Hot of the Press April 2025

Article to ponder

This systematic review examined 20 studies assessing imaging and measurement tools for quantifying the physical aspects of lipedema. A total of 13 different tools were identified, categorized into imaging (n=8) and measurement (n=5) methods. These tools were used to evaluate key physical characteristics, including lymphatic transport disturbances (n=8), limb size/volume (n=4), adipose tissue thickness/mass/volume (n=3), and tissue fluid presence (n=2).

Key findings include:

  • Diversity of Tools: Various techniques were employed, including tape measure, perometry, bioimpedance spectroscopy, ultrasound, Dual-Energy X-ray Absorptiometry (DEXA), MRI, and lymphangiographic imaging.

  • Lack of Standardization: Measurement protocols varied significantly across studies, including differences in anatomical locations, patient positioning, and calculation methods.

  • Limited Clinimetric Data: The studies often lacked validation or reliability data, with most using small, heterogeneous cohorts.

  • Recent Trends: Studies post-2020 incorporated multiple tools for assessment, indicating a growing trend toward multimodal evaluations.

Overall, while objective assessment methods exist for lipedema, a standardized, validated measurement protocol is lacking, necessitating further research for clinical and research applications.

Assessment Tools to Quantify the Physical Aspects of Lipedema: A Systematic Review

Eason HE, Kilbreath SL, Fearn N, Dylke ES,  Lymphat Res Biol. 2025 Mar 5. doi: 10.1089/lrb.2024.0102. Epub ahead of print. PMID: 40042124.

Key Takeaway: The systematic review highlights the lack of standardized, validated assessment protocols for quantifying the physical aspects of lipedema, underscoring the need for further research to establish reliable measurement tools for clinical and research applications.

We have collated some great articles and material published over the last month. Click on the links below to read the  abstract or download the full paper.

Anatomy / Physiology /Pathophysiology

The association between allostatic load and lymphedema in breast cancer survivors

Barnabas Obeng-Gyasi, Yevgeniya Gokun, Mohamed I. Elsaid, J.C. Chen, Barbara L. Andersen, William E. Carson, Sachin Jhawar, Jesus D. Anampa, Dionisia Quiroga, Roman Skoracki, Samilia Obeng-Gyasi. Support Care Cancer. 2025 Mar 21.

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Prevalence and Risk Factors

Incidence and predictors of lower extremity lymphedema after postoperative radiotherapy for prostate cancer

Giuseppe Facondo, Marta Bottero, Lucia Goanta, Alessia Farneti, Adriana Faiella, Pasqualina D’Urso, Giuseppe Sanguineti. Radiat Oncol. 2025 Mar 18.

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Assessment

The Comparative Evaluation of Depression, Life Satisfaction, and Quality of Life Between Female Patients with Lipedema and Lymphedema

Ayşegül Yaman, Pınar Borman, Esra Gizem Koyuncu, Ayşegül Balcan Aslan, Ayça Utkan Karasu, Cansu Şahbaz Pirinççi. Lymphat Res Biol. 2025 Mar 13.

Introduction: Lymphedema and lipedema are chronic conditions significantly impacting psychosocial status and quality of life (QOL). However, comparative studies on depression, life satisfaction, functional status, and QoL in these conditions are lacking. This study aims to fill this gap by providing a comparative evaluation of functional status, depression, life satisfaction, and QoL in patients with lymphedema and lipedema.
Method: Over 12 months, 73 female patients diagnosed with pure lymphedema or lipedema were recruited according to inclusion/exclusion criteria. A range of demographic variables, including age, body mass index (BMI), disease duration, stage of disease, and exercise/smoking conditions, were recorded. The lower-extremity functional scale (LEFS), life satisfaction index (LSI), patient health questionnaire (PHQ-9), and Lymphedema QOL Questionnaire for Legs were used to assess functional status, life satisfaction, depression, and QoL, respectively, in both groups. The relationship between questionnaire scores and demographic variables was carefully evaluated.
Results: Thirty-six individuals with lymphedema (mean age: 55.1 years) and 37 patients with lipedema (mean age: 50.7 years) were included in the study. Demographical variables were statistically similar between the groups (p > 0.05). Duration of disease was longer (mean: 159.3 months vs. 39.6 months) in a lipedema group than in lymphedema patients. PHQ-9 (mean:11.4 vs. 10.4) and overall QoL scores (mean: 5.06 vs. 5.47) were similar between groups, while LEFS (mean: 44 vs. 62) and LSI scores (mean: 11.5 vs. 14.3) were worse in patients with lymphedema than in a lipedema group. There were correlations between age and LEFS (p = 0.014, r = -0.40) and LSI (p = 0.013, r = -0.41) in the lymphedema group; and between BMI and LEFS (p = 0.013, r = -0.041) and QoL (p = 0.034, r = 0.37) scores; and duration of disease and PHQ-9 scores (p = 0.028, r = -0.41) in the lipedema group.
Conclusions: Patients with lipedema have similar depression and impaired QoL as lymphedema patients. However, lymphedema patients experience more functional disability and less life satisfaction. As the BMI and duration of illness are correlated with depression and QoL, early diagnosis and early management are essential to improve disability and QoL in patients suffering from lipedema.:10.1089.0117

