Lymphoscintigraphy for Evaluation of Lymphedema Treatment: A Systematic Review

Abstract

Lymphoscintigraphy is a well-established radiologic examination to evaluate lymphatic function. We conducted a systematic review of the use of lymphoscintigraphy for evaluation of lymphedema treatment. We hypothesized that this radiologic examination could add relevant findings of treatment outcomes of lymphedema patients. We conducted a systematic review of articles in PubMed, without any time frame or language limitations, about the use of lymphoscintigraphy for the evaluation of lymphedema treatment. Articles were excluded if they investigated other uses of lymphoscintigraphy, such as diagnosis or prevention of lymphedema. Abstracts, presentations, reviews, and meta-analyses were also excluded. Of 101 potential articles found in the literature, 5 fulfilled our study eligibility criteria, and they were all case series. These articles included a total of 327 patients, most of whom had breast cancer-related lymphedema. Interventions included lymph node or vessel transfer (3 of 5 articles), complex decongestive therapy (1 of 5), and adipose-derived stem cell injection (1 of 5). The authors of these studies used lymphoscintigraphy to investigate the treatment functional outcomes, prognostic value, and complications. Lymphoscintigraphy detected lymphangiogenesis in transferred lymph nodes, and it was able to predict patient response to complex decongestive therapy. Studies that used lymphoscintigraphy to evaluate lymphedema treatment demonstrated its flexibility to provide various types of information. We hope this review will support future studies.

Primary Prevention of Cancer-Related Lymphedema Using Preventive Lymphatic Surgery: Systematic Review and Meta-analysis

“…Indeed, only 16.6% of the studies used reliable methods with an appropriate sensitivity and specificity like lymphoscintigraphy. 64 65 …”

Total groin defect reconstruction by lymphatic flow‐through (LyFT) pedicled deep inferior epigastric artery perforator (DIEP) flap resorting to its superficial veins for lymphovenous anastomosis (LVA): A case report

“…We routinely rely on it preoperatively to exclude underlying lymphedema and to map the lymphatic network of the whole leg. We also use it during the follow up to confirm the efficacy of the procedure checking that no lymphatic obstructions would form in the affected area (De Roo et al, 1995; Forte, Boczar, Huayllani, Lu, & Ciudad, 2019).…”

Combined pedicled superficial circumflex iliac artery perforator (SCIP) flap with lymphatic tissue preservation and lymphovenous anastomosis (LVA) for defect reconstruction and lymphedema–lymphocele prevention in thigh sarcoma surgery: Preliminary results

“…Another important radiologic examination for the management of lymphatic diseases is the lymphoscintigraphy. It has a proved efficacy in terms of lymphatic network evaluation from many points of view, being able to detect neo‐lymphangiogenesis in transferred lymph nodes and to predict patient response to complex decongestive therapy 26 . Moreover, it has been well established as a follow‐up procedure to evaluate the efficacy of LVA, especially in those cases that did not present an overt swelling decrease but could still have a functional improvement 27 …”

“…It has a proved efficacy in terms of lymphatic network evaluation from many points of view, being able to detect neo-lymphangiogenesis in transferred lymph nodes and to predict patient response to complex decongestive therapy. 26 Moreover, it has been well established as a follow-up procedure to evaluate the efficacy of LVA, especially in those cases that did not present an overt swelling decrease but could still have a functional improvement. 27 Considering the good outcomes obtained by means of these treatments (VLVT and LVA), we had the idea of combining both the procedures in order to emphasize their efficacy.…”