique that does not require the injection of contrast agents into the body [59]. NC-MRL provides high-resolution images of the lymphatic system, allowing for a detailed visualization of the lymph nodes, lymphatic vessels, and lymphatic flow. It identifies abnormalities, such as lymphatic obstruction, dilation, or lymph node enlargement [59].
In addition, the multiplane imaging allows for a comprehensive assessment of the lymphatic system, providing functional information about lymphatic flow dynamics. Indeed, by employing specialized imaging sequences and techniques, it is possible to evaluate the direction and velocity of lymphatic flow, detect areas of flow obstruction or reflux, and assess lymphatic pump function [59,63].
Despite its advantages, there are specific considerations when using MRI for volumetric assessment. MRI scans are relatively time-consuming and may require the patient to remain still within the scanner for an extended period [64]. Additionally, the cost and availability of MRI scanners may limit their widespread use, especially in resource-limited settings. Careful consideration of contraindications, such as the presence of metallic implants or claustrophobia, is necessary before performing an MRI scan [65,66].
Taken together, MRI and NC-MRL are extremely precise techniques providing several advantages in lymphedema assessment. Technological advantages might simplify these techniques with potential implication for further integration into the routine management of upper-limb lymphedema.

4.7. Computed Tomography (CT)

CT is a widely used imaging technique that has found applications in the volumetric assessment of upper-limb lymphedema. This method utilizes X-rays and advanced computer algorithms to create detailed cross-sectional images of the limb, providing valuable information about tissue volumes and morphology [67,68].
CT offers several advantages in the volumetric assessment of upper-limb lymphedema. It provides high-resolution images with excellent tissue contrast, enabling precise delineation of anatomical structures and accurate measurement of tissue volumes [69]. This capability allows for the detailed evaluation of edematous tissue, muscle, and fat distribution, aiding in assessing lymphedema severity and response to treatment [67].
Moreover, CT can provide valuable insights into the presence of other coexisting conditions or complications, such as fibrosis or lymphatic vessel abnormalities, which may impact the management of lymphedema. The ability to visualize the limb in three dimensions enhances the understanding of anatomical relationships and facilitates treatment planning [70,71].
However, it is important to consider certain considerations when using CT for volumetric assessment. In particular, CT scans involve exposure to ionizing radiation in a wide area, and precautions should be taken to ensure appropriate radiation doses, especially when repeated scans are necessary for monitoring purposes [68]. Moreover, the availability and cost of CT scanners may also limit their widespread use, particularly in resource-limited settings [72].
Altogether, these findings underline the utility of CT in assessing limb volume and tissue composition in lymphedema. Despite the ability to provide detailed anatomical information, excellent tissue contrast, and accurate volumetric measurements, different barriers affect its comprehensive integration into the routine rehabilitation management of upper-limb lymphedema.

4.8. Three-Dimensional (3D) Scanning Techniques

Three-dimensional (3D) scanning techniques have emerged as an innovative tool for volumetric assessment in upper-limb lymphedema. These techniques utilize various technologies, such as laser scanning or structured light projection, to capture detailed surface information and create a digital representation of the affected limb [9,10,38]. 3D scanning offers a non-invasive and convenient method to assess limb volume and shape, providing valuable insights for the management of lymphedema [10].
The principle behind 3D scanning involves projecting a light pattern onto the limb’s surface and capturing the reflected light using sensors. By analyzing the distortions in the light pattern, the system can create a digital model of the limb’s surface. Advanced algorithms then process this data to calculate limb volume and provide visualizations of the limb’s shape and contours [38].
One of the primary advantages of 3D scanning techniques is their non-invasive nature and ease of use. The scanning process is typically quick and comfortable for the patient, as it does not involve direct contact or radiation exposure [73]. Additionally, the digital models generated by 3D scanning provide a comprehensive visualization of the limb, allowing for a detailed assessment of volume, shape, and symmetry [74].
Furthermore, 3D scanning techniques offer the advantage of capturing surface information, which can be particularly valuable in the assessment of lymphedema. Surface irregularities, such as swelling or fibrotic changes, can be accurately captured and quantified, aiding in the identification and monitoring of edema [42]. Moreover, 3D scanning facilitates the comparison of pre- and post-treatment measurements, enabling the objective assessment of treatment outcomes [10].
It is important to note that different 3D scanning techniques may have variations in their equipment and processes. Laser scanning, structured light projection, and other methods each have their own advantages and limitations [10,33,38,75,76]. Factors such as scanning speed, accuracy, and resolution should be considered when selecting a 3D scanning technique for volumetric assessment in upper-limb lymphedema [75].
Multiple studies have investigated the utility of 3D scanning techniques in assessing limb volume and shape in lymphedema [10,38,42,76]. These techniques have shown good agreement with other established volumetric assessment methods and have been validated in various patient populations [10,76].
Altogether, this evidence highlighted that 3D scanning techniques might be considered promising tools in evaluating lymphedema and monitoring the efficacy of comprehensive rehabilitation programs. Their non-invasive nature, ability to capture surface information, and quantitative analysis capabilities represent essential advantages in the routine monitoring and the follow-up of upper-limb lymphedema, with intriguing implications for more precise and tailored therapeutic interventions.

