Table 2.

Grading Systems for Lymphedema

ISL Stage	ISL Grading	CTCAE Grade
0: Subclinical impaired lymphatic transport without lymphedema	Mild, <20% increase in volume	Grade 1: Trace thickening or faint skin discoloration
1: Relatively high protein edema that reverses with elevation +/− pitting +/− increase in proliferating cells	Moderate, 20–40% increase in volume Grade 2: Limits activities of daily living. Characterized by marked skin discoloration, leathery texture, papillary formation.
2: High protein edema with dermal fibrosis that does not easily reverse with elevation. Usually no pitting.
3. Trophic skin changes: warty overgrowths, acanthosis, fat deposits, usually without pitting. Also known as lymphatic elephantiasis.	Severe, >40% increase in size	Grade 3: Severe symptoms limiting self-care and activities of daily living.