Universal indocyanine green lymphography staging for extremity lymphedema: Universal ICG stage

Abstract

We read with great interest the article entitled “Correlation of ICG lymphography and lymphoscintigraphy severity stage in secondary upper limb lymphedema.” by J.A. Yoon, et al. (J Plast Reconstr Aesthet Surg 2020; 73(11): 1982–8.). 1 Yoon J.A. Shin M.J. Shin Y.B. et al. Correlation of ICG lymphography and lymphoscintigraphy severity stage in secondary upper limb lymphedema. J Plast Reconstr Aesthet Surg. 2020; 73: 1982-1988 Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar Their work is of clinically significant importance for patients who suffer from secondary lymphedema, because they have elucidated strong correlationship between lymphoscintigraphy severity stage and arm dermal backflow (ADB) stage 2 Yamamoto T. Yamamoto N. Doi K. et al. Indocyanine green–enhanced lymphography for upper extremity lymphedema: a novel severity staging system using dermal backflow patterns. Plast Reconstr Surg. 2011; 128: 941-947 Crossref PubMed Scopus (179) Google Scholar ,3 Yamamoto T. Yamamoto N. Fuse Y. et al. Optimal sites for supermicrosurgical lymphaticovenular anastomosis: an analysis of lymphatic vessel detection rates on 840 surgical fields in lower extremity lymphedema. Plast Reconstr Surg. 2018; 142: 924e-930e Crossref PubMed Scopus (25) Google Scholar on indocyanine green (ICG) lymphography. These two different modalities compensate each other and may lead correct diagnosis and severity assessment. Although the authors classified the cases according to ADB stage and modified MD Anderson Cancer Center (MDACC) stage, sometimes there are unclassifiable cases or error classification due to its ambiguity. To address this challenge, we developed and adopted a new modified DB, universal ICG stage, for severity staging of extremity lymphedema. 2 Yamamoto T. Yamamoto N. Doi K. et al. Indocyanine green–enhanced lymphography for upper extremity lymphedema: a novel severity staging system using dermal backflow patterns. Plast Reconstr Surg. 2011; 128: 941-947 Crossref PubMed Scopus (179) Google Scholar , 3 Yamamoto T. Yamamoto N. Fuse Y. et al. Optimal sites for supermicrosurgical lymphaticovenular anastomosis: an analysis of lymphatic vessel detection rates on 840 surgical fields in lower extremity lymphedema. Plast Reconstr Surg. 2018; 142: 924e-930e Crossref PubMed Scopus (25) Google Scholar , 4 Yamamoto T. Onco-reconstructive supermicrosurgery. Eur J Surg Oncol. 2019; 45: 1146-1151 Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar , 5 Yamamoto T. Yamamoto N. Kageyama T. et al. Technical pearls in lymphatic supermicrosurgery. Global Health Med. 2020; 2: 29-32 Crossref PubMed Google Scholar Correlation of ICG lymphography and lymphoscintigraphy severity stage in secondary upper limb lymphedemaJournal of Plastic, Reconstructive & Aesthetic SurgeryVol. 73Issue 11PreviewTo examine the correlation between lymphedema severity stages on lymphoscintigraphy and on indocyanine green (ICG) lymphography in patients with secondary lymphedema after breast cancer. Full-Text PDF