Building evidence for diagnosis of lipedema: using a classification and regression tree (CART) algorithm to differentiate lipedema from lymphedema patients

I Forner-Cordero, J Muñoz-Langa, L Morilla-Bellido – International angiology. 2025 Feb 26.

Background: Discriminating lipedema from lymphedema becomes challenging in the absence of a pathognomonic test. The objective was to find the best manifestations that discriminate between lipedema and lymphedema and to build a diagnosis algorithm.

Methods: Prospective cohort study of two cohorts of patients, one with lipedema and another with lymphedema. Inclusion criteria for lipedema cohort involved bilateral lower limbs (LL) enlargement and at least three symptoms: pain/tenderness, bruising, familial history, no Stemmer’s sign, symmetrical involvement, and non-swollen feet. The lymphedema cohort included female patients with LL lymphedema. A univariate analysis was performed to determine which clinical features were different between both samples. We used a TREE procedure to create a tree-based classification model using the CART (Classification And Regression Tree) algorithm, in order to discriminate lipedema from lymphedema patients.

Results: Currently, 138 lipedema and 111 lymphedema patients were included. After univariate analysis, symmetrical involvement, disproportion between upper and lower parts of the body, spare feet, bruising, spider veins, family history, and pain were significantly more present in lipedema than in lymphedema (P<0.0001). Stemmer's sign, lymphangitis bouts, pitting and fibrosis were more representative of lymphedema (P<0.0001). The most important variables for discrimination were: disproportion (100%), spare feet (92.6%), bruising (92.3%) and symmetrical involvement (90.3%). After CART analysis, only three variables were retained in the final model: bruising, disproportion and spare feet. The model's accuracy was 100% with a probability error of 0.0% (SE: 0.00).

Historical Review and Clinical Uses of Skin Indentation to Assess Limb Lymphedema

HN Mayrovitz – Cureus, 2025

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Management Strategies

Compression terms: Defining terminology of compression therapy – An international compression club consensus document

Giovanni Mosti, Jean P. Benigni, Serge Bohbot, Nele Devoogdt, Isabel Forner-Cordero, Eduardo da Matta, Didier Rastel, Claas Roes, Sara Thomis. Phlebology. 2025 Feb 4.

BACKGROUND: The terminology in compression therapy is not always consistent. Confusion arises from layers, components, materials, whether elastic or inelastic, stiff or not stiff, compression class, and other terms. The aim of this paper is to define a standard terminology for compression therapy.

METHOD: the International Compression Club (ICC) board members prepared a draft consensus paper, which was circulated among the ICC members and refined by GM according to the comments and suggestions received.

RESULTS: All the terms used in compression therapy, from the definition to the materials, compression kits or systems, their physical properties, compression pressure, compression characteristics, and components and layers, were considered and agreed upon.

CONCLUSIONS: The given definitions allow for consistent classification of compression materials or devices. The International Compression Club hopes that the proposed terminology will be widely accepted and that papers and congress presentations on compression will use precise terminology.:10.1177/02683555241313422

Efficacy of Therapeutic Ultrasound Added to Complex Decongestive Therapy in Breast Cancer-Related Lymphedema

Mihriban Cağlı, Burcu Duyur Çakıt, Secil Pervane. Lymphat Res Biol. 2025 Mar 5.

