Use of fluorescence imaging during lymphatic surgery: A Delphi survey of experts worldwide

Dip, Fernando; Nistor, Alexandru; Amore, Miguel; Becker, C.; Belgrado, Jean-Paul; Bourgeois, Pierre; Chang, Edward I.; Koshima, Isao; Liberale, Gabriel; Masià, Jaume; Mortimer, Peter; Neligan, Peter C.; Batista, Bernardo Nogueira; Olszewski, Waldemar L.; Salvia, Sophia Alexia; Suami, Hiroo; Vankerckhove, Sophie; Yamamoto, Takumi; Menzo, Emanuele Lo; White, Kevin P.; Rosenthal, Raúl J.

doi:10.1016/j.surg.2022.08.026

Cited by 7 publications

(2 citation statements)

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“…Near infrared fluorescence imaging of the lymphatic system, also called lymphofluoroscopy, is an imaging technique that can be used to evaluate the superficial lymphatic architecture [8,9]. A tracer, indocyanine green (ICG), is injected intradermally into the patient's hand.…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, in patients with lymphoedema, three dysfunctional dermal backflow patterns can be distinguished [10]: (1) splash pattern, representing tortuous dermal dilated lymph capillaries; (2) stardust pattern, which demonstrates spotted fluorescent signals, representing the effusion of lymph fluid out of the lymph capillaries; and (3) diffuse pattern, by which the tracer is widely distributed without identifiable spots and lymph vessels [11]. Lymphofluoroscopy is safe, non-invasive, and has a low cost [9]. A disadvantage is that it only visualises superficial structures and tissue (maximal depth of 2 cm) [8].…”

Section: Introductionmentioning

confidence: 99%

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The Effectiveness of Fluoroscopy-Guided Manual Lymph Drainage as Part of Decongestive Lymphatic Therapy on the Superficial Lymphatic Architecture in Patients with Breast Cancer-Related Lymphoedema: A Randomised Controlled Trial

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Groef

et al. 2023

Cancers

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The objective of this trial was to investigate the effectiveness of fluoroscopy-guided manual lymph drainage (MLD), as part of decongestive lymphatic therapy (DLT), on the superficial lymphatic architecture in patients with chronic mild to moderate breast cancer-related lymphoedema (BCRL). This trial was a multicentre, double-blind, randomised controlled trial involving 194 participants with BCRL. Participants were randomised into (1) DLT with fluoroscopy-guided MLD (intervention group), (2) DLT with traditional MLD (control group), or (3) DLT with placebo MLD (placebo group). Superficial lymphatic architecture was evaluated as a secondary outcome, visualised by ICG lymphofluoroscopy at the baseline (B0), post-intensive (P), and post-maintenance phases (P6). Variables were (1) number of efferent superficial lymphatic vessels leaving the dermal backflow region, (2) total dermal backflow score, and (3) number of superficial lymph nodes. The traditional MLD group showed a significant decrease in the number of efferent superficial lymphatic vessels at P (p = 0.026), and of the total dermal backflow score at P6 (p = 0.042). The fluoroscopy-guided MLD and placebo group showed significant decreases in the total dermal backflow score at P (p < 0.001 and p = 0.044, respectively) and at P6 (p < 0.001 and p = 0.007, respectively); the placebo MLD group showed a significant decrease in the total number of lymph nodes at P (p = 0.008). However, there were no significant between-group differences for the changes in these variables. In conclusion, based on lymphatic architecture outcomes, the added value of MLD, in addition to the other parts of DLT, could not be demonstrated in patients with chronic mild to moderate BCRL.

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Section: Introductionmentioning

confidence: 99%