Skip to main content

Perometry versus simulated circumferential tape measurement for the detection of breast cancer-related lymphedema



Despite increasing emphasis on screening and early intervention for breast cancer-related lymphedema (BCRL), there is marked heterogeneity in diagnostic methodology, including for volumetric measures. This retrospective study compared two volumetric modalities, perometry and simulated circumferential tape measurement (anatomic- and interval-based), for BCRL detection.


Between 2005 and 2017, 287 female patients with unilateral breast cancer were prospectively screened for BCRL by perometry and the relative volume change (RVC) formula. Circumferential measurement was performed by sampling at five anatomic landmark-based points or 4-cm intervals from pairs of perometer arm diameter measurements. Volumetric conversion was by a frustum model. The Bland–Altman method was used to compare segmental volume differences. Confusion matrix analysis was performed for each circumferential measurement technique against perometry.


Median follow-up was 34.7 months over 4 postoperative visits. There was no difference in total arm volume comparing any of the circumferential measurement techniques to perometry. Landmark-based methods significantly underestimated upper arm volume (mean difference − 207 mL [− 336, − 78 mL]) and overestimated forearm volume (mean difference + 170 mL [+ 105, + 237 mL]). Landmark-based methods had greater sensitivity and specificity compared to 4-cm interval methods for detection of both RVC ≥ 10 and 5–10%. Landmark-based methods were comparable to perometry for detection of RVC ≥ 10%, but sensitivity was only 63.2–66.7% for RVC 5–10%.


This hypothesis-generating study suggested the superiority of anatomic landmark-based circumferential tape measurement compared to interval-based methods, while generating questions about the underestimation of upper arm volume and overestimation of forearm volume of circumferential tape measurement compared to perometry.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3



Axillary lymph node dissection


Breast cancer-related lymphedema


Bioimpedance spectroscopy


Body mass index


Confidence interval


National Lymphedema Network


Negative predictive value


Partial breast irradiation


Positive predictive value


Relative volume change


Regional lymph node radiation


Sentinel lymph node biopsy






  1. Smith BD, Jiang J, McLaughlin SS et al (2011) Improvement in breast cancer outcomes over time: are older women missing out? J Clin Oncol 29:4647–4653.

    Article  PubMed  Google Scholar 

  2. Jammallo LS, Miller CL, Horick NK et al (2014) Factors associated with fear of lymphedema after treatment for breast cancer. Oncol Nurs Forum 41:473–483.

    Article  PubMed  Google Scholar 

  3. Taghian NR, Miller CL, Jammallo LS et al (2014) Lymphedema following breast cancer treatment and impact on quality of life: a review. Crit Rev Oncol Hematol 92:227–234.

    Article  PubMed  Google Scholar 

  4. Khan F, Amatya B, Pallant JF, Rajapaksa I (2012) Factors associated with long-term functional outcomes and psychological sequelae in women after breast cancer. Breast 21:314–320.

    Article  PubMed  Google Scholar 

  5. Chachaj A, Malyszczak K, Pyszel K et al (2010) Physical and psychological impairments of women with upper limb lymphedema following breast cancer treatment. Psychooncology 19:299–305.

    Article  PubMed  Google Scholar 

  6. Cheville AL, McGarvey CL, Petrek JA et al (2003) The grading of lymphedema in oncology clinical trials. Semin Radiat Oncol 13:214–225.

    Article  PubMed  Google Scholar 

  7. Armer JM, Radina ME, Porock D, Culbertson SD (2003) Predicting breast cancer-related lymphedema using self-reported symptoms. Nurs Res 52:370–379

    Article  PubMed  Google Scholar 

  8. Ridner SH (2005) Quality of life and a symptom cluster associated with breast cancer treatment-related lymphedema. Support Care Cancer 13:904–911.

    Article  PubMed  Google Scholar 

  9. Basta MN, Fox JP, Kanchwala SK et al (2016) Complicated breast cancer-related lymphedema: evaluating health care resource utilization and associated costs of management. Am J Surg 211:133–141.

    Article  PubMed  Google Scholar 

  10. Armer JM, Stewart BR (2010) Post-breast cancer lymphedema: incidence increases from 12 to 30 to 60 months. Lymphology 43:118–127.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  11. DiSipio T, Rye S, Newman B, Hayes S (2013) Incidence of unilateral arm lymphoedema after breast cancer: a systematic review and meta-analysis. Lancet Oncol 14:500–515.