Objective: To determine the efficacy of therapeutic ultrasound (TUS) added to complex decongestive therapy (CDT) in patients with breast cancer-related lymphedema (BCRL).
Materials and Methods: Thirty female volunteer patients who developed stage 2-3 BCRL were included in the study. The patients were randomly assigned to one of two groups: standard treatment with CDT alone and CDT + TUS. Before the study, both groups were given a training and home program consisting of remedial exercises and skin care. All patients received 15 sessions of treatment over 3 weeks. Circumferential and ultrasonographic (USG) measurements of all patients were performed before and after treatment. Treatment efficacy was evaluated based on extremity volume and soft tissue thickness.
Results: The demographic data and volume measurements of the patients were similar at the beginning of treatment. There was a statistically significant decrease in the affected extremity in both groups in posttreatment circumferential measurements. However, the reductions in volume difference and volume difference percentage were significantly higher in the CDT + TUS group (p = 0.001 and p = 0.002, respectively). In the USG measurements, a greater decrease was observed in the soft tissue thickness below the elbow in the CDT + TUS group compared with the CDT alone group (p = 0.003).
Conclusion: In the treatment of BCRL, TUS added to CDT resulted in a reduction in lymphedema. We consider that when added to CDT, TUS can increase the efficacy of treatment by reducing lymphedema in stages 2 and 3 lymphedema cases.:10.1089.0019

Randomized Trial Assessing Prospective Surveillance and Exercise for Preventing Breast Cancer-Related Lymphedema in High-Risk Patients

Karol Ramírez-Parada, Cesar Sánchez, Irene Cantarero-Villanueva, Álvaro Reyes, Mauricio P. Pinto, M. Loreto Bravo, Denise Montt-Blanchard, Francisco Acevedo, Benjamín Walbaum, Margarita Alfaro-Barra, Margarita Barra-Navarro, Scarlet Muñoz-Flores, Constanza Pinto, Sabrina Muñiz, Felipe Contreras-Briceño, Tomás Merino, Gina Merino. Arch Phys Med Rehabil. 2025 Mar 1.

OBJECTIVE: to evaluate if combining prospective surveillance model (PSM) with a supervised multimodal exercise program prevents breast cancer-related lymphedema (BCRL) and its impact on the functional capacity and quality of life (QoL) of high-risk breast cancer (BC) patients undergoing treatment.
DESIGN: two-arm parallel superiority randomized controlled trial.
SETTING: outpatient physical therapy service in a public hospital.
PARTICIPANTS: 116 adult women (≥18-year-old) diagnosed with stage I-III BC were enrolled. Inclusion criteria included recent surgery and indication for adjuvant chemotherapy. Exclusion criteria were significant arm volume difference, previous cancer, exercise contraindications, and extreme BMI values.
INTERVENTIONS: participants were randomized into experimental (n=61) or control groups (n=55) in a 1:1 ratio. The experimental group received PSM with a supervised multimodal exercise program for 12 weeks. The control group received PSM alone.
MAIN OUTCOME MEASURES: arm volume, grip strength, 6-minute walk test, and QoL were blindly assessed at baseline, 3, 6, and 9 months.
RESULTS: the combination of PSM with a supervised multimodal exercise program significantly reduced arm volume and body weight and improved grip strength, functional capacity, and the QoL of patients.
CONCLUSION: combining PSM and physical exercise reduces arm volume, prevents BCRL, and improves physical performance and QoL in high-risk patients. The combination of PSM and STRONG-B was superior to PSM alone, validating the study’s superiority design.:10.1016/j.apmr.2025.03.002

Effects of aerobic cycling training in patients with gynaecologic cancer-related lower extremity lymphedema: A randomised comparative study

Onur Kara, Gül Mete Civelek, Cansu Şahbaz Pirinççi, Rabia Tarlabölen, Meltem Dalyan. Support Care Cancer. 2025 Mar 19.

