Comparison of lymphoscintigraphy and indocyanine green lymphography for the diagnosis of extremity lymphoedema.

Comparison of lymphoscintigraphy and indocyanine green lymphography for the diagnosis of extremity lymphedema.

Mar 2013

Akita S, Mitsukawa N, Kazama T, Kuriyama M, Kubota Y, Omori N, Koizumi T, Kosaka K, Uno T, Satoh K.

Source

Department of Plastic, Reconstructive and Aesthetic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan. Electronic address: sakita-chiba@umin.ac.jp.

Abstract

BACKGROUND:

Lymphoscintigraphy is the gold-standard examination for extremity lymphoedema. Indocyanine green lymphography may be useful for diagnosis as well. We compared the utility of these two examination methods for patients with suspected extremity lymphoedema and for those in whom surgical treatment of lymphoedema was under consideration.

METHODS:

A total of 169 extremities with lymphoedema secondary to lymph node dissection and 65 extremities with idiopathic oedema (suspected primary lymphoedema) were evaluated; the utility of indocyanine green lymphography for diagnosis was compared with lymphoscintigraphy. Regression analysis between lymphoscintigraphy type and indocyanine green lymphography stage was conducted in the secondary lymphoedema group.

RESULTS:

In secondary oedema, the sensitivity of indocyanine green lymphography, compared with lymphoscintigraphy, was 0.972, the specificity was 0.548 and the accuracy was 0.816. When patients with lymphoscintigraphy type I and indocyanine green lymphography stage I were regarded as negative, the sensitivity of the indocyanine green lymphography was 0.978, the specificity was 0.925 and the accuracy was 0.953. There was a significant positive correlation between the lymphoscintigraphy type and the indocyanine green lymphography stage. In idiopathic oedema, the sensitivity of indocyanine green lymphography was 0.974, the specificity was 0.778 and the accuracy was 0.892.

CONCLUSION:

In secondary lymphoedema, earlier and less severe dysfunction could be detected by indocyanine green lymphography. Indocyanine green lymphography is recommended to determine patients' suitability for lymphaticovenular anastomosis, because the diagnostic ability of the test and its evaluation capability for disease severity is similar to lymphoscintigraphy but with less invasiveness and a lower cost. To detect primary lymphoedema, indocyanine green lymphography should be used first as a screening examination; when the results are positive, lymphoscintigraphy is useful to obtain further information.

PubMed

The Impact of Living With Severe Lower Extremity Lymphedema: A Utility Outcomes Score Assessment.

March 2013

Sinno H, Izadpanah A, Tahiri Y, Christodoulou G, Thibaudeau S, Williams HB, Slavin SA, Lin SJ.

Source

From the *Division of Plastic and Reconstructive Surgery, Montreal General Hospital, †Faculty of Medicine, McGill University, Montreal, Quebec, Canada; and ‡Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.

Abstract

BACKGROUND: Debilitating lower extremity lymphedema can be either congenital or acquired. Utility scores are an objective measure used in medicine to quantify degrees of impact on an individual's life. Using standardized utility outcome measures, we aimed to quantify the health state of living with severe unilateral lower extremity lymphedema.

METHODS:

A utility outcomes assessment using visual analog scale, time trade-off, and standard gamble was used for lower extremity lymphedema, monocular blindness, and binocular blindness from a sample of the general population and medical students. Average utility scores were compared using a paired t test. Linear regression was performed using age, race, and education as independent predictors.

RESULTS:  A total of 144 prospective participants were included. All measures [visual analog scale, time trade-off, and standard gamble; expressed as mean (SD)] for unilateral lower extremity lymphedema± 0.22, and 0.76 ± respectively) were significantly different from the corresponding scores for monocular blindness (0.64 ± 0.18, 0.84 ± 0.16, and 0.83 ± 0.17, respectively) and binocular blindness and 0.62 ± 0.26, respectively).

CONCLUSIONS:

We found that a sample of the general population and medical students, if faced with severe lymphedema, is willing to theoretically trade 8.64 life-years and undergo a procedure with a 24% risk of mortality to restore limb appearance and function to normal. These findings provide a frame of reference regarding the meaning of a diagnosis of severe lower extremity lymphedema to a patient and will allow objective comparison with other health states.

PubMed