5. Comparison and Evaluation of Methods

The selection of an appropriate method for volumetric assessment in upper-limb lymphedema requires the careful consideration of various factors, including accuracy, reliability, feasibility, and cost-effectiveness. Thus, Figure 1 has been realized to highlight the advantages and disadvantages of the different volumetric assessment methods of upper-limb lymphedema.
One of the key factors in the comparison of volumetric assessment methods is their accuracy in measuring limb volume. Water displacement, considered the gold standard, provides a direct measurement of limb volume but may be impractical for routine clinical use [77]. Tape measures, perometry, BIS, and DXA have all shown good agreement with water displacement in various studies [10,36,39,78]. However, it is essential to consider the specific characteristics of the patient population and the accuracy required for the intended clinical or research purpose.
Another important aspect is the reliability and repeatability of the measurements. Ideally, a volumetric assessment method should provide consistent results when repeated on the same limb. Studies have shown that methods such as perometry, BIS, and 3D scanning techniques demonstrate good intra- and inter-rater reliability [7,10,44,46,74,75]. However, factors such as operator experience, the positioning of the limb, and the calibration of the equipment can influence the reliability of the measurements.
Practicality and ease of use are crucial considerations for clinical implementation. Water displacement and perometry require specialized equipment, dedicated spaces, and may be time-consuming [33,36,44]. In contrast, centimetric measures and 3D scanning techniques offer non-invasive and relatively quick assessments [9,10]. In contrast, MRI and CT, while providing detailed anatomical information, are more resource-intensive, require dedicated protectionists, and may not be readily available in all clinical settings [59,61,68,69].
Cost-effectiveness is another important factor, especially in healthcare systems with limited resources. The water displacement and centimetric methods are relatively cost-effective, whereas MRI and CT can be more expensive due to equipment costs and associated imaging expenses [3,69,79]. BIS and 3D scanning techniques can have varying costs depending on the specific technology and equipment used [9,10,41,42,52,54,74].
The clinical utility of volumetric assessment methods should also be considered. While the accurate measurement of limb volume is crucial, the clinical relevance of the obtained measurements is equally important [42,44]. Methods that provide additional information, such as tissue composition, shape irregularities, or anatomical abnormalities, may offer valuable insights for treatment planning [59]. Consideration should also be given to the ability of the method to capture changes over time and assess treatment outcomes.
Overall, the choice of a volumetric assessment method should be based on a careful evaluation of the specific requirements of the clinical or research setting, considering factors such as accuracy, reliability, feasibility, cost-effectiveness, and clinical utility. A combination of methods or the use of different methods at different stages of patient management may be necessary to obtain a comprehensive assessment of upper-limb lymphedema and to tailor effective rehabilitation interventions.

6. Clinical Applications and Implications

An accurate and reliable volumetric assessment provides valuable information for treatment decision making, disease progression monitoring, and the assessment of intervention effectiveness [1]. In this section, we will explore the clinical applications and implications of volumetric assessment in upper-limb lymphedema.

6.1. Treatment Planning and Monitoring

Volumetric assessment methods offer insights into the severity and distribution of edema in the affected limb, aiding in treatment planning and monitoring. By quantifying the limb volume, clinicians can determine the extent of the edematous tissue and establish baseline measurements for comparison throughout the treatment course. This information allows for individualized treatment approaches, including the selection of appropriate compression therapy, manual lymphatic drainage, or surgical interventions [1,45,71].
In this context, different rehabilitation treatments have been proposed, including skin care, manual lymphatic drainage (MLD), intermittent pneumatic compression (IPC), compression therapy, exercise therapy, education and self-care, and lifestyle modifications [1,45,71]. These treatments might be effectively combined and vary based on patients’ characteristics [30]. By periodically measuring the limb volume, clinicians can objectively evaluate the response to interventions and make necessary adjustments to the treatment plan [43]. Reductions in limb volume indicate successful edema management, while stable or increasing volumes may necessitate modifications to the treatment approach. Moreover, the long-term monitoring of limb volume changes can also provide valuable data on the natural history of lymphedema and the efficacy of different treatment modalities.
Moreover, specific assessment methods might provide insights into tissue composition and anatomical anomalies, offering valuable information for informed treatment planning [80]. For instance, BIS might reveal a substantial increase in extracellular fluid in the lymphedematous limb compared to the unaffected limb [81,82]. On the other hand, MRI can identify anatomical abnormalities such as fibrotic tissue or lymphatic vessel obstructions [83], providing further insight to clinicians for tailoring specific rehabilitation interventions based on tissue characteristics.
Integrating specific methods enriches the evaluation by showcasing how a precise assessment might offer actionable insights beyond mere volume measurements. These insights into tissue composition and anatomical nuances enable clinicians to develop interventions that align more closely with the unique needs of individual patients with lymphedema.

6.2. Patient Education and Compliance

Volumetric assessment methods offer visualizations of the limb shape and contours, enhancing patient understanding of their condition [84]. Three-dimensional representations or graphical depictions of the limb’s volume changes can help patients visualize the impact of lymphedema on their body and the progress made through treatment [9,74]. This visual feedback can motivate patients to adhere to their treatment regimens, improving compliance and treatment outcomes.
Furthermore, volumetric assessment provides objective measurements that can be used to educate patients about the effectiveness of their treatment. Showing patients the quantitative changes in limb volume over time can instill confidence in the treatment process and reinforce the importance of self-care practices [85]. By actively involving patients in monitoring their limb volume, they become partners in their own care, potentially impacting treatment engagement and empowerment [85].

6.3. Research and Outcome Measures

Volumetric assessment methods are essential tools in research studies focused on lymphedema. These methods provide quantitative data that can be used to evaluate the efficacy of new treatment modalities, compare different interventions, and assess the long-term outcomes of management strategies [43]. Standardized volumetric measurements can serve as objective outcome measures, facilitating the comparison of study results and the pooling of data across research centers [38].
Furthermore, volumetric assessment can contribute to developing and refining staging systems and classification schemes for lymphedema [1,45,71]. By quantifying the extent of edema, researchers can explore correlations between limb volume and clinical indicators, such as symptom severity, functional limitations, or QoL measures [86]. These findings can inform the development of comprehensive assessment tools and help establish evidence-based guidelines for lymphedema management [87].
In summary, volumetric assessment methods have significant clinical applications and implications in managing upper-limb lymphedema. Integrating accurate and reliable volumetric assessments into clinical practice can improve patient care, enhance treatment outcomes, and advance our understanding of lymphedema. On the other hand, several challenges are still open and emerging technologies might overcome barriers in a more precise volumetric assessment of upper-limb lymphedema, improving rehabilitation outcomes in people suffering from this disabling condition.

7. Future Directions and Challenges

Volumetric assessment methods have made significant advancements in the evaluation of upper-limb lymphedema. However, several challenges and opportunities are remain for future research and rehabilitation advances.

7.1. Emerging Technologies

Advancements in technology present emerging opportunities for the improvement of volumetric assessment methods. One area of development is the integration of artificial intelligence (AI) and machine-learning algorithms [88]. AI can enhance the accuracy and efficiency of volumetric measurements by automating the segmentation of edematous tissue and reducing inter-observer variability [38,88]. Machine-learning algorithms can also assist in the identification of patterns and predictive models for treatment outcomes, helping to personalize therapeutic interventions [2,38].
Furthermore, wearable devices and smartphone applications hold promise for convenient and accessible volumetric assessments [89,90]. These technologies can provide patients with tools for self-monitoring and facilitate remote monitoring by healthcare providers. By leveraging sensors and imaging capabilities in smartphones or wearable devices, volumetric measurements can be obtained outside clinical settings, enhancing patient engagement and enabling real-time data collection [38,89,90].

