A phase III, multicenter, single-arm study to assess the utility of indocyanine green fluorescent lymphography in the treatment of secondary lymphedema

Akita, Shinsuke; Unno, Naoki; Maegawa, Jiro; Kimata, Yoshihiro; Fukamizu, Hidekazu; Yabuki, Yuichiro; Kitayama, Shinya; Shinaoka, Akira; Yamada, Kiyoshi; Sano, Masaki; Ota, Yusuke; Ohnishi, Fumio; Sakuma, Hisashi; Nuri, Takashi; Ozawa, Yoshihito; Shiko, Yuki; Kawasaki, Yohei; Hanawa, Michiko; Fujii, Yasuhisa; Imanishi, Eri; Fujiwara, T.; Hanaoka, Hideki; Mitsukawa, Nobuyuki

doi:10.1016/j.jvsv.2021.09.006

Cited by 11 publications

(16 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Diagnosis and severity staging were most often based on either the MD Anderson Cancer Center (MDACC) scale 59 , 65 – 70 or the Dermal Backflow Scale (DBS). 61 , 62 , 67 , 71 – 82 The MDACC scale focuses on the visualization of patent lymphatic vessels in combination with the presence of DBF. In contrast, the DBS focuses on the proximal to distal extension of different DBF patterns 61 , 71 , 75 , 78 , 81 , 82 (in order of severity: normal, splash, stardust and diffuse) [see Fig.…”

Section: Resultsmentioning

confidence: 99%

“…59 The reported range of sensitivity was higher or similar for NIRF-L (89.0-89.5%) compared with lymphoscintigraphy (45-93%), with highly variable specificities between studies (NIRF-L: 80-86%; lymphoscintigraphy: 26.7-100%). 61,95 NIRF-L is superior to lymphoscintigraphy for early lymphedema diagnosis, with a sensitivity and specificity of 76% and 80% for NIRF-L and 11% and 0% for lymphoscintigraphy, respectively. 94,95 Injection and Imaging Protocols Generally, ICG was injected in the interdigital spaces (electronic supplementary Table 5); however, some studies investigated the advantages of multi-lymphosome injections.…”

Section: Parameters For Diagnosis and Severity Stagingmentioning

confidence: 99%

“…53 Near-Infrared Fluorescence Lymphangiography (NIRF-L) NIRF-L uses the fluorescence properties of indocyanine green (ICG) 54 for real-time visualization of the lymphatic vessels. It is applied to identify normal and altered drainage pathways, [55][56][57][58][59][60] evaluating anastomosis patency, 61 and provides information about vessel functionality by visualizing pulsatile behavior. 59 It also provides more insight into anatomical variations and the relation between the development of lymphedema after cancer treatment and the formation of accessory pathways.…”

Section: Computed Tomographymentioning

confidence: 99%

See 2 more Smart Citations

Imaging of the Lymphatic Vessels for Surgical Planning: A Systematic Review

et al. 2022

View full text Add to dashboard Cite

Background Secondary lymphedema is a common complication after surgical or radiotherapeutic cancer treatment. (Micro) surgical intervention such as lymphovenous bypass and vascularized lymph node transfer is a possible solution in patients who are refractory to conventional treatment. Adequate imaging is needed to identify functional lymphatic vessels and nearby veins for surgical planning. Methods A systematic literature search of the Embase, MEDLINE ALL via Ovid, Web of Science Core Collection and Cochrane CENTRAL Register of Trials databases was conducted in February 2022. Studies reporting on lymphatic vessel detection in healthy subjects or secondary lymphedema of the limbs or head and neck were analyzed. Results Overall, 129 lymphatic vessel imaging studies were included, and six imaging modalities were identified. The aim of the studies was diagnosis, severity staging, and/or surgical planning. Conclusion Due to its utility in surgical planning, near-infrared fluorescence lymphangiography (NIRF-L) has gained prominence in recent years relative to lymphoscintigraphy, the current gold standard for diagnosis and severity staging. Magnetic resonance lymphography (MRL) gives three-dimensional detailed information on the location of both lymphatic vessels and veins and the extent of fat hypertrophy; however, MRL is less practical for routine presurgical implementation due to its limited availability and high cost. High frequency ultrasound imaging can provide high resolution imaging of lymphatic vessels but is highly operator-dependent and accurate identification of lymphatic vessels is difficult. Finally, photoacoustic imaging (PAI) is a novel technique for visualization of functional lymphatic vessels and veins. More evidence is needed to evaluate the utility of PAI in surgical planning.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Parameters For Diagnosis and Severity Stagingmentioning

