NEW CLINICAL AND LABORATORY STAGING SYSTEMS TO IMPROVE MANAGEMENT OF CHRONIC LYMPHEDEMA

Abstract

We have developed new clinical (C) andlaboratory (L) staging systems to improve theclinical management of chronic lymphedema.These systems were retrospectively assessedin 220 chronic lymphedema patients followedup for 4 years. Clinical evaluation of thetreatment response/disease progression wasperformed at 6 month intervals and laboratoryevaluation at a yearly interval except forrecurrent sepsis cases. The reliability ofC-stage and L-stage for the progression ofdisease were analyzed separately. TheC-staging was based on the subjective andobjective findings of local and systemicconditions, while L-staging was based onlymphoscintigraphic findings. Clinicalimplementation of this new staging systemfacilitated interpretation of the progress/deterioration of the clinical response to CDTtreatment, and it was found to be a usefulguideline for the decision/selection of furthersurgical treatment. We propose that these twoseparate staging systems could now become anew guideline for improved management oflymphedema with a better prediction oftreatment outcome and decision point foradditional medical/surgical therapy. Furtherclinical implementation and evaluation isnecessary to demonstrate clinical usefulnessespecially to guide surgical therapy andL-staging in followup.