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. 2021 May 12;11(5):402. doi: 10.3390/jpm11050402

Table 1.

Comparison between Different Diagnostic Tools for the Diagnosis of Breast Cancer-related Lymphedema.

Diagnostic Tool Lymphedema Features Advantages Disadvantages
Circumferential Measurements

  • Circumferential difference

  • Easy and economic

  • To monitor the progress of the disease

  • Not provide a precise volume assessment
Water displacement

  • water overflow

  • Reliable

  • Validated

  • Hygienic concerns

  • Not provide information about swelling localization

  • Contraindicated in patients with open wounds
Perometry

  • Infrared scanning with calculation of multiple areas of the limb

  • To measure bilateral lymphedema

  • To localize swelling

  • To detect 3% limb volume change

  • Not available in all centers

  • Expensive
Bioimpedence Spectroscopy

  • Impedance Ratio between the limbs. Lymphedema Index (L-Dex) ratio

  • Safe, painless and rapid

  • Early detection of lymphedema

  • Repeatable

  • Not appropriate for bilateral lymphedema

  • Expensive
Three-Dimensional Laser Scanner

  • Real-time digital reconstruction of 3D upper limb

  • Able to identify extremely small variations of arm volume

  • High costs

  • Difficulty in arm reference points detection and acquisition

  • Time-consuming for software elaboration
Computed Tomography

  • Skin thickening

  • Honeycombing

  • Fat lobules

  • Objective method for limb volume

  • Radiation exposure

  • Expensive
Lymphoscintigraphy

  • Axillary/Elbow LNs

  • Lymphatic ducts

  • Dermal backflow

  • Gold standard for the diagnosis

  • Provide assessment of the lymphatic obstruction severity (partial or total)

  • Allows assessment of deep lymph flows

  • No standardized protocol

  • Occasional fuzzy images

  • No detailed information on subdermal lymphatics
ICG Lymphography

  • Superficial Lymphatic ducts

  • Dermal backflow

  • Detailed visualization of superficial lymphatic ducts

  • Visualization and mark of lymphatic ducts intra-operatively

  • No radiation exposure

  • Can only visualize lymphatics about 1.5 cm into the subcutaneous tissue
Magnetic Resonance Lymphangiography

  • Lymphatics

  • Fat deposition

  • Muscle compartments

  • Precise limb volume

  • No radiation exposure

  • Good information on the lymphatics function

  • No available in all centers

  • Technically demanding

  • Expensive

LNs: lymph nodes; CT: computed tomography; MR: magnetic resonance.