Reliability and validity of arm volume measurements for assessment of lymphedema

Arm lymphedema following breast cancer surgery is a continuing problem. In this study, we assessed the reliability and validity of circumferential measurements and water displacement for measuring upper-limb volume.

Participants included subjects who had had breast cancer surgery, including axillary dissection--19 with and 22 without a diagnosis of arm lymphedema--and 25 control subjects.

Two raters measured each subject by using circumferential tape measurements at specified distances from the fingertips and in relation to anatomic landmarks and by using water displacement. Interrater reliability was calculated by analysis of variance and multilevel modeling. Volumes from circumferential measurements were compared with those from water displacement by use of means and correlation coefficients, respectively. The standard error of measurement, minimum detectable change (MDC), and limits of agreement (LOA) for volumes also were calculated.

Arm volumes obtained with these methods had high reliability. Compared with volumes from water displacement, volumes from circumferential measurements had high validity, although these volumes were slightly larger. Expected differences between subjects with and without clinical lymphedema following breast cancer were found. The MDC of volumes or the error associated with a single measure for data based on anatomic landmarks was lower than that based on distance from fingertips. The mean LOA with water displacement were lower for data based on anatomic landmarks than for data based on distance from fingertips.

Volumes calculated from anatomic landmarks are reliable, valid, and more accurate than those obtained from circumferential measurements based on distance from fingertips.