ISL stage | ISL grading | CTCAE grade |
0: Subclinical impaired lymphatic transport without lymphedema | Mild,<20% increase in volume | Grade 1: Trace thickening or faint skin discoloration |
1: Relatively high protein edema that reverses with elevation +/-pitting +/- increase in proliferating cells | Moderate, 20%–40% increase in volume Grade 2: Limits activities of daily living. Characterized by marked skin discoloration, leathery texture, papillary formation. | |
2: High protein edema with dermal fibrosis that does not easily reverse with elevation. Usually no pitting. | ||
3.Trophic skin changes: warty overgrowths, acanthosis, fat deposits, usually without pitting. Also known as lymphatic elephantiasis. | Severe,>40% increase in size | Grade 3: Severe symptoms limiting self-care and activities of daily living. |