Indocyanine green lymphangiography is superior to clinical staging in breast cancer-related lymphedema

Steffanie Christensen,Mads Gustaf Jørgensen,Jens Ahm Sørensen,Anette Riis Madsen,Anne Pernille Hermann

doi:10.1038/s41598-021-00396-2

Steffanie Christensen, Mads Gustaf Jørgensen + Show 3 more

Open Access

https://doi.org/10.1038/s41598-021-00396-2

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Abstract

Precise staging of breast cancer-related lymphedema (BCRL) is important to guide treatment-decision making. Recent studies have suggested staging of BCRL using indocyanine green lymphangiography (ICG-L) based on the extent of lymphatic injury and dermal backflow patterns. Currently, the benefits of ICG-L compared to conventional clinical staging are unknown. For this study, we included 200 patients with unilateral BCRL. All BCRL patients were staged using ICG-L and clinical exam. The amounts of excess arm volume, fat mass and lean mass were compared between stages using Dual Energy X-Ray Absorptiometry. Multivariate regression models were used to adjust for confounders. For each increase in the patient's ICG-L stage, the excess arm volume, fat mass and lean mass was increased by 8, 12 and 6.5 percentage points respectively (P < 0.001). For each increase in the patient's clinical ISL stage, the volume was increased by 3.5 percentage points (P < 0.05), however no statistically significant difference in the lean and fat mass content of the arm was observed for ascending stages. However, the residual plots showed a high degree of variance for both ICG-L and clinical staging. This study found that ICG-L staging of BCRL was superior to clinical staging in forecasting BCRL excess arm volume, fat mass, and lean mass. However, there was a high degree of variance in excess arm volume, fat mass, and lean mass within each staging system, and neither the ICG-L nor clinical staging forecasted perfectly.

Highlights

Precise staging of breast cancer-related lymphedema (BCRL) is important to guide treatment-decision making
We described the baseline characteristics of patients with means ± standard deviation (SD) for continuous parametric variables, median and interquartile range (IQR) for nonparametric continuous variables, and rounded frequencies (%) for categorical variables
Excess arm fat mass increased from International Society of Lymphology (ISL) stage 0 to stage 1 and 2a but was again lower in stage 2b than for stage 2a (Fig. 2C)

Summary

Introduction

Precise staging of breast cancer-related lymphedema (BCRL) is important to guide treatment-decision making. For each increase in the patient’s ICG-L stage, the excess arm volume, fat mass and lean mass was increased by 8, 12 and 6.5 percentage points respectively (P < 0.001). This study found that ICG-L staging of BCRL was superior to clinical staging in forecasting BCRL excess arm volume, fat mass, and lean mass. There was a high degree of variance in excess arm volume, fat mass, and lean mass within each staging system, and neither the ICG-L nor clinical staging forecasted perfectly. The benefits of ICG-L over clinical staging have not been established, and much less is known whether the degree of lymphatic injury is associated with BCRL s everity[3]. This study aimed to investigate the usefulness of ICG-L staging by comparing ICG-L and clinical staging of BCRL to the excess arm volume, fat, and lean mass. We hypothesized that ICG-L would be more appropriate than clinical staging at stratifying BCRL patients

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