    Article  PubMed  Google Scholar 

  12. McLaughlin SA, Staley AC, Vicini F et al (2017) Considerations for clinicians in the diagnosis, prevention, and treatment of breast cancer-related lymphedema: recommendations from a multidisciplinary expert ASBrS panel: part 1: definitions, assessments, education, and future directions. Ann Surg Oncol 24:2818–2826.

    Article  PubMed  Google Scholar 

  13. Shah C, Arthur DW, Wazer D et al (2016) The impact of early detection and intervention of breast cancer-related lymphedema: a systematic review. Cancer Med 5:1154–1162.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Clinical Resource Efficacy Support Team (2008) Guidelines for the diagnosis, assessment and management of lymphoedema. Available at:

  15. NLN Medical Advisory Committee (2011) Position statement of the National Lymphedema Network: screening and measurement for early detection of breast cancer-related lymphedema. 1–2.

    Article  PubMed  Google Scholar 

  16. Avon Foundation (2011) Recent advances in breast cancer-related lymphedema detection and treatment. 4/11 update. Available at:

  17. Levenhagen K, Davies C, Perdomo M et al (2017) Diagnosis of upper quadrant lymphedema secondary to cancer: clinical practice guideline from the oncology section of the American Physical Therapy Association. Phys Ther 97:729–745

    Article  PubMed  PubMed Central  Google Scholar 

  18. Sun F, Skolny MN, Swaroop MN et al (2016) The need for preoperative baseline arm measurement to accurately quantify breast cancer-related lymphedema. Breast Cancer Res Treat 157:229–240.

    CAS  Article  PubMed  Google Scholar 

  19. NLN Medical Advisory Committee (2012) Position statement of the National Lymphedema Network TOPIC : summary of lymphedema risk reduction practices. 1–2. Available at:

  20. ISL (2013) The diagnosis and treatment of peripheral lymphedema: 2013 consensus document of the International Society of Lymphology. Lymphology 46:1–11

    Google Scholar 

  21. Tierney S, Aslam M, Rennie K, Grace P (1996) Infrared optoelectronic volumetry, the ideal way to measure limb volume. Eur J Vasc Endovasc Surg 12:412–417.

    CAS  Article  PubMed  Google Scholar 

  22. Moffatt C, Doherty D, Morgan P (2006) International consensus: best practices for the management of lymphoedema. Int Lymphoedema Fram 4–7. Available at:

  23. Ancukiewicz M, Miller CL, Skolny MN et al (2012) Comparison of relative versus absolute arm size change as criteria for quantifying breast cancer-related lymphedema: the flaws in current studies and need for universal methodology. Breast Cancer Res Treat 135:145–152.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Brunelle C, Skolny M, Ferguson C et al (2015) Establishing and sustaining a prospective screening program for breast cancer-related lymphedema at the massachusetts general hospital: lessons learned. J Pers Med 5:153–164.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Brunelle CL, Swaroop MN, Skolny MN et al (2018) Hand edema in patients at risk of breast cancer-related lymphedema (BCRL): Health professionals should take notice. Phys Ther.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Ancukiewicz M, Russell T, Otoole J et al (2011) Standardized method for quantification of developing lymphedema in patients treated for breast cancer. Int J Radiat Oncol Biol Phys 79:1436–1443.

    Article  PubMed  Google Scholar 

  27. Specht MC, Miller CL, Russell T et al (2013) Defining a threshold for intervention in breast cancer-related lymphedema: what level of arm volume increase predicts progression? Breast Cancer Res Treat 140:485–494.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  28. Brunelle CL, Swaroop MN, Asdourian M et al (2017) Evaluation of methods of upper extremity measurement for breast cancer-related lymphedema: a comparison of perometry, circumferential tape measurement, and bioimpedance spectroscopy. In: National Lymphedema Network International Conference

  29. Memorial Sloan Kettering Cancer Center (2016) A prospective surveillance program for assessment and treatment of breast cancer-related lymphedema after axillary lymph node dissection. Bethesda Natl Libr Med (US) Identifier: NCT02743858

  30. Meir Medical Center (2012) The validity and reliability of self measurement of upper limb volume in treating lymphedema in breast cancer patients. Bethesda Natl Libr Med (US) Identifier: NCT01225783

  31. Abant Izzet Baysal University (2017) early detection of lymphedema with bio-electrical impedance analysis in patients after breast cancer surgery. Bethesda Natl Libr Med (US) Identifier: NCT02748746

  32. Mukaka MM (2012) Statistics corner: a guide to appropriate use of correlation coefficient in medical research. Malawi Med J 24:69–71.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  33. Stout NL, Pfalzer L, Levy E et al (2011) Segmental limb volume change as a predictor of the onset of lymphedema in women with early breast cancer. PM R 3:1098–1105.

