Preliminary experience with a novel fluorescence lymphography using indocyanine green in patients with secondary lymphedema.
BACKGROUND
Lymphoscintigraphy has largely been performed to diagnose lymphedema. It is, however a time-consuming and expensive technique, which has not been covered by Japanese medical insurance since the year 2002. In this report we introduce a new imaging technique of fluorescent lymphography to diagnose lymphedema.


METHODS
Fluorescence images of subcutaneous lymphatic drainage after subcutaneous injection of indocyanine green (ICG) at the foot were obtained using a newly developed near-infrared camera system. ICG fluorescent lymphography was performed in 12 patients with secondary lymphedema and 10 healthy volunteers. The 12 patients were diagnosed with secondary lymphedema according to the medical history and lymphoscintigram, of which 11 had a history of hysterectomy with extended lymph node dissection and local radiation therapy for uterine cancer. Lymphedema developed in one patient after femorotibial artery bypass for peripheral artery occlusive disease.


RESULTS
Four abnormal fluorescent patterns of the lymph drainage were observed in lymphedema: dermal backflow (an abnormal filling of the lymph capillaries), extended fluorescent signal at the dorsum and plantar region of the foot, dilated lymph channels with proximal obliteration, and diffuse glittering of fluorescent signals with scattered twinkling of the dye. Continuous lymph channels from the injection site of the foot to the groin were observed along the medial aspect of thigh in healthy subjects.


CONCLUSIONS
ICG fluorescence lymphography is safe, simple, and minimally invasive. The device is portable and easy to use. The technique may be useful in clinical practice to identify presence of lymphatic disorder.
Unno
Naoki
N
Division of Vascular Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan. unno@hama-med.ac.jp
Inuzuka
Kazunori
K
Suzuki
Minoru
M
Yamamoto
Naoto
N
Sagara
Daisuke
D
Nishiyama
Motohiro
M
Konno
Hiroyuki
H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004396:Coloring Agents; D005260:Female; D006801:Humans; D007044:Hysterectomy; D007208:Indocyanine Green; D008197:Lymph Node Excision / Q000009:adverse effects; D008209:Lymphedema / Q000175:diagnosis* / Q000209:etiology; D008220:Lymphography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D014594:Uterine Neoplasms / Q000601:surgery
D004396:Coloring Agents; D007208:Indocyanine Green