Monitoring

Once the diagnosis of lymphedema has been established, patients can be followed up at 6-month to yearly intervals, depending on the severity of disease and the frequency of cellulitis. Expert consensus is that patients with lymphedema should have an objective quantification of swelling, both as a baseline and to monitor disease progression and treatment effectiveness over time.[1]​ The AFTD-pitting test may be used and is recommended by the International Lymphoedema Framework as a physical sign to identify and categorize lymphedema; it includes four factors: Anatomical location of edema, Force required to pit, the amount of Time, and the Definition of edema.[1][53]​​

Circumferential tape measurements or water-displacement volumetry are used to monitor disease progression and treatment response.[129] Water-displacement volumetry is achieved by placing the affected extremity into a cylinder, with the displaced water representing the volume of the extremity. Tape measurements of limb circumference at 5 to 10 cm intervals from routine anatomic landmarks are not as accurate. In addition, bioimpedance analysis, a technique used to compare the composition of fluid compartments within the body (achieved by using resistance to electrical current), can also be used to determine tissue alterations and fluid changes in patients with lymphedema.[10][55]

Additional assessment using imaging techniques such as lymphoscintigraphy, ultrasound or magnetic resonance imaging may provide useful additional information regarding disease progression and treatment outcomes.[47]

Ongoing assessment of health-related quality of life and patient’s perceptions of symptoms and functioning using validated disease-specific tools is recommended.[47]​ Examples include the Lymph-ICF-Lower Limb (Lymph-ICF-LL) and Lymphedema Quality of Life Inventory (LyQLI).[124][125]​​​

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