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Prospective Analysis Of The Sensitivity And Specificity Of Patient Reported Outcome Measures (proms) For The Diagnosis Of Cancer-related Lymphedema
Stav Brown, MD, Lilian Boe, PhD, Richard Diwan, BA, Michelle Coriddi, MD, Babak J. Mehrara, MD, Joseph H. Dayan, MD MBA;
Memorial Sloan Kettering Cancer Center, New York, NY, USA
Purpose: Lymphedema symptoms are usually present prior to lymphedema diagnosis by current clinical metrics. However, a diagnostic threshold for Patient Reported Outcome Measures (PROMs) has not been yet established. The purpose of this study was to determine the sensitivity and specificity of PROMs in lymphedema diagnosis and suggest an optimal diagnostic cutoff.
Methods: Between 2014 and 2023, we performed arm volume and bioimpedance measurements in patients at a tertiary cancer center. The Lymphedema Life Impact Scale (LLIS), a validated lymphedema-specific questionnaire was administered during each visit. Survey scores were compared to volume measurements (volume differential=10%) and bioimpedance scores (LDEX=6.5) to generate receiver operator characteristic (ROC). Youden’s method was used to determine the optimal cutoff scores and the sensitivity and specificity of LLIS for lymphedema diagnosis.
Results: 1354 patients were included in this study.
Using volume differential as diagnostic criteria, The LLIS was highly accurate (AUC=0.711, 95% CI 0.664-0.757, p<0.001) in diagnosing lymphedema with a sensitivity of 66.2%, and specificity of 66.1% at a cutoff of LLIS=36.8% overall percent impairment score. The same cutoff of was determined using bioimpedance scores as diagnostic criteria with high accuracy (AUC=0.742, 95% CI 0.693-0.792, p<0.001), sensitivity of 62.2% and specificity of 74.8%.
Conclusion: This is the largest study to date to define the role of PROMs in lymphedema diagnosis and provide a numeric diagnostic threshold. Early-stage lymphedema diagnosis using PROMs would enable us to target patients who might benefit from early referral to physical therapy or surgical interventions.
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