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DOI: 10.1055/s-0035-1564608
Indocyanine Green Lymphography Findings in Limb Lymphedema
Publication History
10 August 2015
12 August 2015
Publication Date:
30 September 2015 (online)
![](https://www.thieme-connect.de/media/jrm/201601/lookinside/thumbnails/10-1055-s-0035-1564608_150213-1.jpg)
Abstract
Background and Methods Indocyanine green (ICG) lymphography is one of several methods of lymphography to detect lymphatic channels and evaluate patients clinically with limb lymphedema. ICG imaging is made possible by the use of a near-infrared camera device. The fluorescence images were digitalized for real-time display.
Results ICG lymphography findings are largely classifiable into two patterns: normal linear pattern and abnormal dermal backflow (DB) pattern. ICG lymphography pattern changes from the normal linear pattern to abnormal DB patterns in obstructive peripheral lymphedema; with progression of lymphedema, DB patterns change from splash pattern, to stardust pattern, and finally to diffuse pattern. We classify ICG lymphography progression into 0 to V stages for the upper extremity, the lower extremity and into 0 to IV stages for the genital area.
Conclusion In DB stage II, most patients are symptomatic; thus, aggressive treatments, such as lymphaticovenular anastomosis, are indicated. In DB stages III to V, lymphaticovenular anastomosis is recommended because most patients are refractory to conservative therapies.
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Reference
- 1 Henze E, Schelbert HR, Collins JD, Najafi A, Barrio JR, Bennett LR. Lymphoscintigraphy with Tc-99m-labeled dextran. J Nucl Med 1982; 23 (10) 923-929
- 2 Szuba A, Shin WS, Strauss HW, Rockson S. The third circulation: radionuclide lymphoscintigraphy in the evaluation of lymphedema. J Nucl Med 2003; 44 (1) 43-57
- 3 Tomczak H, Nyka W, Lass P. Lymphoedema: lymphoscintigraphy versus other diagnostic techniques—a clinician's point of view. Nucl Med Rev Cent East Eur 2005; 8 (1) 37-43
- 4 Case TC, Witte CL, Witte MH, Unger EC, Williams WH. Magnetic resonance imaging in human lymphedema: comparison with lymphangioscintigraphy. Magn Reson Imaging 1992; 10 (4) 549-558
- 5 Gamba JL, Silverman PM, Ling D, Dunnick NR, Korobkin M. Primary lower extremity lymphedema: CT diagnosis. Radiology 1983; 149 (1) 218
- 6 Doldi SB, Lattuada E, Zappa MA, Pieri G, Favara A, Micheletto G. Ultrasonography of extremity lymphedema. Lymphology 1992; 25 (3) 129-133
- 7 Ogata F, Azuma R, Kikuchi M, Koshima I, Morimoto Y. Novel lymphography using indocyanine green dye for near-infrared fluorescence labeling. Ann Plast Surg 2007; 58 (6) 652-655
- 8 Ogata F, Narushima M, Mihara M, Azuma R, Morimoto Y, Koshima I. Intraoperative lymphography using indocyanine green dye for near-infrared fluorescence labeling in lymphedema. Ann Plast Surg 2007; 59 (2) 180-184
- 9 Kitai T, Inomoto T, Miwa M, Shikayama T. Fluorescence navigation with indocyanine green for detecting sentinel lymph nodes in breast cancer. Breast Cancer 2005; 12 (3) 211-215
- 10 Detter C, Russ D, Iffland A , et al. Near-infrared fluorescence coronary angiography: a new noninvasive technology for intraoperative graft patency control. Heart Surg Forum 2002; 5 (4) 364-369
- 11 Holm C, Mayr M, Höfter E, Ninkovic M. Perfusion zones of the DIEP flap revisited: a clinical study. Plast Reconstr Surg 2006; 117 (1) 37-43
- 12 Yamaguchi S, De Lorenzi F, Petit JY , et al. The “perfusion map” of the unipedicled TRAM flap to reduce postoperative partial necrosis. Ann Plast Surg 2004; 53 (3) 205-209