confidence: 99%

Section: Computed Tomographymentioning

confidence: 99%

See 1 more Smart Citation

Imaging of the Lymphatic Vessels for Surgical Planning: A Systematic Review

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Before surgery, indocyanine green (ICG) fluorescent lymphography was performed by injecting 0.2 mL of 0.5 mg/mL ICG solution subcutaneously at a 5 cm distal point on the upper arm from the axilla to determine whether a linear pattern of lymph flow from the upper arm into the axilla could be observed or not [ 17 ].…”

Section: Methodsmentioning

confidence: 99%

“…The changes in estimated limb volumes, ultrasonographic findings, and ICG lymphography findings at 6 months after surgery were compared between the two groups. The limb volume was calculated using the circumference of the four points and the distance between the measurement sites [ 17 ]. The difference between the preoperative and postoperative limb volumes was defined as the amount of volume reduction achieved by the treatment.…”

Section: Methodsmentioning

confidence: 99%

Clinical and Histological Effects of Partial Blood Flow Impairment in Vascularized Lymph Node Transfer

Akita

Ikehara

Arai

et al. 2022

JCM

Self Cite

View full text Add to dashboard Cite

Regarding vascularized lymph node transfer (VLNT) for lymphedema, partial blood flow impairment in transferred lymph node (LN) flaps may adversely affect the therapeutic results. We investigated the clinical and histological effects of partial blood flow impairment in LN flaps. In upper extremity lymphedema cases, based on ultrasonographic examination at 2 weeks after VLNT, we compared the treatment results depending on whether the postoperative blood flow in transferred LNs was good (Group G) or poor (Group P). Novel partial ischemia and congestion of LN flap mouse models were developed to determine their histological features. In 42 cases, significant differences were observed between Group G (n = 37) and Group P (n = 5) based on the amount of volume reduction (136.7 ± 91.7 mL and 55.4 ± 60.4 mL, respectively; p = 0.04) and lymph flow recanalization rate in indocyanine green fluorescent lymphography (67.6% and 0%, respectively; p = 0.0007). In mouse models, thrombi formation in the marginal sinus and numerous Myl9/12-positive immunocompetent cells in follicles were observed in congested LNs. Blood flow maintenance in the transferred LNs is an essential factor influencing the therapeutic effect of VLNT. Postoperatively, surgeons should closely monitor blood flow in the transferred LNs, particularly in cases of congestion.

show abstract

Research progress of indocyanine green fluorescence technology in gynecological applications

Li,

Zhang,

Fang

et al. 2023

Intl J Gynecology & Obste

View full text Add to dashboard Cite

Indocyanine green is a near‐infrared fluorescent dye which is widely used in various fields of surgery and gynecology. It is currently mainly used to detect various malignant tumors, sentinel lymph nodes, endometriosis lesions, ureter or intestinal occlusion, vaginal perfusion, uterine arterial blood perfusion, pelvic nerve, uterine niche, lymphatic edema, metastatic lesion shadow, and so on, providing new methods for decision‐making during surgery. This article elaborates the application progress of indocyanine green fluorescence technology in gynecology.

show abstract

A phase III, multicenter, single-arm study to assess the utility of indocyanine green fluorescent lymphography in the treatment of secondary lymphedema

Cited by 11 publications

References 38 publications

Imaging of the Lymphatic Vessels for Surgical Planning: A Systematic Review

Imaging of the Lymphatic Vessels for Surgical Planning: A Systematic Review

Clinical and Histological Effects of Partial Blood Flow Impairment in Vascularized Lymph Node Transfer

Research progress of indocyanine green fluorescence technology in gynecological applications

Contact Info

Product

Resources

About