Takumi Yamamoto1, Nana Yamamoto2, Hidehiko Yoshimatsu2, Shinya Hayami2, Mitsunaga Narushima2, Isao Koshima2. 1. Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan. Electronic address: tyamamoto-tky@umin.ac.jp. 2. Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan.
Abstract
OBJECTIVE: Treatment of genital lymphedema (GL) is challenging, and early diagnosis and intervention is important to prevent progression of GL. However, early treatment of GL is difficult due to a lack of appropriate evaluation methods allowing early diagnosis. We sought to develop a novel pathophysiological evaluation method for early diagnosis of GL using indocyanine green (ICG) lymphography. METHODS: This was a retrospective observational study set in a teaching hospital. Patient characteristics and ICG lymphography findings of 68 lower limb lymphedema patients secondary to gynecologic cancer treatments were reviewed. The clinical data and dermal backflow (DB) stages based on ICG lymphography findings were analyzed to compare between the left and right region with and without symptomatic GL. RESULTS: Twenty-two of 136 lateralities were symptomatic GL. Univariate analyses revealed statistically significant differences between lateralities with (n = 22) and without GL (n = 114) in the duration of leg edema (6.3 ± 1.1 vs 3.8 ± 0.5 years; P = .032), International Society of Lymphology stage (stage 0/1/2/3: 0/4/15/3 vs 40/32/32/10; P = .001), leg DB stage (stage 0/I/II/III/IV/V: 0/0/7/9/4/2 vs 6/35/23/29/18/3; P = .002), and genital DB stage (stage 0/I/II/III/IV: 0/0/0/20/2 vs 27/43/28/16/0; P < .001). CONCLUSIONS: ICG lymphography can clearly visualize abnormal lymph circulation in the lower abdominal and genital region. Genital DB stage based on ICG lymphography findings allows early diagnosis of GL before symptom manifestation. Further studies are needed to clarify that ICG lymphography is a key evaluation for prevention and early intervention of GL.
OBJECTIVE: Treatment of genital lymphedema (GL) is challenging, and early diagnosis and intervention is important to prevent progression of GL. However, early treatment of GL is difficult due to a lack of appropriate evaluation methods allowing early diagnosis. We sought to develop a novel pathophysiological evaluation method for early diagnosis of GL using indocyanine green (ICG) lymphography. METHODS: This was a retrospective observational study set in a teaching hospital. Patient characteristics and ICG lymphography findings of 68 lower limb lymphedemapatients secondary to gynecologic cancer treatments were reviewed. The clinical data and dermal backflow (DB) stages based on ICG lymphography findings were analyzed to compare between the left and right region with and without symptomatic GL. RESULTS: Twenty-two of 136 lateralities were symptomatic GL. Univariate analyses revealed statistically significant differences between lateralities with (n = 22) and without GL (n = 114) in the duration of leg edema (6.3 ± 1.1 vs 3.8 ± 0.5 years; P = .032), International Society of Lymphology stage (stage 0/1/2/3: 0/4/15/3 vs 40/32/32/10; P = .001), leg DB stage (stage 0/I/II/III/IV/V: 0/0/7/9/4/2 vs 6/35/23/29/18/3; P = .002), and genital DB stage (stage 0/I/II/III/IV: 0/0/0/20/2 vs 27/43/28/16/0; P < .001). CONCLUSIONS:ICG lymphography can clearly visualize abnormal lymph circulation in the lower abdominal and genital region. Genital DB stage based on ICG lymphography findings allows early diagnosis of GL before symptom manifestation. Further studies are needed to clarify that ICG lymphography is a key evaluation for prevention and early intervention of GL.