7.2. Standardization of Volumetric Assessment and Validation

Standardization and validation efforts are crucial to ensure the widespread adoption and comparability of volumetric assessment methods [1]. Establishing standardized protocols for data acquisition, measurement techniques, and interpretation criteria will promote consistency across studies and facilitate the pooling of data [69].
Operator experience might hold significant influence over the precision and reliability of measurements [91]. To establish uniformity, the implementation of a standardized training program for practitioners becomes imperative [92]. In accordance, accurate limb positioning is a cornerstone for minimizing variability in measurements, along with the implementation of a documented calibration of the measurement device [93,94]. Incorporating these practices into the precise assessment of upper-limb volume can elevate methods practical applicability by providing in-depth insights into standardization processes that underlie accurate and consistent volumetric assessments. Offering detailed guidance on operator training, limb positioning, equipment calibration, and documentation practices should be considered to enhance the reproducibility and accuracy of the assessments.
Taken together, validation studies comparing different methods against a reference standard, such as water displacement, should continue to be conducted. These studies will provide valuable insights into different volumetric assessment techniques’ accuracy, reliability, and clinical relevance [43]. In this context, collaborative initiatives and multicenter studies can help establish guidelines and consensus on the best practices for volumetric assessment in upper-limb lymphedema.

7.3. Longitudinal Studies and Outcome Measures

Longitudinal studies tracking volumetric changes over time are essential for understanding the natural history of lymphedema, evaluating treatment outcomes, and identifying prognostic factors. By following patients longitudinally, researchers can investigate the trajectory of limb volume changes, explore factors influencing disease progression or regression, and assess the long-term effects of various interventions [10].
In addition, the development and validation of patient-reported outcome measures and minimal clinically important differences specific to upper-limb lymphedema evaluation techniques are important for capturing the impact of the disease and treatment on patients’ QoL, functional status, and symptomatology [45,95]. Integrating patient-reported outcomes with volumetric measurement discrimination can provide a comprehensive assessment of lymphedema’s physical and psychosocial aspects and enable a more clinical and patient-centered approach to care [85].

7.4. Addressing Challenges, Costs, and Limitations

Challenges associated with volumetric assessment methods should be addressed to maximize their clinical utility. For example, the cost and availability of certain techniques, such as MRI and CT, may limit their widespread use [65,66,72]. By incorporating estimated acquisition costs, clinicians can make informed decisions tailored to their patient demographics and available resources, enhancing practicality [96]. These cost estimates provide a practical dimension to the assessment. For example, by factoring in costs for techniques such as three-dimensional laser scanning, clinicians can assess whether benefits outweigh higher acquisition costs compared to more budget-friendly options [9]. This empowers practitioners to make choices balancing clinical relevance and budget constraints. Efforts to optimize and refine less expensive methods, such as BIS or 3D scanning techniques, should be pursued to improve their accuracy and reliability while reducing costs [38,49].
Furthermore, addressing the limitations of volumetric assessment methods in specific patient populations is important. Lymphedema can occur in various clinical contexts, such as post-surgical, post-radiation, or congenital lymphedema. Understanding the performance of volumetric assessment methods in these specific populations, considering factors such as changes in tissue composition or fibrotic alterations, will enhance their clinical applicability [1]. In summary, the future directions of volumetric assessment for upper-limb lymphedema involve the integration of emerging technologies.
Despite these considerations, this narrative review is not free of limitations. Firstly, a meta-analysis was not performed due to the narrative review design and the heterogeneity of the volumetric assessment methods. On the other hand, according to the Cochrane Handbook of Systematic Review [97], a meta-analysis might not be possible in cases of heterogeneity of study participants, interventions, and outcomes. Therefore, a quality assessment was not performed in accordance with the SANRA quality criteria [16]. However, it should be noted that the decision to adopt a narrative synthesis approach aimed to best address the complexity of the reviewed topic and provide a meaningful synthesis of the available evidence.

8. Conclusions

To date, volumetric assessment has played a crucial role in the comprehensive evaluation and management framework of upper-limb lymphedema. As technology advances and research progresses, there is still the need for further improvements in accuracy, accessibility, and clinical utility. The integration of standardized and validated volumetric assessment methods into the common clinical practice has the potential to significantly improve patient care, enhance treatment outcomes, and advance our understanding of lymphedema.
However, challenges and future directions still exist in the field of volumetric assessment for upper-limb lymphedema. Standardization and validation efforts, including the integration of emerging technologies and the establishment of normative reference values, are necessary to ensure accuracy, reliability, and comparability across studies. Longitudinal studies and patient-reported outcome measures are essential for understanding disease progression, evaluating treatment outcomes, and capturing the impact of lymphedema on patients’ quality of life. Additionally, addressing limitations and challenges specific to different patient populations will enhance the clinical applicability of volumetric assessment methods.

Author Contributions

Conceptualization, L.L. and M.I.; methodology, L.L. and A.d.S.; investigation, L.L., A.T. and A.d.S.; software, S.M.; writing—original draft preparation, L.L. and A.T.; writing—review and editing, A.d.S., L.R. and M.I.; visualization, S.M., M.N., C.C. and L.R.; supervision, A.d.S., L.R. and M.I.; All authors have read and agreed to the published version of the manuscript.

Funding

Mauro Nascimben received funding from European Union’s Horizon 2020 research and innovation program under grant agreement No. 860462 project PREMUROSA.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Not applicable.

Data Availability Statement

Not applicable.

Acknowledgments

We would like to acknowledge Enrico Cavallo for his contribution to this work.

Conflicts of Interest

The authors declare no conflict of interest.

