Page 33 - VOL 26 N. 72 - 2015

MEASUREMENT OF LYMPHEDEMA: PYTHAGORAS VS ARCHIMEDES VS HIGH-TECH
V ALSAMIS J.-B. 1, PERRAUL T S. 1, V ANKERCKHOVE S. 2, V ANDERMEEREN L. 2, MORAINE J.-J. 1, BELGRADO J.-P . 1
1 BEAMS Department, Ecole Polytechnique de Bruxelles, Belgium 2 C.H.U. St-Pierre - Lymphology clinic of Brussels, Belgium
Introduction: Measurement of lymphedema still remains a challenge. It must combine quality of measurement, rapidity, ease of use and minimum intra- and interoperator variation. The device and the method have to be accurate and sensitive enough to detect tiny variations for 2 main reasons: follow the edema in the time and follow patients at risk to develop secondary lymphedema, in order to detect as early as possible the occurence of the edema. In the present study, we compared 3 methods of edema measurements: tape perometry, the Archimedes method and the 3D-imaging.
Material and Methods: The study has been performed on the upper limb. The limb has been graduated every 4cm from the pisiform bone (the reference) along 32cm, defining 5 areas: the hand, and the 4 regions of 8cm. The tape perometry consists in measurement of perimeters on each graduation and the figure 8 method for the hand. The Archimedes method consists in immerging the limb of the patient from the hand to the 32cm of the limb by step of 8cm. The immerged part of the volume can be measured as the reaction of the Archimedes force which is applied on a weight. The 3D-imaging consists in acquiring a 3D model of the arm and in evaluating the volume by software. The study involved the measurement of both side upper limbs of 8 patients, giving a sample size of 16. Two operators performed the measurements. Each operator performed twice the measurements except for the 3D-imaging.
Results: We have evaluated and compared the quality of the measurements of the three techniques according to mathematical and practical aspect as well. The results have highlighted the difference between the intra-operator errors, inter-operator errors and the bias induced by the techniques. The different techniques present specific advantages/weaknesses. The perometry method is very easy, low cost and presents a good trueness and a very low intra-operator error on the areas taken separately (parts of 8cm). However the bias is important. The Archimedes method is also easy and can be automated with a dedicated software including data in the patient files. It shows a very low inter-operator error on the cumulative areas (part 0-32cm). The 3D-imaging is very expensive and time consuming but produces a good trueness of the measurement.
Conclusion: This study has confirmed the problematic of the quality of measuring volumes in lymphedema through different aspects such as reliability, efficiency, use in routine, time consumption, cost... It shows that our simple method revisiting Archimedes principle is well suited to improve the measurement quality. It may therefore be an alternative to the water displacement method.
A simple lecture on a weight determines the volume on a chosen number of limb segments.
Acknoledgment: We would like to thank Florian Federer, Quality/Metrology Manager at EMS, for his help about the 3D-imaging system.
NEAR-INFRA-RED (NIR) FLUORESCENCE IMAGING OF « SENTINEL » LYMPH NODES IN CANCERS AFTER THE INTRA-VENOUS INJECTION (IV) OF FREE INDOCYANINE GREEN (ICG)
PIERRE BOURGEOIS 1, ANTOINE DIGONNET 2, ISABELLE VEYS 2, GABRIEL LIBERALE 2, SOPHIE V ANKERCKHOVE 1, MARIE CHINTINNE 3, MARIA GOMEZ GALDON 3, NICOLAS DE SAINT-AUBAIN 3, DENIS LARSIMONT 3, BISSAN AHMED 1, FILIP DE NEUBOURG 2, DANIÈLE NOTERMAN 2, GUY ANDRY 2 AND JEAN-MARIE-NOGARET 2 (Group R&D Clinical Applications of Fluorescence Imagings)
1 Department of Nuclear Medicine and Clinic-Unit of Lymphology,
Introduction: The«SentinelLymphNode»(SLN)conceptisusuallybasedonthedemonstrationofspecificLN(sodefinedasatriskto harbour cancerous metastases) after the peri-tumoural injection of vital dyes and/or radio-pharmaceutical and/or fluorescent molecules. The aim of our presentation is to report our observations obtained in patients with various cancers after the IV injection of free ICG,
Material and methods: 0.25 mg of free ICG per kg were IV injected just after their anesthesia in patients (15 with breast cancer, 10 with Head and Neck cancer and 3 with colo-rectal cancer), in the framework of various research protocols and with their informed consent (CE2075, CE2088, CE2178 and CE2290: Eudract 2013-0001000-41, 2013-000653-42, 2013-004498-29, 2014-003512-37). The lymph nodes found during these patients’ surgeries were evaluated for their fluorescence using a dedicated NIR imaging device (Photodynamic Eye, PDE; Hamamatsu Photonics, Hamamatsu, Japan) and their fluorescence correlated with their anatomo-pathological status.
Results: In all the patients with Breast Cancer, fluorescent LN were found in their axillary piece of dissection and in the four pN+ patients, metastases were observed in fluorescent LN. Among the patients with nodal relapses of Head and Neck cancer, these pathological LN were also seen fluorescent and in these patients who underwent cervical LN dissection (cN-), fluorescent LN were also systematically found and metastases also seen preferentially in the most fluorescent.ones. Among the patients who were investigated for NIR evaluation of peritoneal carcinomatosis of colo-rectal origin, one had three pathologic LN on pre-operative work- up and these pathologic LN were more fluorescent than the pN- ones. In two other patients with no pre-operatively suspected LN, one epigastric hyper-fluorescent LN was discovered per-operatively in each case and the LN so found was pN+ in one case.
Conclusion: Our observations that LN are found fluorescent after the IV injection of free ICG, either in case of suspected nodal relapse, or in the framework of ”standard” nodal dissection, and, that in the case of the last ones, metastases were preferentially found in these fluorescent LN, have important clinical implications. NIR fluorescence imaging of the LN after such IV injection of free ICG may define in another way the “sentinel” LN at risk to harbour metastases, per-operatively and/or in the Department of Anatomo- Pathology. Actually, we are so investigating prospectively the contributions of such imagings to detect per-operatively these fluorescent “sentinel” and/or pathologic LN.
2 Service of Surgery,
3 Department of Anatomo-Pathology,
Institut Jules Bordet, Université Libre de Bruxelles
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THE EUROPEAN JOURNAL OF LYMPHOLOGY - Vol. XXVI - Nr. 72 - 2015