Comparison of Diagnostic Accuracy of Clinical Measures of Breast Cancer–Related Lymphedema: Area Under the Curve


      Smoot BJ, Wong JF, Dodd MJ. Comparison of diagnostic accuracy of clinical measures of breast cancer–related lymphedema: area under the curve.


      To compare diagnostic accuracy of measures of breast cancer–related lymphedema (BCRL).


      Cross-sectional design comparing clinical measures with the criterion standard of previous diagnosis of BCRL.


      University of California San Francisco Translational Science Clinical Research Center.


      Women older than 18 years and more than 6 months posttreatment for breast cancer (n=141; 70 with BCRL, 71 without BCRL).


      Not applicable.

      Main Outcome Measures

      Sensitivity, specificity, receiver operator characteristic curve, and area under the curve (AUC) were used to evaluate accuracy.


      A total of 141 women were categorized as having (n=70) or not having (n=71) BCRL based on past diagnosis by a health care provider, which was used as the reference standard. Analyses of ROC curves for the continuous outcomes yielded AUC of .68 to .88 (P<.001); of the physical measures bioimpedance spectroscopy yielded the highest accuracy with an AUC of .88 (95% confidence interval, .80–.96) for women whose dominant arm was the affected arm. The lowest accuracy was found using the 2-cm diagnostic cutoff score to identify previously diagnosed BCRL (AUC, .54–.65).


      Our findings support the use of bioimpedance spectroscopy in the assessment of existing BCRL. Refining diagnostic cutoff values may improve accuracy of diagnosis and warrant further investigation.

      Key Words

      List of Abbreviations:

      AUC (area under the curve), BIS (bioimpedance spectroscopy), BCRL (breast cancer–related lymphedema), CI (confidence interval), CTSI (Clinical and Translational Science Institute), ECF (extracellular fluid), LR− (likelihood ratio–negative), LR+ (likelihood ratio–positive), NQ (Norman Questionnaire), R0 (impedance ratio at 0 frequency), ROC (receiver operator characteristic), SOAC (sum of arm circumferences), UCSF (University of California San Francisco), UE (upper extremity)
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