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

Lymphoscintigraphy in unilateral lower limb and scrotal lymphedema caused by filariasis.

Dec 2012

Subramanyam P, Palaniswamy SS.

Source

Department of Nuclear Medicine and PETCT, Amrita Institute of Medical Sciences, Cochin, Kerala, India.

Abstract

Lymphedema is the edema that results from chronic lymphatic insufficiency. Lymphatic filariasis is caused by the filarial nematodes Wuchereria bancrofti, Brugia malayi, and Brugia timori. Lymphatic filariasis is common in tropical and subtropical regions. Early diagnosis and prompt therapy can be implemented using lymphoscintigraphy. Our patient is a 15-year-old boy presenting with a 3-month history of hydrocele. The patient was referred to us to rule out any lower limb lymphatic obstruction as the patient is from an endemic area. Tc Sulfur colloid (filtered) lymphoscintigraphy showed abnormal tracer collection in the scrotum and penis. There is associated dermal backflow or stasis in the left thigh region extending just above the knee, suggesting partial obstruction of left inguinal lymphatic channels.

AJTMH

See also:

Leg Lymphedema

Lymphoscintigraphy

Would complex decongestive therapy reveal long term effect and lymphoscintigraphy predict the outcome of lower-limb lymphedema related to gynecologic cancer treatment?

Sept 2012

Kim YB, Hwang JH, Kim TW, Chang HJ, Lee SG.

Source

Department of Rehabilitation Medicine, Pusan National University Yangsan Hospital, Pusan, 626-770, Republic of Korea.

Abstract

OBJECTIVE:

The aims of this study were to investigate the long-term effect of complex decongestive therapy (CDT) onlymphedema volume reduction, especially considering the proximal and distal parts of the leg, and to evaluate the utility of pre-therapy lymphoscintigraphy in predicting the response to CDT in patients with lower-limb lymphedema after surgery for gynecologic cancer.

METHODS:

Medical records of 158 patients with secondary lymphedema of unilateral leg after surgery for gynecological cancer were reviewed retrospectively. They were treated with two weeks of CDT along with self-administered home therapy and were followed up for 24months. Whole, proximal and distal leg volume was serially measured by using an optoelectric volumeter prior to and immediately after therapy, and follow-up visits at months 3, 6, 12 and 24. Lymphoscintigraphy was performed prior to therapy.

RESULTS:

The percent volume reduction was 22.1% in the whole leg, 30.9% in the distal leg and 18.4% in the proximal legimmediately after CDT. The volume reduction was maintained for 24months, but the distal leg was significantly well maintained better than the proximal leg. Extremity radioisotope uptake ratio (EUR) among lymphoscintigraphic findings could predict the improvement of lymphedema volume in the distal, proximal and whole leg.

CONCLUSION:This study suggests that the long-term edema reducing effects of CDT are better maintained in the distalleg than in the proximal part, and initial lymphoscintigraphic quantitative finding may usefully predict the short and long-term response to CDT.

SciVerse

The contralateral rectus abdominis musculocutaneous flap for treatment of lower extremity lymphedema.

One of my desires is to bring all types of information relating to leg lymphedema to the readers. I must admit,

I really had to grit my teeth on this article.

The authors speak of a long term follow up time frame as 31 months. This is hardly adequate when you are

investigating long term possible complications. Indeed, I had the Thompson'sprocedure done in three surgeries

from 1971 through 1973. The first 31 months did see a reduction in leg size and a slight reduction in cellulitis

episodes.

However, long term should mean a 10, 20 or even longer time frame. After twenty years, I experienced horrific

complications from the surgery, not the least of all was mixed b-cell lymphoma.

Also, if the research proves to be correct about the possibilities that secondary lymphedema patients

are people who are already "at risk" for lymphedema, then the introduction of yet another area of surgery (abdomen)

could prove to be disasterous as well. Any type of surgery that would injury, damage or adversly effect the lymph

system in the abdomen can (as has been well documented) cause abdominal lymphedema.

Please do not consider the posting of this article as an endorsement of any kind and I would further discourage

lymphedema patients from having it.

Pat

The contralateral rectus abdominis musculocutaneous flap for treatment of lower extremity lymphedema.

Ann Plast Surg. 2009 Jan

Parrett BM, Sepic J., Pribaz JJ

Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115

Lymphedema is common after inguinal lymphadenectomy or resection of groin tumors. Animal studies have shown success using the rectus abdominis musculocutaneous (RAM) flap as a treatment for lymphedema. Four patients with acquired lower extremity lymphedema were treated with a contralateral RAM flap with an inferior cutaneous pedicle left intact to facilitate lymphatic drainage into the unaffected groin. One patient also had lymphaticovenous anastomoses performed during flap transfer. All flaps survived with no postoperative complications. With a mean follow-up of 31 months, the mean reduction in limb circumference from the preoperative excess was 81% at the thigh, 70% at the calf, and 71% at the ankle. None of the patients with recurrent cellulitis had further incidences of groin cellulitis. Two patients required future flap debulking. Lymphoscintigraphy was performed in 1 patient and demonstrated reconstitution of lymphatic flow from the affected leg through the flap. According to this preliminary study, transfer of a contralateral RAM flap to the groin of a lymphedematous leg improves lymphedema and decreases the incidence of cellulitis.

PubMed

For further information on surgeries used for the treatment of lymphedema, please see:

Surgery for Lymphedema

and

The Thompson's Procedure

Lymphoscintigraphy in angiomyomatous hamartomas and primary lower limb lymphedema

Lymphoscintigraphy in angiomyomatous hamartomas and primary lower limb lymphedema

Clin Nucl Med. 2009 Jul

Bourgeois P, Dargent JL, Larsimont D, Munck D, Sales F, Boels M, De Valck C.

Department of Nuclear Medicine, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium. pierre.bourgeois@bordet.be

PURPOSE: Angiomyomatous hamartoma (AH) of the lymph node is a rare vascular benign disease of unknown etiology with a predisposition for the lymph nodes of the inguinal area. Only 18 cases have been described up to now in the literature and the disorder was reported to be associated with lymphedema or swelling of the ipsilateral limb in 4 patients. However, scintigraphic investigation of the lymphatic system in these patients was reported in only 2 cases.

MATERIAL AND METHODS: Five patients where the biopsy of inguinal nodes for suspected lymphadenitis led to the diagnosis of angiomyomatous hamartoma were investigated using lymphoscintigraphic techniques (1 girl aged 15; 1 boy aged 9 at the time of first biopsy and 11 at the time of the second one; and 3 men aged 30, 50, and 57). The operated limb was lymphedematous in 3 and 1 developed lymphedema after biopsy. The fifth patient developed a contralateral lymphedema after his second nodal biopsy.

RESULTS: In all cases, lymphoscintigraphic investigation of the limbs showed extensive lymph node abnormalities on the operated side and in 4 cases on the opposite side.

CONCLUSIONS: These observations support not only the hypothesis that lymphatic disturbance was involved in the pathogenesis of these tumors but also the proposition that lymphoscintigraphy should be performed in cases of inguinal lymphadenitis of unknown origin to diagnose the underlying situation of latent lymphedema.

Clinical Nuclear Medicine