ALTERATIONS OF UNTREATED LYMPHEDEMA AND IT GRADE OVER TIME

Abstract

Lymphedema is assumed to increase in amount and Grade with time. This work verifies thatassumption, and may be helpful in persuading patients to undergo treatment and providesprognosis for likelihood of future disability. Before-treatment volumes of lymphedema/normal,Grades and durations are compared in 231 postmastectomy arm, 74 primary leg, and 103secondary leg lymphedemas. These were the first, consecutive, unilateral lymphedemas to receivetreatment at 25 clinics whose therapists we had trained.Amounts of lymphedema increased with time, as did Grades. Arms increased more rapidly(p=0.01) than secondary or primary legs, which did not differ from each other (linearregressions: 1.8 (0.34), 0.63 (0.20) and 0.68 (0.38) %/year, respectively). The Grades of primarylymphedemas increased more slowly than those of either secondary arms (p=0.02) or secondarylegs (p=0.003), which did not differ from each other (regressions: 0.010 (0.0048), 0.038(0.0063) and 0.032 (0.0048) Grades/year, respectively). Increase of lymphedema with Grade wasless for secondary legs than for primary legs (p=0.004) or arms (p=0.009), which did not differsignificantly (regressions: 9.9 (3.5), 35 (8.7) and 25 (3.4) %/Grade, respectively). Thus, armsincreased more rapidly in size than primary or secondary legs; primary legs remained in eachGrade longer%and got larger in them%than did secondary legs. This relative lack of fibrosis inprimary lymphedema permitted greater amounts of edema and accorded well withhistopathological studies. The increases described with duration were not caused simply bypatient aging. Whereas both duration and the age at the onset of lymphedema were significantfor the arms, only duration was significant for the legs. Even in the arms duration was muchmore important than age.