Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/1677-5449.20140037
Jornal Vascular Brasileiro
Original Article

Evaluation of inter-rater reliability of subjective and objective criteria for diagnosis of lymphedema in upper and lower limbs

Avaliação da confiabilidade entre os critérios subjetivos e objetivos utilizados para o diagnóstico de linfedema nos membros superiores e inferiores

Larissa Louise Campanholi; João Pedreira Duprat Neto; José Humberto Tavares Guerreiro Fregnani

http://dx.doi.org/10.1590/1677-5449.20140037 J Vasc Bras, vol.14, n1, p.16-21, 2015
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Abstract

BACKGROUND: The diagnosis of lymphedema can be obtained objectively by measurement methods, and also by subjective methods, based on the patient's complaint. OBJECTIVE: To evaluate inter-rater reliability of objective and subjective criteria used for diagnosis of lymphedema and to propose a lymphedema cut-off for differences in volume between affected and control limbs. METHODS: We studied 84 patients who had undergone lymphadenectomy for treatment of cutaneous melanoma. Physical measures were obtained by manual perimetry (MP). The subjective criteria analyzed were clinical diagnosis of lymphedema in patients' medical records and self-report of feelings of heaviness and/or increase in volume in the affected limb. RESULTS: For upper limbs, the subjective criteria clinical observation (k 0.754, P<0.001) and heaviness and swelling (k 0.689, P<0.001) both exhibited strong agreement with MP results and there was moderate agreement between MP results and swelling (k 0.483 P<0.001), heaviness (k 0.576, P<0.001) and heaviness or swelling (k 0.412, P=0.001). For lower limbs there was moderate agreement between MP results and clinical observation (k 0.423, P=0.003) and regular agreement between MP and self-report of swelling (k 0.383, P=0.003). Cut-off values for diagnosing lymphedema were defined as a 9.7% difference between an affected upper limb and control upper limb and a 5.7% difference between lower limbs. CONCLUSION: Manual perimetry, medical criteria, and self-report of heaviness and/or swelling exhibited better agreement for upper limbs than for lower limbs for diagnosis of lymphedema.

Keywords

lymphedema, diagnosis, methods

Resumo

CONTEXTO: O diagnóstico de linfedema pode ser obtido tanto de forma objetiva, por métodos de mensuração, quanto por métodos subjetivos, através da queixa do paciente. OBJETIVO: Examinar a confiabilidade entre critérios objetivos e subjetivos utilizados para o diagnóstico de linfedema e propor um ponto de corte para linfedema de membros superiores e inferiores. MÉTODOS: Foram estudados 84 pacientes submetidos à linfonodectomias para o tratamento do melanoma cutâneo. As mensurações dos membros foram feitas utilizando a perimetria manual. Os critérios subjetivos foram obtidos através do diagnóstico de linfedema nos prontuários dos pacientes (observação clínica) e de auto-relato de sensação de peso e/ou aumento de volume no membro afetado. RESULTADOS: Nos membros superiores, houve uma forte correlação entre a perimetria manual e cada um dos critérios subjetivos: observação clínica (k 0,754, P<0,001) e sensação de peso eaumento de volume (k 0,689, P<0,001); concordância moderada no aumento de volume (k 0,483, P<0,001), peso (k 0,576, P<0,001) e sensação de peso ou aumento de volume (k 0,412, P=0,001). Nos membros inferiores, houve concordância moderada entre a perimetria e observação clínica (k 0,423, P=0,003) e regular no aumento de volume (k 0,383, P=0,003). O ponto de corte para definir linfedema foi uma diferença de 9,7% entre o membro afetado e o controle, e 5,7% de diferença para membros inferiores. CONCLUSÃO: Perimetria, observação clínica e auto-relato de sensação de peso e/ou aumento de volume, apresentaram melhor concordância para membros superiores que para inferiores no diagnóstico de linfedema.

Palavras-chave

linfedema, diagnóstico, métodos

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