References

  1. de Sire, A.; Losco, L.; Lippi, L.; Spadoni, D.; Kaciulyte, J.; Sert, G.; Ciamarra, P.; Marcasciano, M.; Cuomo, R.; Bolletta, A. Surgical treatment and rehabilitation strategies for upper and lower extremity lymphedema: A comprehensive review. Medicina 2022, 58, 954. [Google Scholar] [CrossRef] [PubMed]
  2. Nascimben, M.; Lippi, L.; de Sire, A.; Invernizzi, M.; Rimondini, L. Algorithm-Based Risk Identification in Patients with Breast Cancer-Related Lymphedema: A Cross-Sectional Study. Cancers 2023, 15, 336. [Google Scholar] [CrossRef] [PubMed]
  3. Warren, A.G.; Brorson, H.; Borud, L.J.; Slavin, S.A. Lymphedema: A comprehensive review. Ann. Plast. Surg. 2007, 59, 464–472. [Google Scholar] [CrossRef] [PubMed]
  4. de Sire, A.; Losco, L.; Cisari, C.; Gennari, A.; Boldorini, R.; Fusco, N.; Cigna, E.; Invernizzi, M. Axillary web syndrome in women after breast cancer surgery referred to an Oncological Rehabilitation Unit: Which are the main risk factors? A retrospective case-control study. Eur. Rev. Med. Pharmacol. Sci. 2020, 24, 8028–8035. [Google Scholar] [CrossRef] [PubMed]
  5. Gençay Can, A.; Ekşioğlu, E.; Çakçı, F.A. Early detection and treatment of subclinical lymphedema in patients with breast cancer. Lymphat. Res. Biol. 2019, 17, 368–373. [Google Scholar] [CrossRef] [PubMed]
  6. Megens, A.M.; Harris, S.R.; Kim-Sing, C.; McKenzie, D.C. Measurement of upper extremity volume in women after axillary dissection for breast cancer. Arch. Phys. Med. Rehabil. 2001, 82, 1639–1644. [Google Scholar] [CrossRef] [PubMed]
  7. Deltombe, T.; Jamart, J.; Recloux, S.; Legrand, C.; Vandenbroeck, N.; Theys, S.; Hanson, P. Reliability and limits of agreement of circumferential, water displacement, and optoelectronic volumetry in the measurement of upper limb lymphedema. Lymphology 2007, 40, 26–34. [Google Scholar]
  8. Sander, A.P.; Hajer, N.M.; Hemenway, K.; Miller, A.C. Upper-extremity volume measurements in women with lymphedema: A comparison of measurements obtained via water displacement with geometrically determined volume. Phys. Ther. 2002, 82, 1201–1212. [Google Scholar] [CrossRef]
  9. Invernizzi, M.; Runza, L.; de Sire, A.; Lippi, L.; Blundo, C.; Gambini, D.; Boldorini, R.; Ferrero, S.; Fusco, N. Integrating augmented reality tools in breast cancer related lymphedema prognostication and diagnosis. JoVE (J. Vis. Exp.) 2020, e60093. [Google Scholar] [CrossRef]
  10. de Sire, A.; Losco, L.; Cigna, E.; Lippi, L.; Gimigliano, F.; Gennari, A.; Cisari, C.; Chen, H.; Fusco, N.; Invernizzi, M. Three-dimensional laser scanning as a reliable and reproducible diagnostic tool in breast cancer related lymphedema rehabilitation: A proof-of-principle study. Eur. Rev. Med. Pharmacol. Sci. 2020, 24, 4476–4485. [Google Scholar]
  11. Tánori-Tapia, J.M.; Romero-Pérez, E.M.; Camberos, N.A.; Horta-Gim, M.A.; Núñez-Othón, G.; Medina-Pérez, C.; de Paz, J.A. Determination of the minimum detectable change in the total and segmental volumes of the upper limb, evaluated by perimeter measurements. Healthcare 2020, 8, 285. [Google Scholar] [CrossRef] [PubMed]
  12. Cornish, B.; Chapman, M.; Hirst, C.; Mirolo, B.; Bunce, I.; Ward, L.; Thomas, B. Early diagnosis of lymphedema using multiple frequency bioimpedance. Lymphology 2001, 34, 2–11. [Google Scholar] [PubMed]
  13. Didem, K.; Ufuk, Y.S.; Serdar, S.; Zümre, A. The comparison of two different physiotherapy methods in treatment of lymphedema after breast surgery. Breast Cancer Res. Treat. 2005, 93, 49–54. [Google Scholar] [CrossRef] [PubMed]
  14. Huang, H.C.; Liu, H.H.; Yin, L.Y.; Yeh, C.H.; Tu, C.W.; Yang, C.S. The upper-limb volumetric changes in breast cancer survivors with axillary web syndrome. Eur. J. Cancer Care 2017, 26, e12637. [Google Scholar] [CrossRef] [PubMed]
  15. Chromy, A.; Zalud, L.; Dobsak, P.; Suskevic, I.; Mrkvicova, V. Limb volume measurements: Comparison of accuracy and decisive parameters of the most used present methods. Springerplus 2015, 4, 707. [Google Scholar] [CrossRef] [PubMed]
  16. Baethge, C.; Goldbeck-Wood, S.; Mertens, S. SANRA—A scale for the quality assessment of narrative review articles. Res. Integr. Peer Rev. 2019, 4, 5. [Google Scholar] [CrossRef] [PubMed]
  17. Cooke, A.; Smith, D.; Booth, A. Beyond PICO: The SPIDER tool for qualitative evidence synthesis. Qual. Health Res. 2012, 22, 1435–1443. [Google Scholar] [CrossRef]
  18. Suami, H.; Taylor, G.I.; Pan, W.-R. The lymphatic territories of the upper limb: Anatomical study and clinical implications. Plast. Reconstr. Surg. 2007, 119, 1813–1822. [Google Scholar] [CrossRef]
  19. Wilting, J.; Becker, J. The lymphatic vascular system: Much more than just a sewer. Cell Biosci. 2022, 12, 157. [Google Scholar] [CrossRef]
  20. Hayes, S.; Sipio, T.D.; Rye, S.; López, J.A.; Saunders, C.; Pyke, C.; Bashford, J.; Battistutta, D.; Newman, B. Prevalence and prognostic significance of secondary lymphedema following breast cancer. Lymphat. Res. Biol. 2011, 9, 135–141. [Google Scholar] [CrossRef]
  21. Donahue, P.M.C.; MacKenzie, A.; Filipovic, A.; Koelmeyer, L. Advances in the prevention and treatment of breast cancer-related lymphedema. Breast Cancer Res. Treat. 2023, 200, 1–14. [Google Scholar] [CrossRef] [PubMed]
  22. Ghanta, S.; Cuzzone, D.A.; Torrisi, J.S.; Albano, N.J.; Joseph, W.J.; Savetsky, I.L.; Gardenier, J.C.; Chang, D.; Zampell, J.C.; Mehrara, B.J. Regulation of inflammation and fibrosis by macrophages in lymphedema. Am. J. Physiol. Heart Circ. Physiol. 2015, 308, H1065–H1077. [Google Scholar] [CrossRef] [PubMed]
  23. Ly, C.L.; Kataru, R.P.; Mehrara, B.J. Inflammatory manifestations of lymphedema. Int. J. Mol. Sci. 2017, 18, 171. [Google Scholar] [CrossRef] [PubMed]
  24. Paolucci, T.; Saggino, A.; Agostini, F.; Paoloni, M.; Bernetti, A.; Mangone, M.; Santilli, V.; Saggini, R.; Tommasi, M. The influence of rehabilitation on quality of life in breast cancer survivors: A clinical study. Int. J. Environ. Res. Public Health 2021, 18, 8585. [Google Scholar] [CrossRef] [PubMed]
  25. Liao, S.; Padera, T.P. Lymphatic function and immune regulation in health and disease. Lymphat. Res. Biol. 2013, 11, 136–143. [Google Scholar] [CrossRef] [PubMed]
  26. Fu, M.R.; Kang, Y. Psychosocial impact of living with cancer-related lymphedema. Semin. Oncol. Nurs. 2013, 29, 50–60. [Google Scholar] [CrossRef] [PubMed]
