Re-evaluation of qualitative lymphangioscintigraphic findings in secondary lower extremity lymphedema

Abstract

To re-evaluate whether qualitative lymphangioscintigraphy (LAS) findings are sensitive enough to diagnose or classify the clinical severity of lower extremity lymphedema. LAS was performed in 78 extremities with lymphedema and 24 extremities without lymphedema between April, 2009 and March, 2012. We assessed the proportion of extremities in which there was no visual evidence of the ilioinguinal lymph nodes (LN-60) or the lymphatic trunk (Tr-60) 60 min after tracer injection, the number of visualized ilioinguinal lymph nodes (#LN), and the proportion of extremities with dermal backflow (pDBF) and lymph stasis (pLS). These were associated with the International Society of Lymphology (ISL) clinical stage. LN-60, Tr-60, #LN, pDBF, and pLS, especially when extending into both the thigh and lower leg, were significantly associated with the ISL stage. The sensitivity of LN-60, Tr-60, and #LN <2 for diagnosing lymphedema was 49, 47, and 59 %, respectively, with no significant difference among these parameters for consecutive ISL stages. None of the above measures was sufficiently sensitive to diagnose lymphedema or classify the severity of the disease; however, each of these criteria can aid in diagnosis, by excluding other diseases and assessing disease pathophysiology.