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Page 4 of 18 Laustsen-Kiel et al. Plast Aesthet Res 2024;11:17 https://dx.doi.org/10.20517/2347-9264.2024.32

Table 1. Diagnostic methods of arm lymphedema in recent literature
Diagnostic method Description Advantages Limitations
Water displacement Immersion of whole limb in water, Sensitive and specific Messy and difficult
measuring the volume of water High interclass correlation Inability to localize to specific limb
displaced by the submerged limb segments
It cannot be used if there are open
wounds
Tape circumferential Measurement of limb circumference, Inexpensive High intra- and inter-rater
measurement often multiple places along the arm In-home application is possible variability
Easy Volume calculation assumes a
circular arm form, which is
seldom the case
Perometry Infrared light measures limb volume and Hygienic Requires specialized equipment
collects two-dimensional information Creates a 3D image of the limb, Cost
from each arm enabling localization of swelling Can only measure limb edema
Can detect a 3% volume change (e.g., Not breast edema)
Useful for bilateral lymphedema
Bioimpedance Uses electrical current to scan the upper Requires minimal training Equipment availability
spectroscopy (BIS) extremities, measuring resistance Rapid Requires trained personnel
Accurate Not applicable for bilateral
Quantitative assessment lymphedema
Limitations in advanced
lymphedema due to fat-dominant
composition
Dual-energy X-ray Measures chemical limb composition Quantitative assessment Radiation exposure
absorptiometry (DEXA) Distinguishes fat and fluid Limited availability
Lymphoscintigraphy Radioactive tracer imaging of the Visualizes lymphatic flow and lymph Invasive
lymphatic system nodes Radiation exposure
Identifies lymphatic damage Limited availability
Magnetic resonance Uses magnetic fields and radio waves Excellent soft tissue contrast Expensive
imaging Detailed anatomical images of fat, Limited availability
muscle and water MR cannot resolve smaller
Can be used as MR lymphangiography lymphatic channels due to
limitations in resolution
Can detect changes in edema much
earlier than most other modalities
Indocyanine green (ICG) Intradermal injection of fluorescent ICG Real-time imaging Assesses Limited penetration depth of 1.5
visualizes lymphatic vessels with a near- lymphatic function cm
infrared camera (NIR) No radiation Operator-dependent
Visualizes dermal backflow With NIR: Depth visualization of
3-4 cm
Photoacoustic imaging Light energy generates ultrasound Real time Needs imaging contrast, such as
waves, which a transducer depicts as an Portable ICG or Evans blue, to view
image lymphatics
Computed tomography X-ray technology for cross-sectional Detailed images Radiation exposure
(CT) images 3-D representation Limited sensitivity for
Evaluates anatomical structures lymphedema
Three-dimensional laser Laser-based scanning for surface Precise surface mapping Limited to surface measurements
scanner measurements Higher intra-rater reliability compared May not assess deep tissues
to water displacement High cost of the device
Time-consuming
Ultrasound High-frequency sound waves for Can measure texture and characterize Operator dependence
imaging and blood flow edema Limited depth perception for
Few limitations to depth perception ultra-high frequency (rarely used)
Easy to transport
Tissue dielectric constant 300 MHz is emitted into the tissue, and Provides a better understanding of Interpretation of values may
(TDC) a wave is returned with information on arm spatial variability in relation to depend on location and total body
local water content girth measures water percentage
Convenient
Non-invasive

breast cancer. A meta-analysis including 25 studies concluded that BCS is superior to mastectomy for
[80]
early breast cancer. Still, mastectomy is the surgical choice for many patients, especially in low and
middle-income countries, where access to adjuvant therapy is limited [81,82] . Conversely, western countries are