The Soft Tissues Ultrasonography Technique in Patient with Upper Limb Lymphedema: methodology, reproducibility, measurement errors

Lymphedema of the upper extremities is evaluated mainly clinically. While being an informative method, ultrasonography has a number of limitations leading to a low level of its use in lymphological practice. This paper describes an ultrasound examination as a standardized method for planimetric assessment of the soft tissues of the upper extremities affected by lymphedema. The article presents the results of 1059 scans performed on the upper arm, forearm and hand of both intact and edematous limbs in 366 patients with secondary lymphedema within the upper limb that developed after radical or organ-preserving treatment for breast cancer. We assessed the thickness of the skin, subcutaneous fat, superficial fascia and muscle tissue. We show the information capacity of the method by the examination of patients with lymphatic edema. To this end, we carried out a comparative analysis of 370 cases of the skin, subcutaneous fat and muscle tissue on intact limbs in the immediate dynamics for 275 patients. Both absolute and relative dynamics parameters were taken into consideration. We also determined the limits of the method error stemming from its technical aspects as well as resulting from the variance of the normal physiological processes. We demonstrate that a comparative analysis of the dynamics of tissue thickness performed in absolute terms is a more preferable method of diagnostics and assessment of treatment efficiency. In contrast, the assessment of relative indicators can lead to erroneous conclusions. The same applies to comparing two limbs with each other. We believe that the latter will expand the diagnostic capacity of the method towards estimation of the severity of pathological changes in the soft tissues of the upper limbs upon initial examination as well as upon dynamic monitoring of the patients in order to assess the treatment efficacy.