  27. Invernizzi, M.; Lippi, L.; Folli, A.; Turco, A.; Zattoni, L.; Maconi, A.; de Sire, A.; Fusco, N. Integrating molecular biomarkers in breast cancer rehabilitation. What is the current evidence? A systematic review of randomized controlled trials. Front. Mol. Biosci. 2022, 9, 50–60. [Google Scholar] [CrossRef] [PubMed]
  28. de Sire, A.; Fusco, N.; Sajjadi, E.; Lippi, L.; Cisari, C.; Invernizzi, M. Lymphedema Rehabilitation Using Self-Adaptive Inelastic Compression in Breast Cancer: A Proof-of-Principle Study. Appl. Sci. 2021, 11, 1901. [Google Scholar] [CrossRef]
  29. Pappalardo, M.; Starnoni, M.; Franceschini, G.; Baccarani, A.; De Santis, G. Breast cancer-related lymphedema: Recent updates on diagnosis, severity and available treatments. J. Pers. Med. 2021, 11, 402. [Google Scholar] [CrossRef]
  30. Borman, P. Lymphedema diagnosis, treatment, and follow-up from the view point of physical medicine and rehabilitation specialists. Turk. J. Phys. Med. Rehabil. 2018, 64, 179. [Google Scholar] [CrossRef]
  31. Sitzia, J. Volume measurement in lymphoedema treatment: Examination of formulae. Eur. J. Cancer Care 1995, 4, 11–16. [Google Scholar] [CrossRef] [PubMed]
  32. Stanton, A.; Badger, C.; Sitzia, J. Non-invasive assessment of the lymphedematous limb. Lymphology 2000, 33, 122–135. [Google Scholar] [PubMed]
  33. Mayrovitz, H.N. Measuring Breast Cancer-Related Lymphedema. In Breast Cancer; Mayrovitz, H.N., Ed.; Exon Publications: Brisbane, Australia, 2022. [Google Scholar]
  34. Singh, C.; De Vera, M.; Campbell, K.L. The effect of prospective monitoring and early physiotherapy intervention on arm morbidity following surgery for breast cancer: A pilot study. Physiother. Can. 2013, 65, 183–191. [Google Scholar] [CrossRef] [PubMed]
  35. Mathieu, J.; Daneau, C.; Lemeunier, N.; Doyon, A.; Marchand, A.A.; Descarreaux, M. Conservative interventions and clinical outcome measures used in the perioperative rehabilitation of breast cancer patients undergoing mastectomy: A scoping review. BMC Womens Health 2022, 22, 343. [Google Scholar] [CrossRef] [PubMed]
  36. Gjorup, C.; Zerahn, B.; Hendel, H.W. Assessment of volume measurement of breast cancer-related lymphedema by three methods: Circumference measurement, water displacement, and dual energy X-ray absorptiometry. Lymphat. Res. Biol. 2010, 8, 111–119. [Google Scholar] [CrossRef]
  37. Sagen, Å.; Kåresen, R.; Skaane, P.; Risberg, M.A. Validity for the simplified water displacement instrument to measure arm lymphedema as a result of breast cancer surgery. Arch. Phys. Med. Rehabil. 2009, 90, 803–809. [Google Scholar] [CrossRef]
  38. Nascimben, M.; Lippi, L.; Fusco, N.; Invernizzi, M.; Rimondini, L. A Software Suite for Limb Volume Analysis Applicable in Clinical Settings: Upper Limb Quantification. Front. Bioeng. Biotechnol. 2022, 10, 730. [Google Scholar] [CrossRef] [PubMed]
  39. Adriaenssens, N.; Buyl, R.; Lievens, P.; Fontaine, C.; Lamote, J. Comparative study between mobile infrared optoelectronic volumetry with a perometer® and two commonly used methods for the evaluation of arm volume in patients with breast cancer related lymphedema of the arm. Lymphology 2013, 46, 132–143. [Google Scholar]
  40. Öhberg, F.; Zachrisson, A.; Holmner-Rocklöv, Å. Three-dimensional camera system for measuring arm volume in women with lymphedema following breast cancer treatment. Lymphat. Res. Biol. 2014, 12, 267–274. [Google Scholar] [CrossRef]
  41. Ridner, S.H.; Dietrich, M.S.; Boyages, J.; Koelmeyer, L.; Elder, E.; Hughes, T.M.; French, J.; Ngui, N.; Hsu, J.; Abramson, V.G.; et al. A Comparison of Bioimpedance Spectroscopy or Tape Measure Triggered Compression Intervention in Chronic Breast Cancer Lymphedema Prevention. Lymphat. Res. Biol. 2022, 20, 618–628. [Google Scholar] [CrossRef]
  42. Mastick, J.; Smoot, B.J.; Paul, S.M.; Kober, K.M.; Cooper, B.A.; Madden, L.K.; Conley, Y.P.; Dixit, N.; Hammer, M.J.; Fu, M.R.; et al. Assessment of Arm Volume Using a Tape Measure Versus a 3D Optical Scanner in Survivors with Breast Cancer-Related Lymphedema. Lymphat. Res. Biol. 2022, 20, 39–47. [Google Scholar] [CrossRef] [PubMed]
  43. Hidding, J.T.; Viehoff, P.B.; Beurskens, C.H.; van Laarhoven, H.W.; Nijhuis-van der Sanden, M.W.; van der Wees, P.J. Measurement properties of instruments for measuring of lymphedema: Systematic review. Phys. Ther. 2016, 96, 1965–1981. [Google Scholar] [CrossRef] [PubMed]
  44. Sharkey, A.R.; King, S.W.; Kuo, R.Y.; Bickerton, S.B.; Ramsden, A.J.; Furniss, D. Measuring Limb Volume: Accuracy and Reliability of Tape Measurement Versus Perometer Measurement. Lymphat. Res. Biol. 2018, 16, 182–186. [Google Scholar] [CrossRef]
  45. O’Toole, J.; Jammallo, L.S.; Skolny, M.N.; Miller, C.L.; Elliott, K.; Specht, M.C.; Taghian, A.G. Lymphedema following treatment for breast cancer: A new approach to an old problem. Crit. Rev. Oncol. Hematol. 2013, 88, 437–446. [Google Scholar] [CrossRef] [PubMed]
  46. Lee, M.-J.; Boland, R.A.; Czerniec, S.; Kilbreath, S.L. Reliability and concurrent validity of the perometer for measuring hand volume in women with and without lymphedema. Lymphat. Res. Biol. 2011, 9, 13–18. [Google Scholar] [CrossRef] [PubMed]
  47. Wanchai, A.; Armer, J.M.; Stewart, B.R.; Lasinski, B.B. Breast cancer-related lymphedema: A literature review for clinical practice. Int. J. Nurs. Sci. 2016, 3, 202–207. [Google Scholar] [CrossRef]
  48. Dylke, E.S.; Ward, L.C. Three decades of bioelectrical impedance spectroscopy in lymphedema assessment: An historical perspective. Lymphat. Res. Biol. 2021, 19, 206–214. [Google Scholar] [CrossRef] [PubMed]
  49. Ward, L.; Czerniec, S.; Kilbreath, S. Quantitative bioimpedance spectroscopy for the assessment of lymphoedema. Breast Cancer Res. Treat. 2009, 117, 541–547. [Google Scholar] [CrossRef]
  50. Shah, C.; Whitworth, P.; Valente, S.; Schwarz, G.S.; Kruse, M.; Kohli, M.; Brownson, K.; Lawson, L.; Dupree, B.; Vicini, F.A. Bioimpedance spectroscopy for breast cancer-related lymphedema assessment: Clinical practice guidelines. Breast Cancer Res. Treat. 2023, 198, 1–9. [Google Scholar] [CrossRef]
