Northern Ireland Guidelines for LE

kira66715 · November 2011

Carol shared this document with me, and I consider it an excellent reference

www.gain-ni.org/Library/Guidelines/CrestGuidelines.pdf

It covers diagnosis and treatment, and I like their diagnostic criteria:

Astudy comparing different definitions of lymphoedema in post breast cancer
patients used 4 diagnostic criteria.26Limb volumes were measured and different
measurement criteria for the diagnosis of lymphoedema (200 ml limb volume increase
detected by perometry, 10% arm volume increase on perometry, 2 cm circumferential
increase or a report of heaviness or swelling either now or in the past year) were
compared to the clinical detection of lymphoedema. In this study the 10% limb
volume change corresponded to a conservative definition, whereas the 2 cm difference
between limbs or from a known pre-treatment baseline constituted a more liberal
definition. In a further study,25a10% volume increase calculated using
circumferential limb measurement was shown to have a sensitivity rate of 49%,
whereas a 5% increase in circumference was shown to have a 91% sensitivity rate.
Other studies have shown that using a circumferential difference of greater than 5 cm
between limbs or from a known pre-treatment baseline give a low pick up rate of
lymphoedema27.

It was the consensus of the CRESTLymphoedema group that a 5% increase in
circumferential measurement should trigger a reference to lymphoedema treatment
services.

If we could agree on a diagnostic criteria, as they did here, it would go a long way toward identifying and treating LE.

Kira

Binney4 · November 2011

Just wanted to add a note to Nitocris about this. In the same way that this could be done in Northern Ireland because it's small enough to arrive at a concensus without too much fuss, it may be easier to establish a diagnostic criteria for lymphedema in Finland than it is in the U.S., just because of the relative sizes of our countries. And with a diagnostic criteria you can push for consistent pre- and post-surgical assessments and prompt referrals. So it's something to consider as you round up all the "players" in your LE community. Especially with Delfin on board you would presumably have people who have a vested interest in pushing for a diagnostic criteria.

That said, it would be better to have as a criteria something that could send women to therapy even for subclinical (stage 0) LE. But since we're starting from nothing, even this criteria would be a major step forward.

Just a thought. Cool
Binney

Northern Ireland Guidelines for LE

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