title: Ultrasound and Clinical Measures for Lymphedema.
abstract: BACKGROUND
  Treatment for breast cancer has increased patient survivorship exponentially over the past few decades. With increased survivorship, more women are living with the longstanding effects of breast cancer treatment, such as lymphedema. Patients, health care providers, and payers depend on practical and efficient clinical measures to accurately diagnose and monitor disease progression or regression. However, current clinical measures do not include objective measures that assess lymphedetamous tissue accurately. This study compared current measures to a novel use of ultrasound (US) imaging to quantify tissue texture.
  
  
  RESULTS
  Seventeen women diagnosed with lymphedema completed self-report questionnaires and then were tested twice by two lymphedema physical therapists who measured edema, fibrosis, and limb volume differences. One therapist measured subjects' limbs using US imaging and derived measures of entropy and average pixel intensity. Volume measures were consistent between therapists (p < 0.01) but palpation was not (0.01 < p < 0.72). Therapists' measures correlated better to subjects' self-report of edema (0.01 < p > 0.32) as compared to fibrosis (0.23 < p > 0.90). US measures were reliable (Cronbachs's α = 0.7 and 0.91 for entropy and API, respectively). Entropy measures demonstrated significant differences between subjects' involved versus uninvolved forearms (p = 0.03).
  
  
  CONCLUSIONS
  Therapists were not consistent with each other when rating edema or fibrosis; however, they were consistent when measuring limb volume differences. US measures (entropy) demonstrated a significant difference between involved and uninvolved. US imaging, as a tool to quantify subcutaneous tissues, holds promise to be a safe, mobile, and effective method to measure lymphedema tissue texture.
authors.affiliation: 1 Department of Rehabilitation and Movement Science, University of Vermont , Burlington, Vermont.
authors.forename: Kristine C
authors.initials: KC
authors.lastname: Johnson
authors.affiliation: 2 Department of Biostatistics, University of Vermont , Burlington, Vermont.
authors.forename: Mike
authors.initials: M
authors.lastname: DeSarno
authors.affiliation: 2 Department of Biostatistics, University of Vermont , Burlington, Vermont.
authors.forename: Taka
authors.initials: T
authors.lastname: Ashikaga
authors.affiliation: 1 Department of Rehabilitation and Movement Science, University of Vermont , Burlington, Vermont.
authors.forename: Justine
authors.initials: J
authors.lastname: Dee
authors.affiliation: 1 Department of Rehabilitation and Movement Science, University of Vermont , Burlington, Vermont.
authors.forename: Sharon M
authors.initials: SM
authors.lastname: Henry
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000072656:Breast Cancer Lymphedema / Q000000981:diagnostic imaging*; D005260:Female; D005355:Fibrosis / Q000000981:diagnostic imaging; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012867:Skin / Q000473:pathology; D011795:Surveys and Questionnaires; D014463:Ultrasonography / Q000379:methods*; D034941:Upper Extremity / Q000473:pathology