  51. Sutherland, A.; Wagner, J.L.; Korentager, S.; Butterworth, J.; Amin, A.L.; Balanoff, C.R.; Hangge, A.; Larson, K.E. Is bioimpedance spectroscopy a useful tool for objectively assessing lymphovenous bypass surgical outcomes in breast cancer-related lymphedema? Breast Cancer Res. Treat. 2021, 186, 1–6. [Google Scholar] [CrossRef]
  52. Czerniec, S.A.; Ward, L.C.; Lee, M.-J.; Refshauge, K.M.; Beith, J.; Kilbreath, S.L. Segmental measurement of breast cancer-related arm lymphoedema using perometry and bioimpedance spectroscopy. Support. Care Cancer 2011, 19, 703–710. [Google Scholar] [CrossRef] [PubMed]
  53. Czerniec, S.; Ward, L.; Refshauge, K.; Beith, J.; Lee, M.; York, S.; Kilbreath, S. Assessment of breast cancer-related arm lymphedema—Comparison of physical measurement methods and self-report. Cancer Investig. 2010, 28, 54–62. [Google Scholar] [CrossRef] [PubMed]
  54. Jain, M.S.; Danoff, J.; Paul, S. Correlation between bioelectrical spectroscopy and perometry in assessment of upper extremity swelling. Lymphology 2010, 43, 85–94. [Google Scholar] [PubMed]
  55. Dylke, E. Measurement of breast cancer-related lymphoedema. J. Physiother. 2022, 68, 238–243. [Google Scholar] [CrossRef] [PubMed]
  56. Smoot, B.J.; Mastick, J.; Shepherd, J.; Paul, S.M.; Kober, K.M.; Cooper, B.A.; Conley, Y.P.; Dixit, N.; Hammer, M.J.; Fu, M.R. Use of Dual-Energy X-ray Absorptiometry to Assess Soft Tissue Composition in Breast Cancer Survivors with and without Lymphedema. Lymphat. Res. Biol. 2022, 20, 391–397. [Google Scholar] [CrossRef] [PubMed]
  57. Bloomquist, K.; Adamsen, L.; Hayes, S.C.; Lillelund, C.; Andersen, C.; Christensen, K.B.; Oturai, P.; Ejlertsen, B.; Tuxen, M.K.; Møller, T. Heavy-load resistance exercise during chemotherapy in physically inactive breast cancer survivors at risk for lymphedema: A randomized trial. Acta Oncol. 2019, 58, 1667–1675. [Google Scholar] [CrossRef] [PubMed]
  58. Messina, C.; Albano, D.; Gitto, S.; Tofanelli, L.; Bazzocchi, A.; Ulivieri, F.M.; Guglielmi, G.; Sconfienza, L.M. Body composition with dual energy X-ray absorptiometry: From basics to new tools. Quant. Imaging Med. Surg. 2020, 10, 1687. [Google Scholar] [CrossRef] [PubMed]
  59. Cellina, M.; Gibelli, D.; Martinenghi, C.; Giardini, D.; Soresina, M.; Menozzi, A.; Oliva, G.; Carrafiello, G. Non-contrast magnetic resonance lymphography (NCMRL) in cancer-related secondary lymphedema: Acquisition technique and imaging findings. Radiol. Med. 2021, 126, 1477–1486. [Google Scholar] [CrossRef]
  60. Forte, A.J.; Boczar, D.; Huayllani, M.T.; Avila, F.R.; Guliyeva, G.; Lu, X.; Mash, W.R.; Kung, T.A. Use of magnetic resonance imaging lymphangiography for preoperative planning in lymphedema surgery: A systematic review. Microsurgery 2021, 41, 384–390. [Google Scholar] [CrossRef]
  61. Grover, V.P.; Tognarelli, J.M.; Crossey, M.M.; Cox, I.J.; Taylor-Robinson, S.D.; McPhail, M.J. Magnetic resonance imaging: Principles and techniques: Lessons for clinicians. J. Clin. Exp. Hepatol. 2015, 5, 246–255. [Google Scholar] [CrossRef]
  62. Hoffner, M.; Peterson, P.; Månsson, S.; Brorson, H. Lymphedema leads to fat deposition in muscle and decreased muscle/water volume after liposuction: A magnetic resonance imaging study. Lymphat. Res. Biol. 2018, 16, 174–181. [Google Scholar] [CrossRef] [PubMed]
  63. Cellina, M.; Oliva, G.; Menozzi, A.; Soresina, M.; Martinenghi, C.; Gibelli, D. Non-contrast Magnetic Resonance Lymphangiography: An emerging technique for the study of lymphedema. Clin. Imaging 2019, 53, 126–133. [Google Scholar] [CrossRef] [PubMed]
  64. Chang, D.W.; Masia, J.; Garza III, R.; Skoracki, R.; Neligan, P.C. Lymphedema: Surgical and medical therapy. Plast. Reconstr. Surg. 2016, 138, 209S–218S. [Google Scholar] [CrossRef] [PubMed]
  65. Miseré, R.M.; Wolfs, J.A.; Lobbes, M.B.; van der Hulst, R.R.; Qiu, S.S. A systematic review of magnetic resonance lymphography for the evaluation of peripheral lymphedema. J. Vasc. Surg. Venous Lymphat. Disord. 2020, 8, 882–892.e882. [Google Scholar] [CrossRef] [PubMed]
  66. Lopes, B.; Azevedo, K.; Abrantes, A.; Rodrigues, S.; Ribeiro, L.; Vicente, B.; Almeida, R. Claustrophobia and Anxiety in Magnetic Resonance Imaging. In Proceedings of the European Congress of Radiology, Online, 2–6 March 2022; p. C-15525. [Google Scholar]
  67. Du, X.; Liu, C. Application of imaging in lymphedema surgical therapies. Gland Surg. 2020, 9, 582–588. [Google Scholar] [CrossRef] [PubMed]
  68. Seeram, E. Computed Tomography: A Technical Review. Radiol. Technol. 2018, 89, 279ct–302ct. [Google Scholar] [PubMed]
  69. Keo, H.H.; Gretener, S.B.; Staub, D. Clinical and diagnostic aspects of lymphedema. Vasa 2017, 46, 255–261. [Google Scholar] [CrossRef]
  70. Lee, S.; Lee, D.G.; Kim, K.T. Temporal Changes in Subcutaneous Fibrosis in Patients with Lower Extremity Lymphedema Following Surgery for Gynecologic Cancer: A Computed Tomography-Based Quantitative Analysis. Diagnostics 2022, 12, 1949. [Google Scholar] [CrossRef]
  71. O’Donnell Jr, T.F.; Allison, G.M.; Iafrati, M.D. A systematic review of guidelines for lymphedema and the need for contemporary intersocietal guidelines for the management of lymphedema. J. Vasc. Surg. Venous Lymphat. Disord. 2020, 8, 676–684. [Google Scholar] [CrossRef]
  72. Iftikhar, S.; Baloch, H.K.N.; Riaz, S.; Iqbal, S. An Analysis of Out-of-Pocket Expenditure Due to Non-Availability of Computed Tomography Scan in Public Sector: A Case Study of Hira Medical Center Sukkur Pakistan. Pak. J. Public Health 2021, 11, 74–78. [Google Scholar] [CrossRef]
  73. Karakashian, K.; Shaban, L.; Pike, C.; van Loon, R. Investigation of Shape with Patients Suffering from Unilateral Lymphoedema. Ann. Biomed. Eng. 2018, 46, 108–121. [Google Scholar] [CrossRef] [PubMed]
  74. White, B.N.; Lu, I.M.; Kao, L.S.; Dixon, J.B.; Weiler, M.J.; Frank, N.D.; Binkley, J.; Subhedar, P.; Okoli, J.; Buhariwalla, K.; et al. An infrared 3D scanning device as a novel limb volume measurement tool in breast cancer patients. World J. Surg. Oncol. 2020, 18, 278. [Google Scholar] [CrossRef] [PubMed]
  75. Fearn, N.; Meybodi, F.; Kilbreath, S.; Dylke, E.; Llanos, C.; Swanton, C.; Stuart, K. Reliability and Measurement Error of Breast Volume Calculation Using Three-Dimensional Surface Imaging. Lymphat. Res. Biol. 2022, 21, 296–303. [Google Scholar] [CrossRef] [PubMed]
