title: 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.
abstract: BACKGROUND
  Early diagnosis and treatment are as important for management of secondary lymphedema following cancer treatment as in primary cancer treatment. Indocyanine green lymphography is the modality of choice for routine follow-up evaluation of patients at high risk of developing lymphedema after cancer therapy.
  
  
  METHODS
  Fifty-six limbs of 28 so-called unilateral secondary lower extremity lymphedema patients who underwent indocyanine green lymphography were compared with dermal backflow patterns of indocyanine green lymphography on 28 asymptomatic limbs and assessed using leg dermal backflow stage.
  
  
  RESULTS
  Of 28 asymptomatic limbs of secondary lower extremity lymphedema patients, the dermal backflow patterns were detected in 19 limbs but were absent in nine limbs. Significant differences were seen between asymptomatic limbs with dermal backflow patterns (n=19) and limbs without them (n=9): age, 51.4±15.3 years versus 34.8±12.7 years (p=0.007); body weight, 75.1±7.9 kg versus 50.1±5.3 kg (p=0.012); body mass index, 23.1±4.2 versus 19.7±1.8 (p=0.005); leg dermal backflow stage of asymptomatic limb, 1.2±0.4 versus 0.0±0.0 (p<0.001); and leg dermal backflow stage of symptomatic limb, 3.5±0.6 versus 2.8±0.8 (p=0.033).
  
  
  CONCLUSIONS
  The splash pattern is the earliest finding on indocyanine green lymphography of asymptomatic limbs of secondary lower extremity lymphedema patients. The leg dermal backflow stage allows early diagnosis of secondary lower extremity lymphedema even in a subclinical stage. The concept of subclinical lymphedema could play an important role in early diagnosis and prevention of lymphedema after cancer treatment.
  
  
  METHODS
  Diagnostic, V.
authors.affiliation: Tokyo, Japan From the Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, University of Tokyo.
authors.forename: Takumi
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Nana
authors.initials: N
authors.lastname: Matsuda
authors.forename: Kentaro
authors.initials: K
authors.lastname: Doi
authors.forename: Azusa
authors.initials: A
authors.lastname: Oshima
authors.forename: Hidehiko
authors.initials: H
authors.lastname: Yoshimatsu
authors.forename: Takeshi
authors.initials: T
authors.lastname: Todokoro
authors.forename: Fusa
authors.initials: F
authors.lastname: Ogata
authors.forename: Makoto
authors.initials: M
authors.lastname: Mihara
authors.forename: Mitsunaga
authors.initials: M
authors.lastname: Narushima
authors.forename: Takuya
authors.initials: T
authors.lastname: Iida
authors.forename: Isao
authors.initials: I
authors.lastname: Koshima
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004396:Coloring Agents; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D007208:Indocyanine Green; D035002:Lower Extremity; D042601:Lymphatic Vessels / Q000000981:diagnostic imaging*; D008209:Lymphedema / Q000000981:diagnostic imaging* / Q000209:etiology; D008220:Lymphography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green