- 13 Still J, Law E, Dawson J, Bracci S, Island T, Holtz J. Evaluation of the circulation of reconstructive flaps using laser-induced fluorescence of indocyanine green. Ann Plast Surg 1999; 42 (3) 266-274
- 14 Suami H, Taylor GI, Pan WR. The lymphatic territories of the upper limb: anatomical study and clinical implications. Plast Reconstr Surg 2007; 119 (6) 1813-1822
- 15 Yamamoto T, Iida T, Matsuda N , et al. Indocyanine green (ICG)-enhanced lymphography for evaluation of facial lymphoedema. J Plast Reconstr Aesthet Surg 2011; 64 (11) 1541-1544
- 16 Sty JR, Boedecker RA, Scanlon GT, Babbitt DP. Radionuclide “dermal backflow” in lymphatic obstruction. J Nucl Med 1979; 20 (8) 905-906
- 17 Campisi C, Boccardo F. Microsurgical techniques for lymphedema treatment: derivative lymphatic-venous microsurgery. World J Surg 2004; 28 (6) 609-613
- 18 Yamamoto T, Narushima M, Doi K , et al. Characteristic indocyanine green lymphography findings in lower extremity lymphedema: the generation of a novel lymphedema severity staging system using dermal backflow patterns. Plast Reconstr Surg 2011; 127 (5) 1979-1986
- 19 Unno N, Nishiyama M, Suzuki M , et al. Quantitative lymph imaging for assessment of lymph function using indocyanine green fluorescence lymphography. Eur J Vasc Endovasc Surg 2008; 36 (2) 230-236
- 20 Unno N, Inuzuka K, Suzuki M , et al. Preliminary experience with a novel fluorescence lymphography using indocyanine green in patients with secondary lymphedema. J Vasc Surg 2007; 45 (5) 1016-1021
- 21 Yamamoto T, Matsuda N, Doi K , et al. The earliest finding of indocyanine green lymphography in asymptomatic limbs of lower extremity lymphedema patients secondary to cancer treatment: the modified dermal backflow stage and concept of subclinical lymphedema. Plast Reconstr Surg 2011; 128 (4) 314e-321e
- 22 Yamamoto T, Yamamoto N, Doi K , et al. Indocyanine green-enhanced lymphography for upper extremity lymphedema: a novel severity staging system using dermal backflow patterns. Plast Reconstr Surg 2011; 128 (4) 941-947
- 23 Yamamoto T, Yamamoto N, Yoshimatsu H, Hayami S, Narushima M, Koshima I. Indocyanine green lymphography for evaluation of genital lymphedema in secondary lower extremity lymphedema patients. J Vasc Surg: Venous and Lym Dis 2013; 1 (4) 400-405
- 24 Homans J. Treatment of elephantiasis of the legs: A preliminary report. N Engl J Med 1936; 215: 1099-1104
- 25 Szuba A, Cooke JP, Yousuf S, Rockson SG. Decongestive lymphatic therapy for patients with cancer-related or primary lymphedema. Am J Med 2000; 109 (4) 296-300
- 26 Warren AG, Brorson H, Borud LJ, Slavin SA. Lymphedema: a comprehensive review. Ann Plast Surg 2007; 59 (4) 464-472
- 27 Kerchner K, Fleischer A, Yosipovitch G. Lower extremity lymphedema update: pathophysiology, diagnosis, and treatment guidelines. J Am Acad Dermatol 2008; 59 (2) 324-331
- 28 Brennan MJ, Miller LT. Overview of treatment options and review of the current role and use of compression garments, intermittent pumps, and exercise in the management of lymphedema. Cancer 1998; 83 (12, Suppl American): 2821-2827
- 29 Narushima M, Mihara M, Yamamoto Y, Iida T, Koshima I, Mundinger GS. The intravascular stenting method for treatment of extremity lymphedema with multiconfiguration lymphaticovenous anastomoses. Plast Reconstr Surg 2010; 125 (3) 935-943
- 30 Akita S, Mitsukawa N, Rikihisa N , et al. Early diagnosis and risk factors for lymphedema following lymph node dissection for gynecologic cancer. Plast Reconstr Surg 2013; 131 (2) 283-290