  76. Taylor, R.; Jayasinghe, U.W.; Koelmeyer, L.; Ung, O.; Boyages, J. Reliability and validity of arm volume measurements for assessment of lymphedema. Phys. Ther. 2006, 86, 205–214. [Google Scholar] [CrossRef] [PubMed]
  77. Rabe, E.; Stücker, M.; Ottillinger, B. Water displacement leg volumetry in clinical studies—A discussion of error sources. BMC Med. Res. Methodol. 2010, 10, 5. [Google Scholar] [CrossRef] [PubMed]
  78. Lahtinen, T.; Seppälä, J.; Viren, T.; Johansson, K. Experimental and analytical comparisons of tissue dielectric constant (TDC) and bioimpedance spectroscopy (BIS) in assessment of early arm lymphedema in breast cancer patients after axillary surgery and radiotherapy. Lymphat. Res. Biol. 2015, 13, 176–185. [Google Scholar] [CrossRef] [PubMed]
  79. Szuba, A.; Rockson, S.G. Lymphedema: Classification, diagnosis and therapy. Vasc. Med. 1998, 3, 145–156. [Google Scholar] [CrossRef]
  80. Patel, K.M.; Manrique, O.; Sosin, M.; Hashmi, M.A.; Poysophon, P.; Henderson, R. Lymphatic mapping and lymphedema surgery in the breast cancer patient. Gland Surg. 2015, 4, 244–256. [Google Scholar] [CrossRef]
  81. Warren, A.G.; Janz, B.A.; Slavin, S.A.; Borud, L.J. The use of bioimpedance analysis to evaluate lymphedema. Ann. Plast. Surg. 2007, 58, 541–543. [Google Scholar] [CrossRef]
  82. Cornish, B.H.; Thomas, B.J.; Ward, L.C.; Hirst, C.; Bunce, I.H. A new technique for the quantification of peripheral edema with application in both unilateral and bilateral cases. Angiology 2002, 53, 41–47. [Google Scholar] [CrossRef]
  83. Sheng, L.; Zhang, G.; Li, S.; Jiang, Z.; Cao, W. Magnetic Resonance Lymphography of Lymphatic Vessels in Upper Extremity With Breast Cancer-Related Lymphedema. Ann. Plast. Surg. 2020, 84, 100–105. [Google Scholar] [CrossRef]
  84. Hidding, J.T.; Beurskens, C.H.; De Vries, M.T.; Nijhuis-van der Sanden, M.W.; van Laarhoven, H.W.; van der Wees, P.J. Accuracy of a single measurement site for self-monitoring of patients with breast cancer at risk for lymphedema. Physiother. Theory Pract. 2019, 35, 1322–1327. [Google Scholar] [CrossRef] [PubMed]
  85. Temur, K.; Kapucu, S. The effectiveness of lymphedema self-management in the prevention of breast cancer-related lymphedema and quality of life: A randomized controlled trial. Eur. J. Oncol. Nurs. 2019, 40, 22–35. [Google Scholar] [CrossRef] [PubMed]
  86. Borman, P.; Yaman, A.; Yasrebi, S.; İnanlı, A.P.; Dönmez, A.A. Combined complete decongestive therapy reduces volume and improves quality of life and functional status in patients with breast cancer-related lymphedema. Clin. Breast Cancer 2022, 22, e270–e277. [Google Scholar] [CrossRef]
  87. Witte, M.; Bernas, M. Evolution of the 2020 international society of lymphology consensus document parallels advances in lymphology: An historical perspective. Lymphology 2020, 53, 1–2. [Google Scholar]
  88. Fu, M.R.; Wang, Y.; Li, C.; Qiu, Z.; Axelrod, D.; Guth, A.A.; Scagliola, J.; Conley, Y.; Aouizerat, B.E.; Qiu, J.M. Machine learning for detection of lymphedema among breast cancer survivors. Mhealth 2018, 4, 17. [Google Scholar] [CrossRef] [PubMed]
  89. Ahmadi, M.; Shahrokhi, S.N.; Khavaninzadeh, M.; Alipour, J. Development of a Mobile-Based Self-care Application for Patients with Breast Cancer-Related Lymphedema in Iran. Appl. Clin. Inf. 2022, 13, 935–948. [Google Scholar] [CrossRef] [PubMed]
  90. Anik, A.R.; Hasan, K.; Islam, M.M.; Hasan, M.M.; Ali, M.F.; Das, S.K. Non-Invasive Portable Technologies for Monitoring Breast Cancer Related Lymphedema to Facilitate Telehealth: A Scoping Review. IEEE J. Biomed. Health Inform. 2023. [Google Scholar] [CrossRef]
  91. Yarmohammadi, H.; Rooddehghan, A.; Soltanipur, M.; Sarafraz, A.; Mahdavi Anari, S.F. Healthcare Practitioners’ Knowledge of Lymphedema. Int. J. Vasc. Med. 2021, 2021, 3806150. [Google Scholar] [CrossRef]
  92. Lawenda, B.D.; Mondry, T.E.; Johnstone, P.A. Lymphedema: A primer on the identification and management of a chronic condition in oncologic treatment. CA Cancer J. Clin. 2009, 59, 8–24. [Google Scholar] [CrossRef]
  93. McLaughlin, S.A.; Brunelle, C.L.; Taghian, A. Breast Cancer-Related Lymphedema: Risk Factors, Screening, Management, and the Impact of Locoregional Treatment. J. Clin. Oncol. Off. J. Am. Soc. Clin. Oncol. 2020, 38, 2341–2350. [Google Scholar] [CrossRef]
  94. Mayrovitz, H.N. The standard of care for lymphedema: Current concepts and physiological considerations. Lymphat. Res. Biol. 2009, 7, 101–108. [Google Scholar] [CrossRef]
  95. Taghian, N.R.; Miller, C.L.; Jammallo, L.S.; O’Toole, J.; Skolny, M.N. Lymphedema following breast cancer treatment and impact on quality of life: A review. Crit. Rev. Oncol. Hematol. 2014, 92, 227–234. [Google Scholar] [CrossRef]
  96. Godman, B.; Finlayson, A.E.; Cheema, P.K.; Zebedin-Brandl, E.; Gutiérrez-Ibarluzea, I.; Jones, J.; Malmström, R.E.; Asola, E.; Baumgärtel, C.; Bennie, M.; et al. Personalizing health care: Feasibility and future implications. BMC Med. 2013, 11, 179. [Google Scholar] [CrossRef]
  97. Cumpston, M.; Li, T.; Page, M.J.; Chandler, J.; Welch, V.A.; Higgins, J.P.; Thomas, J. Updated guidance for trusted systematic reviews: A new edition of the Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Database Syst. Rev. 2019, 2019, ED000142. [Google Scholar] [CrossRef] [PubMed]
Applsci 13 09810 g001
Figure 1. The figure highlights advantages and disadvantages of the different volumetric assessment methods of upper-limb lymphedema.
Figure 1. The figure highlights advantages and disadvantages of the different volumetric assessment methods of upper-limb lymphedema.
Applsci 13 09810 g001
Table 1. Spider tool search strategy.
Table 1. Spider tool search strategy.
SPIDER
SamplePhenomenon of InterestDesignEvaluationResearch Type
People with upper-limb lymphedemaQuantitative Assessment of
Upper-Limb Volume		AnyLimb VolumeQualitative
“Lymphedema”, “Upper Limb Lymphedema”“Water Displacement”, “Centimetric Method”, “Tape Measures”, “Perometry”, “Bioimpedance Spectroscopy”, “Dual-Energy X-ray Absorptiometry”, “Magnetic Resonance Imaging”, “Computed Tomography”, “Three-Dimensional (3D) Scanning Techniques”, “3D Volume Measurement” “Limb Volume”
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MDPI and ACS Style

