The Future of Head and Neck Lymphedema Assessment: Comparative Analysis of 3D Imaging vs. Tape Measurement

BACKGROUND: Head and neck lymphedema (HNL) after head and neck cancer treatment can significantly impact patient quality of life by causing difficulty with swallowing and speech, increasing cost of treatment, leading to facial disfiguration, and decreasing psychosocial wellness. Currently, The M. D. Anderson Cancer Center (MDACC) HNL evaluation protocol is the most commonly used to tool to evaluate the severity and status of head and neck lymphedema by utilizing a series of face and neck tape measurements. However, there is no gold standard assessment tool that reliably and consistently measures HNL despite over 35 assessment tools having been reported in the literature to date. With the continued integration of advanced technology in medicine, three-dimensional (3D) imaging has shown that it’s an effective and reliable tool to assess volume changes. Therefore, we studied the efficacy of 3D imaging as a novel method of tracking changes in head and neck volume in patients with head and neck lymphedema. The aim of this study was to compare changes in 3D measurements against traditional MDACC protocol tape measurements. METHODS: Patients undergoing treatment for head and neck cancer were prospectively enrolled, and 3dMD images were captured at the initial and each subsequent appointment. The MDACC protocol was also used to obtain a composite bilateral hemifacial score from the sum of all facial tape measurements at each appointment. Additionally, the MDACC rating scale was used to determine the degree of lymphedema. Following study completion, the changes in 3dMD imaging measurements and bilateral hemifacial scores from first to last visit were compared for each patient. Pearson’s correlation coefficients were used to assess the strength and direction of the relationship between the two measures. RESULTS: A total of 230 patients were included in the study. The mean age at time of first visit was 61.5 ± 9.4 (SD) years. Most primary cancers originated from the oropharynx (35%), oral cavity (26%), or larynx (17%), with the remaining 22% originating in other locations. 31% of patients received radiotherapy, 8% received surgery, and 61% received both radiotherapy and surgery. 20% of patients were categorized as level 1a lymphedema, 71% as 1b, and 9% as level 2. The median time from first visit to last visit was 3.3 months (2.1-5.8, interquartile range). The average changes in lymphedema measurements were 1.9 ± 25.8 using 3dMD scans and -1 ± 5.2 using the MDACC protocol. The Pearson correlation coefficient for these two variables was 0.207 (p =.002), indicating that there is a low, positive correlation between tape and 3D measurements. CONCLUSIONS: Use of 3D imaging for volume measurement in head and neck lymphedema has not been previously studied. Our study demonstrates that while traditional tape measurement is frequently used to measure HNL, efficacy and accuracy are low. The reliability and accuracy of 3D volume measurement has been validated in other studies, and we believe it is an effective tool in evaluating head and neck lymphedema.