title: Indocyanine green lymphography for evaluation of genital lymphedema in secondary lower extremity lymphedema patients.
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.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan. Electronic address: tyamamoto-tky@umin.ac.jp.
authors.forename: Takumi
authors.initials: T
authors.lastname: Yamamoto
authors.affiliation: Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan.
authors.forename: Nana
authors.initials: N
authors.lastname: Yamamoto
authors.affiliation: Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan.
authors.forename: Hidehiko
authors.initials: H
authors.lastname: Yoshimatsu
authors.affiliation: Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan.
authors.forename: Shinya
authors.initials: S
authors.lastname: Hayami
authors.affiliation: Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan.
authors.forename: Mitsunaga
authors.initials: M
authors.lastname: Narushima
authors.affiliation: Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan.
authors.forename: Isao
authors.initials: I
authors.lastname: Koshima