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Lymphoscintigraphic quantitative parameters in patients with lower limb oedemas: Retrospective review

par Mohamad, Al Makhzomi;Bourgeois, Pierre ;Mortelmans, Luc
Référence The European journal of lymphology and related problems, 21, 61, page (14-19)
Publication Publié, 2010

Article révisé par les pairs

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Résumé :

Aims of the study: To evaluate the sensitivity and the specificity of the lymphoscintihgraphic 'Kleinhans' Transport Index (TI) in a general population of patients suffering from lower limb oedema. Material and Methods: Retrospective study using the medical records and image analysis of 39 patients who have undergone a lymphoscintigraphy for lower limb oedemas (LLE). Patients were divided in 7 groups according to results of the clinical examination, the lymphoscintigraphy and duplex ultrasound investigations. Group A: normal group (n = 23 limbs). Group B: oedema of systemic origin (n = 10 limbs). Group C: Phleboedema (n = 5 limbs). Group D: Latent primary lymph oedema (n = 4 limbs) represented the opposite four limbs in patients with unilateral primary lymph oedema. Group E: primary lymph oedema (n = 12). Group F: secondary lymph oedema (n = 13). Group G: oedema originated from mixed lymphatic-venous insufficiency (n = 8). Kleinhans' lymphoscintigraphic transport index (TI) were calculated for each group. Sensitivity and specificity of the TI were evaluated with two cut-off values (<8) en (>15). Results: In normal group (group A) TI value ranged from 0 to 7 (average 3, standard deviation SD ± 2). In Group B, it ranged from 5 to 19 (average 12, SD ± 7). In group C, it ranged from 3 to 14 (average 7, SD ± 6). In group D, it ranged from 16 to 38 (average 22, SD ± 9). In group E, it ranged from 30 to 45 (average 34, SD ± 8). In group F, it ranged from 25 to 39 (average 32, SD ± 7) and in group G, it ranged from 5 to 22 ( average 16, SD ± 11). We have found that TI (with cut-off value <8 needed to define LLE from lymphatic origin or not) can classify correctly the oedematous limbs as lymphatic or not in 67 of 78, i.e. the overall accuracy equal to 85.9%, the sensitivity and specificity were 89.2% (33/37) and 82.9% (34/41) respectively, the positive predictive value and negative predictive value were 82.5% (33/40) and 89.5% (34/38). However, it has a lower specificity 57.7% (15/26) if it applied only to a swollen limb (n = 26), neither with clinical history typical for primary lymph oedema nor a history of previous surgery and/or radiotherapy of the lymphatic system. Conclusion: The TI appears to have a relatively low specificity in its ability to diagnose patients with lower limb lymph oedema when there is no clinical suspicion of lymphatic origin. Considering that the prevalence of true positive lymph oedematous situation is low, the application of the TI with the proposed threshold value of 7 will lead to one unacceptable high rate of false positive diagnosis of lymph oedematous situations.