Comparison of lymphoscintigraphy and indocyanine green lymphography for the diagnosis of extremity lymphoedema

Clinical and diagnostic aspects of lymphedema

“…In secondary lymphedema of the upper extremity, sensitivity and specifi city of the test has been reported to be 100 %, respectively [20]. In a study of 169 extremities with lymphedema secondary to lymph node dissection and 65 extremities with primary lymphedema, the sensitivity of Indocyanine green lymphography was 97 %, the specifi city was 78 %, and the accuracy was 89 % for primary lymphedema [10]. In secondary lymphedema, the sensitivity of Indocyanine green lymphography, compared with lymphoscintigraphy, was 97 %, the specifi city was 55 %, and the accuracy was 82 % [10].…”

“…In a study of 169 extremities with lymphedema secondary to lymph node dissection and 65 extremities with primary lymphedema, the sensitivity of Indocyanine green lymphography was 97 %, the specifi city was 78 %, and the accuracy was 89 % for primary lymphedema [10]. In secondary lymphedema, the sensitivity of Indocyanine green lymphography, compared with lymphoscintigraphy, was 97 %, the specifi city was 55 %, and the accuracy was 82 % [10]. ICG lymphography with its diagnostic accuracy of the test is a valuable alternative to lymphoscintigraphy with less invasiveness and at lower cost.…”

“…The doses of ICG and the design of devices used in these and other clinical studies vary widely, suggesting variable device performance [32]. Morbidly obese patients cannot be evaluated well by this method because it is impossible to observe lymphatic vessels located more than 2 cm deep in the subcutaneous tissue [10]. Also the existence and location of lymphocysts is better investigated by lymphoscintigraphy than ICG fl uorescence lymphography.…”

Advances in fluorescent-image guided surgery

“…Preoperatively, ICG fluorescence can be used to assess the functional severity of lymphedema of the extremities and can help stage and select patients for surgical treatment (66)(67)(68)(69)(70)(71)(72)(73). Compared to lymphoscintigraphy (the alternative method of imaging lymphedema), ICG fluorescence lymphography is more accurate, less invasive, and of a lower cost, making it more suitable for routine evaluations (74)(75)(76). Fluorescence visualization can also be utilized in evaluating other causes of lymphedema, such as lipedema, Fabry's disease, congenital Milroy lymphedema, lymphatic malformations, or lymphedema praecox (71,77,78).…”

“…Fluorescent visualization provides better insight into lymphatic function when assessing lymphatic function prior to, during, or after surgery (79). It also helps determine the suitability of a lymphaticovenular shunt operation, one of the surgical treatments for lymphedema (74). ICG fluorescence is used intraoperatively to identify active lymphatic channels during lymphaticovenular shunt operations (79,(84)(85)(86)(87)(88).…”