Use of lymphoscintigraphy to differentiate primary versus secondary lower extremity lymphedema after surgical lymphadenectomy: a retrospective analysis

Abstract

BackgroundWhen managing patients with cancer, lymphedema of the lower limbs (LLL) is commonly reported as secondary to the surgical excision and/or irradiation of lymph nodes (LNs). In the framework of lymphoscintigraphic imaging performed to evaluate secondary LLL, some lympho-nodal presentations have been observed that could not be explained by the applied treatments, suggesting that these LLL might be primary. Therefore, all our lymphoscintigraphic examinations that were performed in patients for LLL after surgery for gynecological or urological cancer were retrospectively analyzed in order to evaluate the frequency in which these LLL might not be secondary (either completely or partially) but primary in origin.MethodsLymphoscintigraphies performed in 33 patients who underwent LN dissection (limited to the intra-abdominal LN) with or without radiotherapy for histologically confirmed ovarian cancer (n = 6), uterine cancer (n = 14 with cervical cancer and n = 7 with endometrial cancer), or prostate cancer (n = 6) were compared to lymphoscintigraphies obtained in primary LLL.ResultsIn 12 (33% of the) patients (3 men plus 9 women, 4 with cervical cancer and 5 with endometrial cancer), scintigraphy of the lower limbs revealed lympho-nodal presentation that did not match with the expected consequences of the surgical and/or radiological treatments and were either suggestive or typical of primary lymphedema.ConclusionsThis retrospective analysis of a limited but well-defined series of patients suggests that the appearance of LLL might not be related to cancer treatment(s) but that these LLL may represent the development of a primary lymphatic disease latent prior to the therapeutic interventions.

Liposuction in cancer-related lower extremity lymphedema: an investigative study on clinical applications

“…Pelvic tumor surgery is traditionally characterized by several major complications, including secondary lower extremity lymphedema [1]. Cancer-related lower extremity lymphedema is associated with treatment modalities such as cancer surgery and radiation therapy, which can injure or remove the lymph nodes [2,3].…”

Value of one additional injection at the root of the limb in the lymphoscintigraphic evaluation and management of primary and secondary lower-limb lymphedemas

“…In the second, no LNs could be observed, although they had been observed previously. In the third, the tracer flowed up to the root of the limb[s], sometimes revealing LNs, but to a lesser extent than could be, for example, expected in cases of secondary LLLE, especially when considering the bilaterality of the lymphadenectomies performed and the number of LNs that had been surgically removed [ 12 ].…”

Lower-Limb Lymphedema after Sentinel Lymph Node Biopsy in Cervical Cancer Patients

“…The true incidence of LLL after surgical treatment of cervical cancer is unclear, previously reported in the range of 0–62% [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ]. The incidence varies mainly according to the extent of the surgery and administration of adjuvant treatment [ 16 , 17 , 18 , 19 ]. Namely, the number of removed lymph nodes has been shown to be directly related to the LLL development; however, the critical number of lymph nodes varied from 10 to 31 [ 9 , 15 , 20 , 21 , 22 , 23 ].…”