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Measurement of upper extremity volume in women following axillary dissection for breast cancer Megens, Antoinette Maria

Abstract

Women who have been treated for breast cancer with axillary surgery and/or radiation are at an increased risk of developing lymphedema in the ipsilateral upper extremity. In order to ensure accuracy in the measurement of upper extremity volume, and thus provide appropriate treatment options for lymphedema, a reliable and valid measurement method must be determined. The gold standard for clinical measurement of limb volume is water displacement volumetry, which can be time-consuming and unhygienic. The purpose of this research project was to determine if two methods of calculated upper extremity volume (using arm circumferences) could be substituted for measured water displacement volume in women after treatment for breast cancer. Inter-rater and test-retest reliability of circumferential measurements and water displacement volumetry were also examined. The subjects were 23 women who were at risk for lymphedema, having undergone axillary lymph node dissection surgery for breast cancer. Seventeen of the women had additional radiation therapy. Subjects had circumference and volume measurements taken of bilateral upper extremities by two physical therapists on the first day, and one week later by one of the physical therapists. Intraclass correlation coefficients (ICCs) were calculated to analyze circumferential and volume measurement reliability. Pearson product moment correlation coefficient (Pearson r) was used to evaluate the correlation between volumetry measurements and calculated volumes. Limits of agreement were calculated in order to determine the amount of agreement between the measurement methods. Upper extremities ipsilateral to the breast surgery were compared separately to contralateral upper extremities. Inter-rater and test-retest reliability ICCs for circumferential data were 0.99 and 0.99, for surgical upper extremities and contralateral upper extremities. Inter-rater and test-retest reliability ICCs for volumetric data were 0.99 and 0.99, for surgical upper extremities and contralateral upper extremities. Pearson-r values were 0.93 and 0.97 for the single truncated cone volume calculation and the summed truncated cone volume calculation respectively. Limits of agreement were (mean +/- 2sd) -52 +/- 334 mL, and -40 +/- 234 mL for single truncated cone calculation and summed truncated cone calculation respectively. The results of this investigation suggest that calculated and volumetric measurements in this population are both reliable and closely related, but do not agree with each other, and thus can not be used interchangeably.

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