Evaluation of Peripheral Lymphedema Using ICG Lymphography

Abstract

In secondary lymphedema, lymph flow obstruction by cancer treatments causes dilatation and degeneration of lymphatic vessels distal to the obstruction site, which results in edema, inflammation, and adipose tissue accumulation with extravasation of lymph. Lymph circulation should be evaluated for precise assessment of lymphedema, since abnormal lymph circulation takes place before manifestation of lymphedema symptom. Indocyanine green (ICG) lymphography is a useful lymph circulation evaluation method, which can clearly visualize lymph circulation without radiation exposure. With progression of lymphedema, ICG lymphography findings change from linear, to splash, stardust, and finally to diffuse pattern. Dermal backflow (DB) stage is made According to distribution of dermal backflow (DB) patterns, in which DB stage 1 is critical for early diagnosis at a subclinical stage. Pathophysiological evaluation of lymphedema using ICG lymphography plays an important role in lymphedema management.