Relation Between Early Disturbance of lymphatic transport Visualized With Lymphofluoroscopy and Other Clinical Assessment Methods in Patients With Breast Cancer

Thomis, Sarah; Devoogdt, Nele; Vrieze, Tessa De; Bechter-Hugl, Beate; Heroes, An-Kathleen; Fourneau, Inge

doi:10.1016/j.clbc.2021.06.015

Cited by 5 publications

(15 citation statements)

References 36 publications

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“… 61 , 62 , 67 , 71 – 82 The MDACC scale focuses on the visualization of patent lymphatic vessels in combination with the presence of DBF. In contrast, the DBS focuses on the proximal to distal extension of different DBF patterns 61 , 71 , 75 , 78 , 81 , 82 (in order of severity: normal, splash, stardust and diffuse) [see Fig. 4 ].…”

Section: Resultsmentioning

confidence: 99%

“…Detection of early abnormal flow is indicative of subclinical lymphedema and is a key point for early intervention. 75 , 81 Advanced DBF patterns have been related to longer lymphedema duration, higher age, and longer time until lymphedema diagnosis, suggesting that early detection is of imminent importance. 67 Abnormal patterns can even be detected before clinical symptoms are present.…”

Section: Resultsmentioning

confidence: 99%

“… 67 Abnormal patterns can even be detected before clinical symptoms are present. 62 , 76 , 81 One study reported increased flow in early-stage patients compared with higher-stage and control subjects, which might be useful for effective drainage after LVB surgery. 85 …”

Section: Resultsmentioning

confidence: 99%

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Imaging of the Lymphatic Vessels for Surgical Planning: A Systematic Review

et al. 2022

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Background Secondary lymphedema is a common complication after surgical or radiotherapeutic cancer treatment. (Micro) surgical intervention such as lymphovenous bypass and vascularized lymph node transfer is a possible solution in patients who are refractory to conventional treatment. Adequate imaging is needed to identify functional lymphatic vessels and nearby veins for surgical planning. Methods A systematic literature search of the Embase, MEDLINE ALL via Ovid, Web of Science Core Collection and Cochrane CENTRAL Register of Trials databases was conducted in February 2022. Studies reporting on lymphatic vessel detection in healthy subjects or secondary lymphedema of the limbs or head and neck were analyzed. Results Overall, 129 lymphatic vessel imaging studies were included, and six imaging modalities were identified. The aim of the studies was diagnosis, severity staging, and/or surgical planning. Conclusion Due to its utility in surgical planning, near-infrared fluorescence lymphangiography (NIRF-L) has gained prominence in recent years relative to lymphoscintigraphy, the current gold standard for diagnosis and severity staging. Magnetic resonance lymphography (MRL) gives three-dimensional detailed information on the location of both lymphatic vessels and veins and the extent of fat hypertrophy; however, MRL is less practical for routine presurgical implementation due to its limited availability and high cost. High frequency ultrasound imaging can provide high resolution imaging of lymphatic vessels but is highly operator-dependent and accurate identification of lymphatic vessels is difficult. Finally, photoacoustic imaging (PAI) is a novel technique for visualization of functional lymphatic vessels and veins. More evidence is needed to evaluate the utility of PAI in surgical planning.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Imaging of the Lymphatic Vessels for Surgical Planning: A Systematic Review

et al. 2022

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“…Another possible reason is that this early disturbance is a way to reroute the lymphatic flow, not necessarily resulting in clinical BCRL but merely in subclinical BCRL. Subclinical lymphedema is difficult to assess with other clinical measurements tool according to our previous study [ 25 ] and the study by Jørgensen [ 26 ]. Some patients had disturbances visualized by lymphofluoroscopy, but no volume differences were present.…”

Section: Discussionmentioning

confidence: 99%

Early Disturbance of Lymphatic Transport as a Risk Factor for the Development of Breast-Cancer-Related Lymphedema

