Sensitivity and specificity of fluorescence microlymphography for detecting lymphedema of the lower extremity.
Identifieur interne : 001B76 ( PubMed/Corpus ); précédent : 001B75; suivant : 001B77Sensitivity and specificity of fluorescence microlymphography for detecting lymphedema of the lower extremity.
Auteurs : Hong H. Keo ; Marianne Schilling ; Roland Büchel ; Ernst Gröchenig ; Rolf P. Engelberger ; Torsten Willenberg ; Iris Baumgartner ; Silvia B. GretenerSource :
- Vascular medicine (London, England) [ 1477-0377 ] ; 2013.
English descriptors
- KwdEn :
- MESH :
- methods : Lymphography, Optical Imaging.
- pathology : Lower Extremity.
- surgery : Leg, Lower Extremity, Lymphatic Vessels, Lymphedema.
- Adult, Aged, Female, Humans, Male, Middle Aged.
Abstract
Fluorescence microlymphography (FML) is used to visualize the lymphatic capillaries. A maximum spread of the fluorescence dye of ≥ 12 mm has been suggested for the diagnosis of lymphedema. However, data on sensitivity and specificity are lacking. The aim of this study was to investigate the accuracy of FML for diagnosing lymphedema in patients with leg swelling. Patients with lower extremity swelling were clinically assessed and separated into lymphedema and non-lymphatic edema groups. FML was studied in all affected legs and the maximum spread of lymphatic capillaries was measured. Test accuracy and receiver operator characteristic (ROC) analysis was performed to assess possible threshold values that predict lymphedema. Between March 2008 and August 2011 a total of 171 patients (184 legs) with a median age of 43.5 (IQR 24, 54) years were assessed. Of those, 94 (51.1%) legs were diagnosed with lymphedema. The sensitivity, specificity, positive and negative likelihood ratio and positive and negative predictive value were 87%, 64%, 2.45, 0.20, 72% and 83% for the 12-mm cut-off level and 79%, 83%, 4.72, 0.26, 83% and 79% for the 14-mm cut-off level, respectively. The area under the ROC curve was 0.82 (95% CI: 0.76, 0.88). Sensitivity was higher in the secondary versus primary lymphedema (95.0% vs 74.3%, p = 0.045). No major adverse events were observed. In conclusion, FML is a simple and safe technique for detecting lymphedema in patients with leg swelling. A cut-off level of ≥ 14-mm maximum spread has a high sensitivity and high specificity of detecting lymphedema and should be chosen.
DOI: 10.1177/1358863X13485505
PubMed: 23624356
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Keo</name><affiliation><nlm:affiliation>Swiss Cardiovascular Center, Division of Angiology, Inselspital, University Hospital and University of Bern, Switzerland. keoxx006@umn.edu</nlm:affiliation></affiliation></author><author><name sortKey="Schilling, Marianne" sort="Schilling, Marianne" uniqKey="Schilling M" first="Marianne" last="Schilling">Marianne Schilling</name></author><author><name sortKey="Buchel, Roland" sort="Buchel, Roland" uniqKey="Buchel R" first="Roland" last="Büchel">Roland Büchel</name></author><author><name sortKey="Grochenig, Ernst" sort="Grochenig, Ernst" uniqKey="Grochenig E" first="Ernst" last="Gröchenig">Ernst Gröchenig</name></author><author><name sortKey="Engelberger, Rolf P" sort="Engelberger, Rolf P" uniqKey="Engelberger R" first="Rolf P" last="Engelberger">Rolf P. Engelberger</name></author><author><name sortKey="Willenberg, Torsten" sort="Willenberg, Torsten" uniqKey="Willenberg T" first="Torsten" last="Willenberg">Torsten Willenberg</name></author><author><name sortKey="Baumgartner, Iris" sort="Baumgartner, Iris" uniqKey="Baumgartner I" first="Iris" last="Baumgartner">Iris Baumgartner</name></author><author><name sortKey="Gretener, Silvia B" sort="Gretener, Silvia B" uniqKey="Gretener S" first="Silvia B" last="Gretener">Silvia B. Gretener</name></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2013">2013</date><idno type="RBID">pubmed:23624356</idno><idno type="pmid">23624356</idno><idno type="doi">10.1177/1358863X13485505</idno><idno type="wicri:Area/PubMed/Corpus">001B76</idno><idno type="wicri:explorRef" wicri:stream="PubMed" wicri:step="Corpus" wicri:corpus="PubMed">001B76</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Sensitivity and specificity of fluorescence microlymphography for detecting lymphedema of the lower extremity.