PURPOSE: Lower extremity lymphedema (LEL) after gynaecological cancer is a chronic disease that affects quality of life and functionality negatively. Exercise therapies help to volume reduction and improved lower extremity functionality and quality of life in patients with lymphedema. However, studies on this subject were mostly focused on upper extremity lymphedema. In this study, we aimed to compare complete decongestive therapy (CDT) and CDT + cycle ergometry in terms of quality of life, lower extremity functionality and volume measurement in patients with gynaecological cancer-related lower extremity lymphedema.
METHODS: This study included 63 patients who gave written and verbal informed consent. The participants were randomly divided into two groups as cycling (32 patients) and non-cycling group (31 patients). Demographic and clinical data of patients were recorded. While patients in non-cycling group were treated with only CDT for 3 weeks, patients in cycling group were treated with CDT + cycle ergometry for 3 weeks. Cycle ergometry treatment was performed with Voit AT-200 Black Collection horizontal bike for 20 min. Exercise intensity was adjusted to 40-59% of heart rate reserve (HRR). Volume measurement was evaluated by circumference measurement method, quality of life was evaluated by Lymphedema Quality of Life Questionnaire (LYMQOL) and lower extremity functionality was evaluated by Lower Extremity Functional Scale (LEFS) in all participants.
RESULT: Both cycling group and non-cycling group benefited from treatments in terms of volume reduction, LEFS and LYMQOL (function, appearance, symptom, mood and overall quality of life) values (p < 0.001, p < 0.001, p < 0.001, p < 0.001, p < 0.001, p < 0.001, p < 0.001, p < 0.001 and p < 0.001, respectively). In comparison of cycling and non-cycling groups, significant differences were found in favor of cycling group in terms of delta (Δ) extremity volume values (ml), Δ LEFS, Δ LYMQOL (function, appearance, symptom, mood and overall quality of life) (p = 0.04, p = 0.03, p < 0.001, p = 0.04, p = 0.002, p = 0.002, p < 0.001, p < 0.001 and p = 0.003, respectively). In other words; both groups benefited from treatments in terms of volume reduction, functionality and quality of life. However, benefit of cycling group is greater than benefit of non-cycling group.
CONCLUSION: Aerobic exercise added to CDT in gynaecological cancer-related lower extremity lymphedema is effective in terms of volume reduction, improved lower extremity functionality and quality of life. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT06200948 .:10.1007

Supporting patients with lymphoedema: the role of healthcare professionals in improving health-related quality of life

A randomized controlled non-inferiority study of adjustable compression wraps compared with inelastic multilayer bandaging used in the intensive complex decongestive therapy of lower leg lymphedema

Anett Reisshauer, Emmanouil Tsatrafilis, Simone Kornappel, Doerte Huscher, Max E. Liebl. J Vasc Surg Venous Lymphat Disord. 2025 Feb 25.

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Effectiveness of Kinesio Taping for Lymphedema in the Post-Mastectomy Patient: A Systematic Review of Randomized Controlled Trials

Marlena Skwiot. J Clin Med. 2025 Mar 3.

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Physical activity and lower extremity lymphedema among endometrial cancer survivors: A population-based cross-sectional study

Anette Engh, Corina Silvia Rueegg, Pernille K. Bjerre Trent, Linn Ø. Opheim, Ida Engeskaug, Nina Jebens Nordskar, Arnhild Bakken, Jostein Steene-Johannessen, Ane Gerda Z. Eriksson, Lene Thorsen. Gynecol Oncol. 2025 Mar 13.-88

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“Do I buy my children shoes, or do I get a compression garment for my lymphoedema?” Australian stakeholder perspectives on cancer-related lymphoedema care

Bogda Koczwara, Jane Lee, Navaz Naghavi, Monique Bareham, Matthew P. Wallen, Neil B. Piller, Raymond Javan Chan. J Cancer Surviv. 2025 Mar 13.

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Prospective Evaluation of the Safety and Compression Performance of Novel Compression Denim Jeans in Healthy Volunteers and Patients With Lymphedema

Daiki Ousaka, Kiyoshi Yamada, Noriko Sakano, Satoe Kirino, Kazumasa Miyake, Takumi Takahashi, Akihiro Matsuoka, Shintaro Yamada, Akira Shinaoka, Susumu Oozawa. Cureus. 2025 Mar 21. Mar.

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Justification of the role of rehabilitation assistance in lymphedema of the upper extremities based on foreign experience (a literature review)

Solomiia Kopytkoa,b, Olha Basa,b, Andriy Hrynkiva,b, Andriy Vovkanycha, Myroslava Hrynkivc. Physical Rehabilitation and Recreational Health Technologies. Vol 10. No1,2025.

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The MD Anderson Algorithm for Lymphedema Management

Ashleigh M. Francis, Noa G. Kopplin and Edward I. Chang. Department of Plastic & Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA. J. Clin. Med. 2025, 14(6), 1851

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