Correlation of ICG lymphography and lymphoscintigraphy severity stage in secondary upper limb lymphedema

Yoon, Jin A; Shin, Myung Jun; Shin, Yong Beom; Kim, Keunyoung; Park, Heeseung; Kang, Taewoo; Kong, In Joo; Kim, Hyo-Jeong; Park, Min Suk; Kim, Joo Hyoung

doi:10.1016/j.bjps.2020.08.055

Cited by 26 publications

(19 citation statements)

References 15 publications

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“…Using the ADB staging system, scoring was performed based on the posterior aspect rather than the anterior aspect of the upper limb because the posterior aspect depends on gravity more than the anterior aspect, thus allowing ICG to spread more widely and making the extended area of the dermal backflow more visible. Additionally, in our previous study, the lymphoscintigraphy severity stage [22] was more positively correlated with the ADB stage of the posterior aspect than that of the anterior aspect [23]. Therefore, scoring was performed based on the posterior aspect rather than the anterior aspect in this study to obtain a more accurate evaluation of dermal backflow.…”

Section: Discussionmentioning

confidence: 97%

The relationship between lymphedema severity and awareness of lymphedema surgery

et al. 2021

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Background During the early stages of lymphedema, active physiologic surgical treatment can be applied. However, lymphedema patients often have limited knowledge and misconceptions regarding lymphedema and surgical treatment. We analyzed the correlations between lymphedema severity and surgical technique according to patients’ awareness of surgical treatment for secondary upper extremity lymphedema (UEL).Methods Patients with UEL diagnosed between December 2017 and December 2019 were retrospectively evaluated. At the time of their presentation to our hospital for the treatment of lymphedema, they were administered a questionnaire about lymphedema and lymphedema surgery. Based on the results, patients were classified as being aware or unaware of surgical treatment. Lymphedema severity was classified according to the arm dermal backflow (ADB) stage and the MD Anderson Cancer Center (MDACC) stage based on indocyanine green lymphography conducted at presentation. Surgical techniques were compared between the two groups.Results Patients who were aware of surgical treatment had significantly lower initial ADB and MDACC stages (P<0.05) and more frequently underwent physiologic procedures than excisional procedures (P=0.003).Conclusions If patients are actively educated regarding surgical treatment of lymphedema, physiologic procedures may be performed during the early stages of UEL.

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Section: Discussionmentioning

confidence: 97%

The relationship between lymphedema severity and awareness of lymphedema surgery

et al. 2021

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“…Lipectomy was performed for patients with modified MD Anderson Cancer Center (MDACC) stage 4 or higher, Arm Dermal Backflow (ADB) stage 4 or higher, and universal ICG stage 3 or higher. [14][15][16] The circumferences of both extremities were measured before surgery and 1, 3, 6, and 12 months after surgery. ICG dye was injected into the first and third webspaces at the time, the patient visited the outpatient clinic before surgery.…”

Section: Methodsmentioning

confidence: 99%

Outcomes of lipectomy in patients with advanced unilateral upper extremity lymphedema with regard to the difference in time required for indocyanine green to reach the axilla: A retrospective cohort study in a single center

Kim

Lee

et al. 2022

Medicine

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This study aimed to compare and analyze the prognosis after lipectomy with respect to the difference in time required for indocyanine green (ICG) to reach the axilla in patients with advanced unilateral upper extremity lymphedema. The study population was divided into 2 groups, according to the time required by ICG to reach the axilla after injection, that is, <1 hour (<1 hour; n = 9) and over 1 hour (>1 hour; n = 8). The patient’s arm volume was examined before surgery and up to 12 months after surgery. The volume difference between the 2 groups was compared using the excess volume ratio. Statistically significant differences were not observed before surgery ( P = .847) and 1 month ( P = .336), 3 months ( P = .630), and 6 months after surgery ( P = .124) between the excess volume ratio values of the < 1 hour and > 1 hour groups. A statistically significant difference was confirmed 12 months after surgery ( P = .034). The difference in the time when ICG reached the axilla in patients with lymphedema was associated with prognosis after lipectomy. The difference in time could possibly be used as a variable to classify the progress of lymphedema in the future.

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“…Despite the recent innovations, surgical debulking continues to be the mainstay of management in advanced class 3 lymphedema (with fibrosis and warty or ulcerous skin changes), filarial lymphedema and when microvascular facilities are unavailable. [3] Several modifications of the original Charles procedure of supra-fascial excisions and skin grafting have been described. Van der Walt et al applied negative pressure wound therapy on the wound bed to improve skin graft take.…”

Section: Surgical Debulking Of Lymphedemamentioning

confidence: 99%

“…[2] Lymphedema is divided into stages 0-5 using indo cyanine green (ICG) lymphography, based on the patency of lymphatic vessels, dermal backflow, and lymphatic vessel contractility. [3] The International Society of Lymphology (ISL) staging charts the progress and reversibility of lymphedematous changes from subclinical disease in stage 0 to irreversible lymphostatic elephantiasis in stage 3 [Figure 1]. [3,4] With the progression of the disease, the microvascular networks that nourish the collecting lymphatic vessels are lost; the lymphatic vessel lumen is dilated with an increase in endolymphatic pressure in the ectasis type, whereas in contraction and the sclerosis types, an increase in smooth muscles and collagen fibers make the lymphatics more thickened and prominent.…”

Section: Introductionmentioning

confidence: 99%

“…[3] The International Society of Lymphology (ISL) staging charts the progress and reversibility of lymphedematous changes from subclinical disease in stage 0 to irreversible lymphostatic elephantiasis in stage 3 [Figure 1]. [3,4] With the progression of the disease, the microvascular networks that nourish the collecting lymphatic vessels are lost; the lymphatic vessel lumen is dilated with an increase in endolymphatic pressure in the ectasis type, whereas in contraction and the sclerosis types, an increase in smooth muscles and collagen fibers make the lymphatics more thickened and prominent. [5] Patients in early stages of disease will benefit from conservative multi-modality management and physiologic surgical procedures such as lymphovenous anastomosis (LVA) or vascularized lymph node transfers (VLNT).…”

Section: Introductionmentioning

confidence: 99%

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Recent advances in management of lymphedema

Rajan¹,

Venkatramani

2021

JSSTD

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There has been a paradigm shift in the management of lymphedema with a better understanding of the functioning of lymphatics with the introduction of “lymphosome concept” and with the recent advances in super-microsurgical techniques. The most frequently used intraoperative imaging modality now is indo cyanine green lymphangiography. In endemic countries, any patient with lymphedema without prior history of trauma or, oncosurgical or radiotherapy interventions must undergo Alere filariasis test strip. Patients in early stages of disease can benefit from complex decongestive therapy and physiologic surgical procedures such as lymphovenous anastomosis or vascularized lymph node transfers. However, in advanced disease, excisions or debulking through radical reduction with preservation of perforators will be required. The localized adipose tissue deposits in lymphedema can be removed by liposuction. At present, there is still no cure for lymphedema, but emerging research in tissue engineering, lymphangiogenic growth factors, and immunomodulatory therapy may provide better management options for lymphedema in future.

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Correlation of ICG lymphography and lymphoscintigraphy severity stage in secondary upper limb lymphedema

Cited by 26 publications

References 15 publications

The relationship between lymphedema severity and awareness of lymphedema surgery

The relationship between lymphedema severity and awareness of lymphedema surgery

Outcomes of lipectomy in patients with advanced unilateral upper extremity lymphedema with regard to the difference in time required for indocyanine green to reach the axilla: A retrospective cohort study in a single center

Recent advances in management of lymphedema

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