High-accuracy Diagnosis and Regional Classification of Lymphedema Using Indocyanine Green Fluorescent Lymphography After Gynecologic Cancer Treatment

Background: Secondary lymphedema is defined as swelling of the limbs caused by retention of lymph after cancer therapy. We diagnosed lymphedema using indocyanine green (ICG) fluorescent lymphography and developed a classification based on 12 regional types of edema in the lower bodies, with the goal of improved understanding of the pathology. Methods: The subjects were 72 consecutive female patients aged 25 to 88 years (mean, 54.5 years) with secondary lymphedema of the lower extremities and abdominal area. The traditional diagnosis of lymphedema was stages 0, 1, 2, 3 and 4 in 5, 11, 19, 24, and 13 patients, respectively. All patients were examined by ICG lymphography. Results: Features of dermal backflow were noted in most patients after cancer therapy, and the incidence was particularly high after radiotherapy. Regional analysis of lymphedema was classified into 12 types (A to L, definitions are given for major categories). The number of patients (number receiving radiation therapy in parentheses) in each type were A, 1 (0); B, 3 (1); C, 13 (1); D, 1 (0); E, 2 (0); F, 0 (0); G, 1 (0); H, 7 (3); I, 13 (3); J, 6 (2); K, 20 (3); and L, 5 (2). Conclusions: The ICG test permits definite diagnosis of lymphedema at a very early stage and in mild cases. The regional analysis enables establishment of policies for conservative or surgical treatment (for example, lymphaticovenous anastomosis) for individual regions, thereby facilitating more effective lymphedema treatment.