Correlation of Quality of Life in Patients with Lymphedema to Limb Volume, Bioimpedance, and Indocyanine Green Lymphangiography Stage
Itay Wiser, MD, PhD, Elizabeth O. Kenworthy, MD, Babak J. Mehrara, MD, Joe H. Dayan, MD.
Memorial Sloan Kettering, New York, NY, USA.
Background: Assessing outcomes in lymphedema is challenging because there is no single objective metric that measures lymphatic function. Consequently, patient reported outcomes (PRO) have become an important tool in lymphedema assessment. The purpose of this study was to assess correlation between PRO and Lymphedema objective measurments.
Methods: Baseline measurement data from a prospective study of quality of life in lymphedema patients was used for this study. Metrics included limb volume based on perometry, bioimpedance spectroscopy (BIS), and ICG stage. The Lymphedema Life Impact Scale (LLIS) PRO tool was used compared to these measures using a Spearman correlation test.
Results: Twenty eight patients were included. 20 had breast cancer, 4 had gynecologic tumors, and 4 had sarcoma. Overall impairment based on the LLIS was most strongly correlated to ICG stage. There was a lesser but also moderate correlation with limb volume and bioimpedance with the overall LLIS score. Presence or absence of cellulitis did not have a strong correlation to LLIS in this study.
Conclusion: The data in this study suggests the strongest correlation to quality of life in patients with lymphedema is ICG stage. As ICG findings may reflect underlying physiologic function of the lymphatic system, treatments aimed at improving physiologic function may have a relatively greater impact on improving quality of life. Further prospective study is required to evaluate this secondary hypothesis.
Correlation Coefficient of Different Imaging and Objective Lymphedema Measurements*
| Age | |||||||||
| LE Duration | -.027 | LE Duration | |||||||
| ISL | .103 | .426* | ISL | ||||||
| BMI | -.011 | .210 | .267 | BMI | |||||
| L-Dex | .292 | .329 | .621* | .318 | L-Dex | ||||
| Pero%Diff | .198 | .375* | .654* | .314 | .794* | Pero%Diff | |||
| MRA Fluid | -.266 | .308 | .462 | .260 | .312 | .672* | MRA Fluid | ||
| MRA Fat | .207 | -.056 | .555 | -.126 | -.045 | .434 | .590* | MRA Fat | |
| ICG | -.081 | .339 | .630* | .553* | .689* | .410 | .295 | .040 | ICG |
| LLIS Physical | .411* | .498* | .601* | ||||||
| LLIS Psychological | .099 | .188 | .436 | ||||||
| LLIS Functional | .281 | .454 | .350 | ||||||
| LLIS % Impairment | .310 | .451* | .595* |
*
Significant correlations (p<0.05) are marked in yellow and *. ISL= international society of lymphology, BMI= body mass index, L-Dex= lymphedema index, Pero%Diff= permoeter percent difference from normal limb, Man%Diff= manual examination percent difference from normal limb, ICG= indocyanine green lymphangiography staging, LLIS= lymphedema life impact scale version 2 questionnaire (domains included: physical, psychological, functional, and percent impairment). ULL27= upper limb lymphedema questionnaire.
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