Clinical and Scintigraphic Staging Agreement in Limb Lymphedema: A Sex-Stratified Retrospective Analysis

Abstract

Background: The degree of concordance between clinician-assigned and scintigraphic staging in lymphedema, particularly across sexes, remains inadequately characterized. This study assessed agreement between clinical and lymphoscintigraphic staging and evaluated sex-based differences in lymphatic dysfunction grading.

Materials and Methods: A retrospective review of 88 consecutive patients undergoing lymphoscintigraphy at NINMAS (October–December 2025) was performed. Concordance was assessed for the left lower limb (LLL, n=55) and right lower limb (RLL, n=49) using Cohen's kappa and cross-tabulation. Sex-based grade distribution was analyzed with the chi-square test.

Results: Exact concordance was 41.8% (LLL) and 44.9% (RLL). Cohen's kappa indicated slight-to-fair agreement (LLL: κ=0.162; RLL: κ=0.205). Scintigraphy downstaged 34.5% and upstaged 23.6% of LLL cases. Grade II was the predominant scintigraphic grade in both limbs. Sex-wise grade distribution showed no statistically significant difference (LLL p=0.706; RLL p=0.240), though females demonstrated a higher prevalence of patent lymphatic channels in the RLL.

Conclusion: Clinical and lymphoscintigraphic staging showed only slight-to-fair agreement. Scintigraphy frequently downstaged higher clinical grades, underscoring its role as an objective adjunct in lymphedema evaluation.

Bangladesh J Medicine 2026; Vol. 37, No. 2(1): pp. 212