生物电阻抗早期监测乳腺癌术后上肢淋巴水肿的敏感性与特异性研究

目的:研究生物电阻抗监测相对于主观症状体征问卷调查对乳腺癌术后上肢淋巴水肿早期诊断的敏感性与特异性。方法:筛选2016年10月—2017年3月在复旦大学附属华山医院静安分院确诊为乳腺癌并行根治术,符合研究标准的患者。给予受试者主观症状体征问卷调查、生物电阻抗分析设备(bioimpedance spectroscopy,BIS)监测和定点臂围测量,并记录其在术后2周及术后6个月的BIS监测结果及问卷调查、定点臂围测量结果。以患者的健侧与患侧臂围差值作为标准,计算BIS相对于主观症状体征问卷调查对上肢淋巴水肿诊断的敏感性和特异性。结果:以患者的健侧与患侧臂围差值作为参考标准,对88例病例进行分析后,主观症状体征问卷调查诊断的敏感性为94.4%,特异性为96.1%;BIS监测淋巴水肿的敏感度为97.2%,特异性为80.8%。结果显示BIS监测相对于症状体征评定,诊断淋巴水肿敏感性高,特异性差(P0.05)。结论:BIS监测相对于主观症状体征问卷调查,更易诊断淋巴水肿及发现隐匿性淋巴水肿。

A study on sensitivity and specificity of early monitoring of upper limb lymphedema after breast cancer by bioelectrical impedance

Abstract Objective: To study the sensitivity and specificity of bioelectrical impedance monitoring compared with subjective symptom and sign questionnaire in the early diagnosis of upper limb lymphedema after breast cancer operation. Method: From October 2016 to March 2017, a parallel radical mastectomy for breast cancer diagnosed in Jing''an branch of Huashan Hospital Affiliated to Fudan University was carried out, and informed consent was obtained. The subjects were investigated with subjective symptoms and signs, bioimpedance spectroscopy(BIS) monitoring and fixed-point brachial circumference measurement, and BIS monitoring results, questionnaire survey and fixed-point arm measurements were recorded at 2 weeks and 6 months after operation. The sensitivity and specificity of BIS in the diagnosis of upper limb lymphedema were calculated according to the difference between the healthy side and the affected arm girth as the standard. Result: Taking the difference between the healthy side and the affected arm as the reference standard, 88 cases were analyzed. The sensitivity and specificity of the questionnaire were 94.4% and 96.1%, respectively. The sensitivity and specificity of BIS for monitoring lymphedema were 97.2% and 80.8% respectively. The results showed that BIS monitoring was more sensitive to the diagnosis of lymphedema than the symptom assessment, and the specificity was poor (P<0.05). Conclusion: BIS monitoring is more likely to diagnose lymphedema and find occult lymphedema relative to the subjective symptom questionnaire survey.