Validity of the Novel Taiwan Lymphoscintigraphy Staging and Correlation of Cheng Lymphedema Grading for Unilateral Extremity Lymphedema

<jats:sec> <jats:title>Objective:</jats:title> <jats:p>The aim was to validate the new Taiwan Lymphoscintigraphy Staging, correlate it with Cheng Lymphedema Grading (CLG) and evaluate the treatment outcomes of unilateral extremity lymphedema.</jats:p> </jats:sec> <jats:sec> <jats:title>Background:</jats:title> <jats:p>No consensus has been reached for diagnosis and staging for patients with lymphedema among medical specialties.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods:</jats:title> <jats:p>We included 285 patients with unilateral extremity lymphedema using lymphoscintigraphy. Lymphoscintigraphy was correlated to clinical symptoms and signs, and classified into normal lymphatic drainage, partial obstruction, and total obstruction. Inter- and intraobserver reliability of Taiwan Lymphoscintigraphy Staging, correlation between Taiwan Lymphoscintigraphy Staging and clinical findings were conducted. Patients were categorized in “surgical” (n = 154) or “nonsurgical” (n = 131) groups for outcome evaluation.</jats:p> </jats:sec> <jats:sec> <jats:title>Results:</jats:title> <jats:p>Lymphoscintigraphy found 11 patients (3.9%) with normal lymphatic drainage, 128 (44.9%) with partial obstruction, and 146 (51.2%) with total obstruction. Taiwan Lymphoscintigraphy Staging showed high interobserver agreement [intraclass correlation coefficient: 0.89 (95% confidence interval, 0.82–0.94)], and significantly correlated to computed tomography volumetric difference (<jats:italic toggle="yes">r</jats:italic> = 0.66, <jats:italic toggle="yes">P</jats:italic> < 0.001) and CLG [intraclass correlation coefficient: 0.79 (95% confidence interval 0.72–0.84)]. At a mean follow-up of 31.2 ± 2.9 months, significant improvement in the circumferential difference (from 23.9% ± 17.6% to 14.6% ± 11.1%; <jats:italic toggle="yes">P</jats:italic> = 0.03) with a mean circumferential reduction rate of 40.4% ± 4.5% was found in surgical group. At a mean follow-up of 26.6 ± 8.7 months, the nonsurgical group had increase of mean circumferential difference from 24.0% ± 17.2% to 25.3% ± 19.0% (<jats:italic toggle="yes">P</jats:italic> = 0.09), with a mean circumferential reduction rate was −1.9% ± 13.0%.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions:</jats:title> <jats:p>The Taiwan Lymphoscintigraphy Staging is a reliable diagnostic tool, correlated with clinical findings and CLG, aiding in the selection of the appropriate treatment to achieve favorable long-term outcomes in unilateral extremity lymphedema.</jats:p> </jats:sec>