Table 5.
Proposed Lymphedema Staging Matrix
| Symptom | Level | Descriptor | Prospective clinical tests |
|---|---|---|---|
| Edema | 0 | Increased excess extracellular fluid without visible swelling | Bio-impedance spectroscopy Self-reported symptoms Pitting test Circumference or volume measures |
| 1 | Visible swelling that resolves completely after prolonged elevation | ||
| 2 | Visible swelling that does not resolve completely after prolonged elevation | ||
| Skin | 0 | Skin appears normal | Observation Skin calliper Ultrasonography Laboratory testing for pathogens |
| 1 | Hyperkeratosis, sclerosis, or connective tissue fibrosis with shallow or no skin folds | ||
| 2 | Deep folds, knobs, papillomatosis, or other obvious skin pathology | ||
| 3 | Ulceration or nonhealing wounds, significant interdigital lesions | ||
| Disability | 0 | None | Validated QoLa tool relevant to the population tested |
| 1 | Minor interruption to instrumental ADLb | ||
| 2 | Major interruption to instrumental ADL | ||
| 3 | Interruption to self-care ADLc |
a
A QoL tool is a survey that assesses how people's experience of their disease or condition affects their life across multiple domains.
b
Instrumental ADL—the ability to prepare meals, shop for groceries or clothes, use the telephone, manage money, etc.
c
Self-care ADL—the ability to manage bathing, dressing and undressing, feeding self, using the toilet, and taking medications, without being bedridden.
ADL, activities of daily living; QoL, quality of life.