Screening and Early Detection
Lymphedema begins to congest in the body tissue before it is visible as swelling. Symptoms such as heaviness, aching, and tingling, are often reported before visible signs and symptoms of swelling occur. New technology in tissue measurement has enabled early identification of very minimal changes in limb tissue congestion. Screening and early identification of lymphedema is, therefore, an important part of clinical assessment.
Any individual who has had lymph nodes removed from the body is a risk for developing swelling. Most lymph node removal surgeries are planned as part of cancer therapy. Tissue measurements should, therefore, be taken before lymph nodes are removed to establish a baseline limb volume. Repeating this measurement through the duration of cancer treatment allows the provider to assess the tissue and determine if there are any meaningful changes. This approach promotes early identification of tissue changes at Stage 0 or Stage 1 when the condition is less severe and more responsive to conservative therapy.
Several measurement tools are used for early identification, including:
BioImpedance Spectroscopy (BIS) - BIS uses a small electrical wave to understand if fluid congestion is occurring in the tissue. BIS can detect tissue changes before they are visible and is an effective tool to use in early detection.
Perometry - Perometers use an infra-red optoelectronic beam to scan the limb and calculate the volume. The Perometer can detect tissue changes before they are visible and enable early intervention. This device is not widely available in clinics for measurement.
Circumferential Measurement with Volumetric Calculation - Using a standard tape measure, circumferential measures are taken at predetermined distances along the length of the limb. Each circumference is used in a geometric formula for a cylinder or a frustum, which enables calculation of the limb volume.
Early detection depends on having a baseline ‘normal’ measure and repeating that measure over time to identify the early onset of sub-clinical changes. Optimally both limbs are measured so that comparison over time and between limbs can be used to improve the sensitivity of early detection. Along with tissue measures, consideration should be given to the individual’s weight change and level of activity.