    Article  PubMed  Google Scholar 

  34. Ridner SH, Montgomery LD, Hepworth JT et al (2007) Comparison of upper limb volume measurement techniques and arm symptoms between healthy volunteers and individuals with known lymphedema. Lymphology 40:35–46

    CAS  PubMed  Google Scholar 

  35. Armer JM, Stewart BR (2005) A comparison of four diagnostic criteria for lymphedema in a post-breast cancer population. Lymphat Res Biol 3:208–217

    Article  PubMed  Google Scholar 

  36. Meek AG (1998) Breast radiotherapy and lymphedema. Cancer 83:2788–2797

    CAS  Article  PubMed  Google Scholar 

  37. Ribeiro Pereira ACP, Koifman RJ, Bergmann A (2017) Incidence and risk factors of lymphedema after breast cancer treatment: 10 years of follow-up. Breast 36:67–73.

    Article  PubMed  Google Scholar 

  38. Pereira De Godoy JM, De Fatima Guerreiro Godoy M (2013) Evaluation of a new approach to the treatment of lymphedema resulting from breast cancer therapy. Eur J Intern Med 24:59–62.

    Article  Google Scholar 

  39. Bevilacqua JLB, Kattan MW, Changhong Y et al (2012) Nomograms for predicting the risk of arm lymphedema after axillary dissection in breast cancer. Ann Surg Oncol 19:2580–2589.

    Article  PubMed  Google Scholar 

  40. Svensson BJ, Dylke ES, Ward LC, Kilbreath SL (2017) Segmental bioimpedance informs diagnosis of breast cancer-related lymphedema. Lymphat Res Biol 15:349–355

    Article  PubMed  Google Scholar 

  41. Czerniec SA, Ward LC, Meerkin JD, Kilbreath SL (2015) Assessment of segmental arm soft tissue composition in breast cancer-related lymphedema: a pilot study using dual energy X-ray absorptiometry and bioimpedance spectroscopy. Lymphat Res Biol 13:33–39

    Article  PubMed  Google Scholar 

  42. Yang EJ, Kim SY, Lee WH et al (2018) Diagnostic accuracy of clinical measures considering segmental tissue composition and volume changes of breast cancer-related lymphedema. Lymphat Res Biol 00:lrb.2017.0047.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Adriaenssens N, Buyl R, Lievens P et al (2013) Comparative study between mobile infrared optoelectronic volumetry with a Perometer and two commonly used methods for the evaluation of arm volume in patients with breast cancer related lymphedema of the arm. Lymphology 46:132–143

    CAS  PubMed  Google Scholar 

  44. Katz-Leurer M, Bracha J (2012) Test-retest reliability of arm volume measurement in women with breast cancer- related lymphoedema. J Lymphoedema 7:8–12

    Google Scholar 

  45. Tidhar D, Armer J, Deutscher D et al (2015) Measurement issues in anthropometric measures of limb volume change in persons at risk for and living with lymphedema: a reliability study. J Pers Med 5:341–353.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Ostby PL, Armer JM, Dale PS et al (2014) Surveillance recommendations in reducing risk of and optimally managing breast cancer-related lymphedema. J Pers Med 4:424–447.

    Article  PubMed  PubMed Central  Google Scholar 

Download references


The project was supported by Award Number R01CA139118 (AG Taghian) and Award Number P50CA08393 (AG Taghian) from the National Cancer Institute. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute or the National Institutes of Health. This program is supported by the Adele McKinnon Research Fund for Breast Cancer-Related Lymphedema.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Fangdi Sun.

Ethics declarations

Conflict of interest

AG Taghian has been loaned equipment from ImpediMed for use in an investigator initiated clinical trial. ImpediMed has was not involved in the conception or reporting of our research activities. AG Taghian has been a consultant for VisionRT (image-guidance radiation oncology). The other authors have no conflicts of interest to declare.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Sun, F., Hall, A., Tighe, M.P. et al. Perometry versus simulated circumferential tape measurement for the detection of breast cancer-related lymphedema. Breast Cancer Res Treat 172, 83–91 (2018).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Lymphedema
  • Edema
  • Breast neoplasms
  • Quantification