Comparison of lymphoscintigraphy and indocyanine green lymphography for the diagnosis of extremity lymphoedema
Section snippets
Patients and methods
A retrospective study was conducted in 134 consecutive patients who underwent both lymphoscintigraphy and indocyanine green lymphography to investigate extremity oedema at Chiba University Hospital between August 2010 and March 2012. The study protocol was approved by the institutional review board and written informed consent was obtained from all subjects. In all patients, both extremities, whether involved or uninvolved, were injected and imaged simultaneously. Patients were divided into a
Results
The patient population comprised 115 females and 19 males. The average patient age was 58.5 years, ranging from 9 to 82 years. Unilateral oedema was present in 71 patients and 63 had bilateral oedema. Secondary oedema after lymph node dissection was present in 95 patients: these patients made up the secondary group. The other 39 patients had idiopathic extremity oedema, suspected of being primary lymphoedema after other causes were excluded: these patients made up the idiopathic group.
Of the 95
Discussion
In both the secondary group and the idiopathic study group, the sensitivity and NPV of indocyanine green lymphography were very high when their results were compared with those of the gold standard, lymphoscintigraphy. The specificity and the PPV, however, were not very high, as a number of limbs were positive by indocyanine green lymphography but negative by lymphoscintigraphy.
With respect to secondary lymphoedema, Mihara et al. reported that, because histological changes could already be
Conclusion
Indocyanine green lymphography is recommended to evaluate the suitability of patients with secondary lymphoedema for lymphaticovenular anastomosis. The diagnostic ability of the test and its capability to evaluate the severity of oedema are similar to lymphoscintigraphy while the invasiveness and examination costs are less.
To detect primary lymphoedema in patients with idiopathic extremity oedema, we recommend that indocyanine green lymphography be conducted first as a screening examination.
Ethical consent
This study was carried out in Chiba University Hospital (Chiba, Japan) with approval of the institutional review board and permission from the ethics committee. Written permission for publication of photographs was obtained from all patients before they were included in this study.
Conflict of interest/funding
None.
References (26)
- et al.
Lymphoscintigraphy to confirm the clinical diagnosis of lymphedema
J Vasc Surg
(1989) - et al.
Lymphoscintigraphy for differential diagnosis of peripheral edema: diagnostic yield of different scintigraphic patterns
Rev Esp Med Nucl Imagen Mol
(2012) - et al.
Preliminary experience with a novel fluorescence lymphography using indocyanine green in patients with secondary lymphedema
J Vasc Surg
(2007) Assessment of abnormal lymph drainage for the diagnosis of lymphedema by isotopic lymphangiography and by indirect lymphography
Clin Dermatol
(1995)Causes and consequences of lymphatic disease
Ann N Y Acad Sci
(2010)The lymphatic vasculature in disease
Nat Med
(2011)- et al.
Ultrastructural observations of lymphatic vessels in lymphedema in human extremities
Plast Reconstr Surg
(1996) - et al.
Characteristic indocyanine green lymphography findings in lower extremity lymphedema: the generation of a novel lymphedema severity staging system using dermal backflow patterns
Plast Reconstr Surg
(2011) - et al.
Quantitative radionuclide lymphoscintigraphy predicts outcome of manual lymphatic therapy in breast cancer-related lymphedema of the upper extremity
Nucl Med Commun
(2002) - et al.
Lymphology. Relationship between lymphoscintigraphy and clinical findings in lower limb lymphedema (LO): toward a comprehensive staging
Lymphology
(2008)
Types of lymphoscintigraphy and indications for lymphaticovenous anastomosis
Microsurgery
Classification of lymphoscintigraphy and relevance to surgical indication for lymphaticovenous anastomosis in upper limb lymphedema
Lymphology
Indocyanine green-enhanced lymphography for upper extremity lymphedema: a novel severity staging system using dermal backflow patterns
Plast Reconstr Surg
Cited by (93)
Lymphoscintigraphy is frequently recommended but seldom used in a “real world setting”
2024, Journal of Vascular Surgery: Venous and Lymphatic DisordersIdentification of lymph vessels using an indocyanine green camera-integrated operative microscope for lymphovenous anastomosis in the treatment of secondary lymphedema
2023, Journal of Vascular Surgery: Venous and Lymphatic DisordersA phase III, multicenter, single-arm study to assess the utility of indocyanine green fluorescent lymphography in the treatment of secondary lymphedema
2022, Journal of Vascular Surgery: Venous and Lymphatic DisordersIn Vivo Quantitative Ultrasound on Dermis and Hypodermis for Classifying Lymphedema Severity in Humans
2022, Ultrasound in Medicine and BiologyIndocyanine green lymphography as novel tool to assess lymphatics in patients with lipedema
2022, Microvascular ResearchCitation Excerpt :For the purpose of this study, to compare patients, measured distances were normalized by limb length and expressed as the distance (cm) from the ground to the iliac crest. ICG lymphography anatomical patterns were classified as linear or non-linear, according to previous studies (Akita et al., 2013; Yamamoto et al., 2015). Briefly, linear pattern was defined as the presence of superficial collectors visualized as a linear pattern from the injection site to the superficial inguinal lymph nodes.
Lower limb lymphedema staging based on magnetic resonance lymphangiography
2022, Journal of Vascular Surgery: Venous and Lymphatic Disorders