Diagnostic Accuracy of Fluorescence Microlymphography for Detecting Limb Lymphedema

Abstract

FML is an almost atraumatic and safe technique for detecting lymphedema in patients with leg swelling. In this series the greatest accuracy was observed at a cut off level of ≥14 mm maximum spread.

Diagnostics of Lower Limbs Lymphedema

“…Разновидностью цветовой лимфографии является флюоресцентный метод исследования лимфатических сосудов [25]. Он основан на субэпидермальной микроигольной инъекции флюоресцирующего вещества (FITC-декстрана) с последующей флюоресцентной микроскопией [26,27]. Флюоресцентная микролимфография -атравматичный метод, позволяющий визуализировать поверхностную сеть лимфатических сосудов кожи, достаточно достоверно подтверждает диагноз и стадию лимфедемы, способствует дифференциальной диагностике с другими формами отека конечности.…”

Clinical and diagnostic aspects of lymphedema

“…The maximal distance between the outer border of the dye depot and the most distant visible lymph vessels normally does not exceed 14 mm in healthy controls. An extension higher than 14 mm strongly suggests the presence of lymphedema [27]. Due to hypoplastic or obstructed lymph vessels in the deep system, FITC-dextran expands more into the intact superfi cial network.…”

“…In a study of 184 chronic lower extremity swellings the sensitivity of FML was 79 %, the specifi city was 83 %, and likelihood ratio for a positive test was 4.72 and 0.26 for a negative test for detecting lymphedema [25], In a recent study of 70 patients with unilateral lower extremity lymphedema the sensitivity, specifi city, positive and negative likelihood ratio, and positive and negative predictive values of FML compared to healthy contralateral legs were 91.4 %, 85.7 %, 6.40, 0.10, 86.5 %, and 90.9 %, respectively [27]. FML is a useful test in the evaluation of the chronically swollen limb.…”

“…The contrast medium is produced by dissolving FITC-dextran to a 25 % solution with physiologic saline solution. Into the subepidermal layer of the skin a solution of 0.1 ml FITC-labeled dextran can be injected using a tuberculin syringe and a 25-gauge needle (Figure 3) [27].…”

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).…”