Lympho-fluoroscopy in cancer-related secondary lymphedema: from imaging to daily practice

Conference Paper · September 2014
Conference: National Lymphatic Network 11th International Conference, At Washington

Jean-Paul Belgrado
Liesbeth Vandermeeren
Jean-Baptiste Valsamis
Sophie Vankerckhove
Jean-Jacques Moraine
R Deraemaecker

Abstract

Near infrared fluoroscopy is an emerging imaging tool in the field of lymphology. The intradermal injection of diluted Indocyanine green (ICG) coupled with a dedicated camera (PDE®) allow to visualize the superficial lymphatic network architecture and its functioning in real-time. When substitution pathways have been identified we mark them on the patient's skin in order to map them. This way of doing can be used to optimize the physical treatment. Our experience is based on 262 lympho-fluoroscopies (154 upper limbs, 107 lower limbs I or II lymphedema & healthy subject). Illustrating cases are reported below. Lower limb secondary lymphedema Ethics board approval Sept 2013 OM 026_CE2013/96 Approved by Federal Agency for Medicines & Health Products – Belgium EudraCT number 2013-001360-36.) Woman, 28 years old : Melanoma left thigh Large excision and left inguinal, retroperitoneal lymph node dissection Secondary lymphoedema of the left leg after 2 years after surgery , descending oedema Upper limb secondary lymphedema Woman, 62 years old Left BCRL Woman 42 years old right BCRL Conclusion Management of lymphoedema, in daily practice, requires as much information as possible about lymphatic network architecture and physiology. A mapping of functional lymphatic collectors , dermal rerouting areas, dermal backflow areas, substitution functional pathways visualized by near infra red lympho-fluoroscopy could contribute to monitor and optimize the treatment of lymphedema. In that way specific individual adaptations can be integrated into protocols based on evidence. LRU L y m p h o l o g y R e s e a r c h U n i t