{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T03:16:23Z","timestamp":1785813383169,"version":"3.56.0"},"reference-count":16,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2024,7,30]],"date-time":"2024-07-30T00:00:00Z","timestamp":1722297600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Australasian Lymphology Association"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>The pitting qualities of lymphoedema tissue change with disease progression. However, little is known about the underlying tissue response to the pitting test or the tissue characteristics that enhance or resist indentation. The pitting test is currently unstandardised, and the influence of test technique on pitting outcomes is unknown. Understanding how tissue reacts to applied pressure will build evidence for the standardisation of the pitting test. Ninety pitting test sites from fifteen women with unilateral breast cancer-related lymphoedema were evaluated using high-frequency ultrasound (HFUS), bioelectrical impedance spectroscopy (BIS), and limb volume measures. Three sites on each lymphoedema and non-lymphoedema arm were subject to a 60-s (s) staged pitting test, with changes in tissue features captured with ultrasound imaging before, throughout, and after the pitting test. Pitting qualities of tissues varied greatly, with lymphoedema sites pitting more frequently (p &lt; 0.001) with greater depth (p &lt; 0.001) and requiring a longer recovery time (p = 0.002) than contralateral unaffected tissue. Pitting is not solely attributable to oedema volume. Non-structural and structural characteristics of dermal and subcutaneous layers also influence tissue responses to sustained pressure. To enhance the validity and reliability of pitting assessment, a 60 s staged pitting test with an observation of tissue recovery is recommended for lymphoedema presentations.<\/jats:p>","DOI":"10.3390\/diagnostics14151645","type":"journal-article","created":{"date-parts":[[2024,7,30]],"date-time":"2024-07-30T17:08:34Z","timestamp":1722359314000},"page":"1645","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Pitting Is Not Only a Measure of Oedema Presence: Using High-Frequency Ultrasound to Guide Pitting Test Standardisation for Assessment of Lymphoedema"],"prefix":"10.3390","volume":"14","author":[{"given":"Jennifer","family":"Sanderson","sequence":"first","affiliation":[{"name":"Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD 4215, Australia"},{"name":"School of Health Sciences and Social Work, Griffith University, Brisbane, QLD 4111, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neil","family":"Tuttle","sequence":"additional","affiliation":[{"name":"School of Health Sciences and Social Work, Griffith University, Brisbane, QLD 4111, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robyn","family":"Box","sequence":"additional","affiliation":[{"name":"QLD Lymphoedema and Breast Oncology Physiotherapy, Brisbane, QLD 4051, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hildegard","family":"Reul-Hirche","sequence":"additional","affiliation":[{"name":"School of Health Sciences and Social Work, Griffith University, Brisbane, QLD 4111, Australia"},{"name":"Royal Brisbane and Women\u2019s Hospital, Brisbane, QLD 4029, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4820-1090","authenticated-orcid":false,"given":"E-Liisa","family":"Laakso","sequence":"additional","affiliation":[{"name":"Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD 4215, Australia"},{"name":"Mater Research Institute, University of Queensland, South Brisbane, QLD 4101, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,7,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1016\/j.jvsv.2019.12.075","article-title":"The 2020 update of the CEAP classification system and reporting standards","volume":"8","author":"Lurie","year":"2020","journal-title":"J. Vasc. Surg. Venous Lymphat. Disord."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"International Society of Lymphology (2020). The diagnosis and treatment of peripheral lymphoedema: 2020 consensus document of the International Society of Lymphology. Lymphology, 53, 3\u201319.","DOI":"10.2458\/lymph.4649"},{"key":"ref_3","first-page":"175","article-title":"The pitting test: An investigation into an unstandardized assessment of lymphoedema","volume":"48","author":"Sanderson","year":"2015","journal-title":"Lymphology"},{"key":"ref_4","unstructured":"Lymphoedema Framework (2006). Lymphoedema Framework. Best Practice for the Management of Lymphoedema [International Consensus], MEP Ltd."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1586\/17469872.2.6.741","article-title":"A guide to lymphedema","volume":"2","author":"Gordon","year":"2007","journal-title":"Expert Rev. 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Leprol."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Sanderson, J., Tuttle, N., and Laakso, L. (2022). Acoustic Radiation Force Impulse Elastography Assessment of Lymphoedema Tissue: An Insight into Tissue Stiffness. 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