</title><author><name sortKey="Keo, Hong H" sort="Keo, Hong H" uniqKey="Keo H" first="Hong H" last="Keo">Hong H. Keo</name><affiliation><nlm:affiliation>Swiss Cardiovascular Center, Division of Angiology, Inselspital, University Hospital and University of Bern, Switzerland. keoxx006@umn.edu</nlm:affiliation></affiliation></author><author><name sortKey="Schilling, Marianne" sort="Schilling, Marianne" uniqKey="Schilling M" first="Marianne" last="Schilling">Marianne Schilling</name></author><author><name sortKey="Buchel, Roland" sort="Buchel, Roland" uniqKey="Buchel R" first="Roland" last="Büchel">Roland Büchel</name></author><author><name sortKey="Grochenig, Ernst" sort="Grochenig, Ernst" uniqKey="Grochenig E" first="Ernst" last="Gröchenig">Ernst Gröchenig</name></author><author><name sortKey="Engelberger, Rolf P" sort="Engelberger, Rolf P" uniqKey="Engelberger R" first="Rolf P" last="Engelberger">Rolf P. Engelberger</name></author><author><name sortKey="Willenberg, Torsten" sort="Willenberg, Torsten" uniqKey="Willenberg T" first="Torsten" last="Willenberg">Torsten Willenberg</name></author><author><name sortKey="Baumgartner, Iris" sort="Baumgartner, Iris" uniqKey="Baumgartner I" first="Iris" last="Baumgartner">Iris Baumgartner</name></author><author><name sortKey="Gretener, Silvia B" sort="Gretener, Silvia B" uniqKey="Gretener S" first="Silvia B" last="Gretener">Silvia B. Gretener</name></author></analytic><series><title level="j">Vascular medicine (London, England)</title><idno type="eISSN">1477-0377</idno><imprint><date when="2013" type="published">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult</term><term>Aged</term><term>Female</term><term>Humans</term><term>Leg (surgery)</term><term>Lower Extremity (pathology)</term><term>Lower Extremity (surgery)</term><term>Lymphatic Vessels (surgery)</term><term>Lymphedema (surgery)</term><term>Lymphography (methods)</term><term>Male</term><term>Middle Aged</term><term>Optical Imaging (methods)</term></keywords><keywords scheme="MESH" qualifier="methods" xml:lang="en"><term>Lymphography</term><term>Optical Imaging</term></keywords><keywords scheme="MESH" qualifier="pathology" xml:lang="en"><term>Lower Extremity</term></keywords><keywords scheme="MESH" qualifier="surgery" xml:lang="en"><term>Leg</term><term>Lower Extremity</term><term>Lymphatic Vessels</term><term>Lymphedema</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adult</term><term>Aged</term><term>Female</term><term>Humans</term><term>Male</term><term>Middle Aged</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Fluorescence microlymphography (FML) is used to visualize the lymphatic capillaries. A maximum spread of the fluorescence dye of ≥ 12 mm has been suggested for the diagnosis of lymphedema. However, data on sensitivity and specificity are lacking. The aim of this study was to investigate the accuracy of FML for diagnosing lymphedema in patients with leg swelling. Patients with lower extremity swelling were clinically assessed and separated into lymphedema and non-lymphatic edema groups. FML was studied in all affected legs and the maximum spread of lymphatic capillaries was measured. Test accuracy and receiver operator characteristic (ROC) analysis was performed to assess possible threshold values that predict lymphedema. Between March 2008 and August 2011 a total of 171 patients (184 legs) with a median age of 43.5 (IQR 24, 54) years were assessed. Of those, 94 (51.1%) legs were diagnosed with lymphedema. The sensitivity, specificity, positive and negative likelihood ratio and positive and negative predictive value were 87%, 64%, 2.45, 0.20, 72% and 83% for the 12-mm cut-off level and 79%, 83%, 4.72, 0.26, 83% and 79% for the 14-mm cut-off level, respectively. The area under the ROC curve was 0.82 (95% CI: 0.76, 0.88). Sensitivity was higher in the secondary versus primary lymphedema (95.0% vs 74.3%, p = 0.045). No major adverse events were observed. In conclusion, FML is a simple and safe technique for detecting lymphedema in patients with leg swelling. A cut-off level of ≥ 14-mm maximum spread has a high sensitivity and high specificity of detecting lymphedema and should be chosen.</div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">23624356</PMID><DateCreated><Year>2013</Year><Month>05</Month><Day>30</Day></DateCreated><DateCompleted><Year>2014</Year><Month>01</Month><Day>21</Day></DateCompleted><DateRevised><Year>2013</Year><Month>05</Month><Day>30</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1477-0377</ISSN><JournalIssue CitedMedium="Internet"><Volume>18</Volume><Issue>3</Issue><PubDate><Year>2013</Year><Month>Jun</Month></PubDate></JournalIssue><Title>Vascular medicine (London, England)</Title><ISOAbbreviation>Vasc Med</ISOAbbreviation></Journal><ArticleTitle>Sensitivity and specificity of fluorescence microlymphography for detecting lymphedema of the lower extremity.