Table 2

Methods for diagnosis and quantification of lymphedema

		Advantages	Disadvantages
Linear measurements	Circumference	Inexpensive Easily performed as part of in-office evaluation	Time-consuming Requires user experience Less sensitive for small-volume changes Requires normal contralateral limb
Volume measurements	Water displacement	Simple to use Easily reproducible Direct measurements Detects small changes in volume	Cumbersome to set up Limited by limb size Contraindicated with infection of open wounds Difficult to identify location of changes
	Calculated	Same advantages as circumference measurement but offered estimations of volume changes	Estimations based on mathematical models, that is, not true volumes Less sensitive for small-volume changes
	Perometry	High interobserver reliability Minimal experience necessary for use	Expensive Does not take into consideration hand and foot edema
Objective tissue evaluation	Bioimpedance spectroscopy	Identifies early tissue changes Does not require an internal control – useful in bilateral lymphedema High interobserver reliability	Expensive Not widely available
Objective tissue evaluation	Tonometry	Good for quantifying other improvements in lymphedema even when volume is fixed or change is mimimal	Not widely available Requires an internal control (contralateral limb) or patient-specific baseline