Lippi, L.; Turco, A.; Moalli, S.; Nascimben, M.; Curci, C.; de Sire, A.; Rimondini, L.; Invernizzi, M. Quantitative Assessment of Upper-Limb Volume: Implications for Lymphedema Rehabilitation? Appl. Sci. 2023, 13, 9810. https://doi.org/10.3390/app13179810

AMA Style

Lippi L, Turco A, Moalli S, Nascimben M, Curci C, de Sire A, Rimondini L, Invernizzi M. Quantitative Assessment of Upper-Limb Volume: Implications for Lymphedema Rehabilitation? Applied Sciences. 2023; 13(17):9810. https://doi.org/10.3390/app13179810

Chicago/Turabian Style

Lippi, Lorenzo, Alessio Turco, Stefano Moalli, Mauro Nascimben, Claudio Curci, Alessandro de Sire, Lia Rimondini, and Marco Invernizzi. 2023. "Quantitative Assessment of Upper-Limb Volume: Implications for Lymphedema Rehabilitation?" Applied Sciences 13, no. 17: 9810. https://doi.org/10.3390/app13179810

APA Style

Lippi, L., Turco, A., Moalli, S., Nascimben, M., Curci, C., de Sire, A., Rimondini, L., & Invernizzi, M. (2023). Quantitative Assessment of Upper-Limb Volume: Implications for Lymphedema Rehabilitation? Applied Sciences, 13(17), 9810. https://doi.org/10.3390/app13179810

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