Page 32 - VOL 26 N. 72 - 2015

June 6, 2015 - Auditoire A. Tissot
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DIAGNOSTIC ACCURACY OF FLUORESCENCE MICROLYMPHOGRAPHY FOR DETECTING LIMB LYMPHEDEMA
1 Division of Angiology, Kantonsspital Aarau AG, Aarau, Switzerland
2 Clinic for Angiology, University Hospital and University of Zurich, Switzerland
3 Berner VenenZentrum, Bern, Switzerland and Swiss Cardiovascular Center, Division of Angiology, Inselspital, University Hospital and University of Bern, Switzerland
4 Angiology Oberaargau, Langenthal, Switzerland
Objectives: Fluorescence microlymphography (FML) is a minimally invasive technique for visualization of the cutaneous lymphatic network. The aim of the study was to assess the accuracy and safety of FML in patients with unilateral lymphedema.
HONGH.KEO1,MARCHUSMANN2,ERNSTGROECHENIG1, TORSTENWILLENBERG3,SILVIAB.GRETENER4
Design: Crossectional study
Material and Methods: Patients with unilateral leg swelling were assessed and compared with the unaffected contralateral limb. FML was performed in all index legs and the contralateral leg. FML was performed by injecting 0.1 ml fluorescein isothiocyanate (FITC)- labeled dextran intradermally in both limbs at the same level and most prominent swelling of the affect limb was the anatomical reference. The spread of the dye in the lymphatic capillaries of the skin was measured in all dimensions by epiluminator intravital microscopy and the maximum dye spread value ten minutes after injection was used for statistical analysis. The contralateral leg served as control. Test accuracy and receiver operator characteristic (ROC) analysis was performed to assess threshold values that best predict lymphedema.
Results: Between March 2008 and February 2014 a total of 70 patients with unilateral chronic leg swelling were clinically diagnosed with lymphedema. Median age was 45 (IQR 27- 56) years. Of those 46 (65.7%) were female and 71.4% had primary and 28.6% had secondary lymphedema. Sensitivity, specificity, positive and negative likelihood ratio and positive and negative predictive value were 94.3%, 78.6%, 4.40, 0.07, 81.5% and 93.2% for the 12 mm cutoff level and 91.4%, 85.7%, 6.40, 0.10, 86.5% and 90.9% for the 14 mm cutoff level, respectively. The area under the ROC curve was 0.89 (95% CI: 0.83, 0.95). No major adverse events were observed.
Conclusion: FML is an almost atraumatic and safe technique for detecting lymphedema in patients with leg swelling. In our series the best accuracy was observed at a cut-off level of ≥14 mm maximum spread.
STUDY ON REAL-TIME LYMPH FLOW IN THE LYMPH VESSELS OF THE LOWER LIMB BY INTERMITTENT PNEUMATIC COMPRESSION IN HEALTHY VOLUNTEERS AND LYMPHEDEMA PATIENTS
MAEGAWA J. 1, MATSUBARA S. 1, MIKAMI T. 1, TOSAKI A. 2
1 Yokohama City University Hospital, Yokohama, Japan
2 Higashikanagawa acupuncture clinic, Yokohama, Japan
Background: It has been still unknown how lymph flows by intermittent pneumatic compression (IPC). Aims of this study were to reveal real-time lymph-flow and lymph-flow patters in the superficial lymphatics of the leg by ICG fluorescence lymphography during IPC in the healthy volunteers and lymphedema patients.
Materials: Nine healthy volunteers and six patients with lower limb lymphedema participated in this study. After subcutaneous injection of Indocyanine Green lymph-flow in the leg was observed by PDE system (Hamamatsu Photonics, Japan) and a transparent garment with 6 chambers connected to a pneumatic pump, Physical Medomer (Medor Inc., Japan) was then put on the leg. Each chamber inflates with a maximum pressure of 90 mmHg for the volunteers and 90 and 45 mmHg for the patients in sequence or at the same time and deflates according to some orders we set. During the inflation and deflation the lymph-flow in the mid lower leg was recorded through the PDE system and brightness of the recorded images was calculated by software.
Results: Real-time lymph-flow could be observed through the transparent garment during IPC by ICG fluorescence lymphography. The brightness in the images in the mid lower leg changed more quickly in the deflation period we set than in the inflation period, which means the lymph flowed faster in the deflation period than the inflation.
Discussions: IPC accelerates lymph-flow in the superficial lymphatic vessels of the leg in the healthy volunteers with faster flow in the deflation period than inflation. Timing of deflation seems to be important to obtain effective lymph-flow in IPC. Lymph flows similarly by inflation with both 90 and 45 mmHg in lymphedema patients, which suggests low pressures of IPC is sufficient to promote lymph flow in some lymphedema patients.
THE EUROPEAN JOURNAL OF LYMPHOLOGY - Vol. XXVI - Nr. 72 - 2015
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