</ArticleTitle><Pagination><MedlinePgn>117-21</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1177/1358863X13485505</ELocationID><Abstract><AbstractText>Fluorescence microlymphography (FML) is used to visualize the lymphatic capillaries. A maximum spread of the fluorescence dye of ≥ 12 mm has been suggested for the diagnosis of lymphedema. However, data on sensitivity and specificity are lacking. The aim of this study was to investigate the accuracy of FML for diagnosing lymphedema in patients with leg swelling. Patients with lower extremity swelling were clinically assessed and separated into lymphedema and non-lymphatic edema groups. FML was studied in all affected legs and the maximum spread of lymphatic capillaries was measured. Test accuracy and receiver operator characteristic (ROC) analysis was performed to assess possible threshold values that predict lymphedema. Between March 2008 and August 2011 a total of 171 patients (184 legs) with a median age of 43.5 (IQR 24, 54) years were assessed. Of those, 94 (51.1%) legs were diagnosed with lymphedema. The sensitivity, specificity, positive and negative likelihood ratio and positive and negative predictive value were 87%, 64%, 2.45, 0.20, 72% and 83% for the 12-mm cut-off level and 79%, 83%, 4.72, 0.26, 83% and 79% for the 14-mm cut-off level, respectively. The area under the ROC curve was 0.82 (95% CI: 0.76, 0.88). Sensitivity was higher in the secondary versus primary lymphedema (95.0% vs 74.3%, p = 0.045). No major adverse events were observed. In conclusion, FML is a simple and safe technique for detecting lymphedema in patients with leg swelling. A cut-off level of ≥ 14-mm maximum spread has a high sensitivity and high specificity of detecting lymphedema and should be chosen.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Keo</LastName><ForeName>Hong H</ForeName><Initials>HH</Initials><AffiliationInfo><Affiliation>Swiss Cardiovascular Center, Division of Angiology, Inselspital, University Hospital and University of Bern, Switzerland. keoxx006@umn.edu</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Schilling</LastName><ForeName>Marianne</ForeName><Initials>M</Initials></Author><Author ValidYN="Y"><LastName>Büchel</LastName><ForeName>Roland</ForeName><Initials>R</Initials></Author><Author ValidYN="Y"><LastName>Gröchenig</LastName><ForeName>Ernst</ForeName><Initials>E</Initials></Author><Author ValidYN="Y"><LastName>Engelberger</LastName><ForeName>Rolf P</ForeName><Initials>RP</Initials></Author><Author ValidYN="Y"><LastName>Willenberg</LastName><ForeName>Torsten</ForeName><Initials>T</Initials></Author><Author ValidYN="Y"><LastName>Baumgartner</LastName><ForeName>Iris</ForeName><Initials>I</Initials></Author><Author ValidYN="Y"><LastName>Gretener</LastName><ForeName>Silvia B</ForeName><Initials>SB</Initials></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2013</Year><Month>04</Month><Day>26</Day></ArticleDate></Article><MedlineJournalInfo><Country>England</Country><MedlineTA>Vasc Med</MedlineTA><NlmUniqueID>9610930</NlmUniqueID><ISSNLinking>1358-863X</ISSNLinking></MedlineJournalInfo><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000328" MajorTopicYN="N">Adult</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000368" MajorTopicYN="N">Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D007866" MajorTopicYN="N">Leg</DescriptorName><QualifierName UI="Q000601" MajorTopicYN="Y">surgery</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D035002" MajorTopicYN="N">Lower Extremity</DescriptorName><QualifierName UI="Q000473" MajorTopicYN="N">pathology</QualifierName><QualifierName UI="Q000601" MajorTopicYN="Y">surgery</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D042601" MajorTopicYN="N">Lymphatic Vessels</DescriptorName><QualifierName UI="Q000601" MajorTopicYN="Y">surgery</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D008209" MajorTopicYN="N">Lymphedema</DescriptorName><QualifierName UI="Q000601" MajorTopicYN="Y">surgery</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D008220" MajorTopicYN="Y">Lymphography</DescriptorName><QualifierName UI="Q000379" MajorTopicYN="N">methods</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D061848" MajorTopicYN="Y">Optical Imaging</DescriptorName><QualifierName UI="Q000379" MajorTopicYN="N">methods</QualifierName></MeshHeading></MeshHeadingList><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">edema</Keyword><Keyword MajorTopicYN="N">fluorescence dyes</Keyword><Keyword MajorTopicYN="N">leg</Keyword><Keyword MajorTopicYN="N">lymphedema</Keyword><Keyword MajorTopicYN="N">microscopy fluorescence</Keyword></KeywordList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="entrez"><Year>2013</Year><Month>4</Month><Day>30</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2013</Year><Month>4</Month><Day>30</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2014</Year><Month>1</Month><Day>22</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">23624356</ArticleId><ArticleId IdType="pii">1358863X13485505</ArticleId><ArticleId IdType="doi">10.1177/1358863X13485505</ArticleId></ArticleIdList></PubmedData></pubmed></record>Pour manipuler ce document sous Unix (Dilib)
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