Thomis

Devoogdt

Bechter-Hugl

et al. 2023

Cancers

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Introduction: Breast-cancer-related lymphedema (BCRL) is a frequently occurring and debilitating condition. When lymphedema is diagnosed late, treatment can be expected to be less effective. Lymphofluoroscopy can provide details about the superficial lymphatic architecture and can detect an early disturbance of lymphatic transport (i.e., dermal backflow) before the lymphedema is clinically visible. The main objective of this study is to investigate whether this early disturbance of lymphatic transport visualized by lymphofluoroscopy is a risk factor for the development of BCRL. Methodology: All patients scheduled for unilateral breast cancer surgery with axillary lymph node dissection or sentinel node biopsy were considered. Patients were assessed at baseline and 1, 3, 6, 9, 12, 18, 24 and 36 months postoperatively. During each visit, a clinical assessment was performed to determine the volume difference between both arms and hands (through circumference measurements and water displacement). Clinical BCRL was defined as a ≥5% increase in relative arm volume difference compared to the baseline value. Variables related to (1) the disturbance of lymphatic transport (through lymphofluoroscopy), (2) the demographics and general health of the patient and (3) the breast cancer and treatment of the patient were collected. Results: We included data of 118 patients in the present study. Thirty-eight patients (39.8%) developed BCRL. Early disturbance of lymphatic transport was identified as a risk factor for the development of clinical BCRL (HR 2.808). Breast-cancer- and treatment-related variables such as axillary lymph node dissection (ALND) (HR 15.127), tumor stage (HR 1.745), mastectomy (HR 0.186), number of positive lymph nodes (HR 1.121), number of removed lymph nodes (HR 1.055), radiotherapy of the axilla (HR 2.715), adjuvant taxanes (HR 3.220) and postsurgical complications (HR 2.590) were identified as significant risk factors for the development of BCRL. In the multivariate analysis, age and ALND were withheld as independent risk factors for the development of BCRL. Conclusion: Lymphofluoroscopy can identify an early disturbance of lymphatic transport after breast cancer treatment. Patients with an early disturbance of lymphatic transport are considered to be a high-risk group for the development of BCRL. This study also confirms that age and ALND are predictors for the development of BCRL. Therefore, a surveillance program of these patients with lymphofluoroscopy could be useful to identify lymphedema in subclinical stages.

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“…• Implementation barriers are seen as surmountable by staff when they hold positive beliefs about the innovation and its impact. early lymphoedema detection (Thomis et al, 2022). In addition to evidence for its diagnostic benefits, there is growing support for the potential of ICG lymphography to transform therapy planning for people with lymphoedema.…”

Section: • the Consolidated Framework For Implementationmentioning

confidence: 99%

Navigating the application of new innovations: Establishing an indocyanine green lymphography clinic in Australia

Trevethan

Bennett

Doig

et al. 2022

Health Social Care Comm

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Translation of evidence into practice in healthcare is challenging, particularly with new innovations. Indocyanine Green (ICG) lymphography is a novel innovation where the superficial lymphatics are imaged to provide information about lymphoedema diagnosis and to guide individualised therapy for a person's long‐term chronic management of lymphoedema, supporting care across the continuum to the community setting. Despite the unique information ICG lymphography provides, the technology itself is complex and highly specialised and currently has limited adoption in clinical practice. This paper sought to determine the barriers and enablers to establishing an ICG lymphography clinic within an outpatient lymphoedema service by exploring staff perceptions and experiences. An interpretive descriptive design was used with semi‐structured interviews of key staff participants from a quaternary public hospital six months after ICG lymphography clinic establishment. An interview guide was developed, underpinned by the Consolidated Framework for Implementation Research (CFIR), to guide the inquiry. Interview data were transcribed, inductively coded and analysed to identify themes. All eligible management, clinical and ancillary staff were included (N = 8). Four key themes were identified from the data as essential to implementation success. These were support is critical for implementation; beliefs about the technology; practicalities are achievable; and sustainability for ongoing success. Themes were found to be interrelated and centred around support from staff and the organisation as a critical process facilitator. The study demonstrated an ICG lymphography clinic can be successfully established as part of an outpatient lymphoedema service. Key enablers related to positive staff attitudes and beliefs about ICG lymphography and its application. Future implementation sites may consider that although the complexity of this innovation creates process challenges, the use of an implementation framework can assist in identifying determinants of success for effective implementation to practice.

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Relation Between Early Disturbance of lymphatic transport Visualized With Lymphofluoroscopy and Other Clinical Assessment Methods in Patients With Breast Cancer

Cited by 5 publications

References 36 publications

Imaging of the Lymphatic Vessels for Surgical Planning: A Systematic Review

Imaging of the Lymphatic Vessels for Surgical Planning: A Systematic Review

Early Disturbance of Lymphatic Transport as a Risk Factor for the Development of Breast-Cancer-Related Lymphedema

Navigating the application of new innovations: Establishing an indocyanine green lymphography clinic in Australia

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