Changes in Indocyanine Green Lymphography Patterns after Physical Treatment in Secondary Upper Limb Lymphedema

Indocyanine green (ICG) lymphography is used to evaluate the lymphatic function before and after pneumatic compression or post-manual lymphatic drainage. The aim of this study was to ascertain the changes in the fluoroscopic pattern produced by the provision of complex physical therapy. This prospective analytic (pretest-posttest) study was conducted in 19 patients with upper lymphedema secondary to breast cancer. Nine patients were excluded due to ICG found after 3 weeks. The ICG patterns were analyzed under basal conditions and after three weeks of treatment. After the treatment, 45% of the patients presented tracer remains in the affected limb, and this finding was significantly related to time of the lymphedema development. In one subject, the patterns remain unchanged or cannot be defined. Three of the ten patients observed present the worsening of at least 1 of the patterns and in the rest of the subjects, six cases, the improvement of the patterns is observed. In 60% of the cases, the most severe pattern reversed towards slight (splash) cases, and moderate cases reversed towards a slight case in 70% of cases. Therefore, after treatment with complex physical therapy, the pathological patterns observed in the pretest, which evolved positively, reverted their severity toward milder disease patterns or towards normality.

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The evaluation of selected physiotherapeutic methods in the treatment of post-mastectomy lymphoedema

Advances in Rehabilitation ◽

10.1515/rehab-2015-0063 ◽

2017 ◽

Vol 31 (2) ◽

pp. 5-15

Author(s):

Rafał Sapuła ◽

Joanna Braniewska ◽

Ryszard Weremczuk ◽

Marta Wolanin ◽

Joanna Sapuła

Keyword(s):

Breast Cancer ◽

Statistical Analysis ◽

Cancer Registry ◽

Upper Limb ◽

Lymphatic Drainage ◽

Upper Extremities ◽

Manual Lymphatic Drainage ◽

Physiotherapy Treatment ◽

Arm Circumference ◽

Before And After

Abstract Introduction: Breast cancer constitutes 10.9% of all new cases of tumours registered in the Polish National Cancer Registry. Post-mastectomy lymphoedema of the upper limb is the most common post-operative complication. The aim of the study was to evaluate the effectiveness of selected physiotherapeutic methods in the treatment of post-mastectomy lymphoedema. Material and methods: The study included 90 post-mastectomy patients in Stalowa Wola, Zamość and Tyczyn in the period from January 2014 to July 2016. The patients participated in two-week outpatient physiotherapy. In order to assess the effectiveness of lymphoedema treatment, circumferences of upper extremities were measured before and after physiotherapy. The results were then statistically analysed. Results: The majority of the subjects had undergone mastectomy within a period shorter than 5 years before. It was noted that the post-mastectomy upper limb had a significantly smaller circumference after physiotherapy than before physiotherapy (p<0.001). The study revealed no differences in the measurements of arm circumference with regard to the time since the mastectomy was performed. According to the patients, manual lymphatic drainage was the most effective type of physiotherapy treatment (p=0.04). Statistical analysis revealed significantly smaller arm circumferences after physiotherapy than before physiotherapy in patients treated 2-3 times (p=0.001) compared to patients who underwent either fewer or more treatments at the same time. Conclusions: 1. Two-week physiotherapy treatment proved to be the most effective in reducing lymphoedema in the arm area. 2. The period since the performance of the mastectomy had no impact on the effectiveness of lymphoedema treatment. 3. According to the post-mastectomy patients, manual lymphatic drainage was the most effective type of lymphoedema treatment. 4. Applying 2-3 physiotherapeutic procedures at the same time showed the best results.

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A new indocyanine green fluorescence lymphography protocol for identification of the lymphatic drainage pathway for patients with breast cancer-related lymphoedema

BMC Cancer ◽

10.1186/s12885-019-6192-1 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 9

Author(s):

Hiroo Suami ◽

Asha Heydon-White ◽

Helen Mackie ◽

Sharon Czerniec ◽

Louise Koelmeyer ◽

...

Keyword(s):

Breast Cancer ◽

Indocyanine Green ◽

Lymphatic Drainage ◽

Common Side Effect ◽

Upper Limbs ◽

Manual Lymphatic Drainage ◽

Imaging Data ◽

Spontaneous Movement ◽

Lymphatic Imaging ◽

Ipsilateral Axilla

Abstract Background Breast cancer related lymphoedema (BCRL) is a common side effect of cancer treatment. Recently indocyanine green (ICG) fluorescent lymphography has become a popular method for imaging the lymphatics, however there are no standard protocols nor imaging criteria. We have developed a prospective protocol to aid in the diagnosis and therapeutic management of BCRL. Methods Lymphatic imaging procedures were conducted in three phases. Following initial observation of spontaneous movement of ICG in phase one, manual lymphatic drainage (MLD) massage was applied to facilitate ICG transit via the lymphatics in phase two. All imaging data was collected in phase three. Continuous lymphatic imaging of the upper limb was conducted for approximately an hour and lymphatic drainage pathways were determined. Correlations between the drainage pathway and MD Anderson Cancer Centre (MDACC) ICG lymphoedema stage were investigated. Results One hundred and three upper limbs with BCRL were assessed with this new protocol. Despite most of the patients having undergone axillary node dissection, the ipsilateral axilla drainage pathway was the most common (67% of upper limbs). We found drainage to the ipsilateral axilla decreased as MDACC stage increased. Our results suggest that the axillary pathway remained patent for over two-thirds of patients, rather than completely obstructed as conventionally thought to be the case for BCRL. Conclusions We developed a new ICG lymphography protocol for diagnosing BCRL focusing on identification of an individual patient’s lymphatic drainage pathway after lymph node surgery. The new ICG lymphography protocol will allow a personalised approach to manual lymphatic drainage massage and potentially surgery.

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Visualization of Accessory Lymphatic Pathways, before and after Manual Drainage, in Secondary Upper Limb Lymphedema Using Indocyanine Green Lymphography

Journal of Clinical Medicine ◽

10.3390/jcm8111917 ◽

2019 ◽

Vol 8 (11) ◽

pp. 1917

Author(s):

María Elena Medina-Rodríguez ◽

María de-la-Casa-Almeida ◽

Efrén Martel-Almeida ◽

Arminda Ojeda-Cárdenes ◽

Esther M. Medrano-Sánchez

Keyword(s):

Indocyanine Green ◽

Upper Limb ◽

Statistical Significance ◽

Infrared Camera ◽

Lymphatic Drainage ◽

Secondary Lymphedema ◽

Before And After ◽

Post Test ◽

After Cancer ◽

Lymphatic Pathways

Manual Lymphatic Drainage (MLD) appears to stimulate lymphatic contraction, aid in the development of secondary derivation pathways, and stimulate the appearance of collateral pathways that could function as the main drainage routes of the limb in case of lymphedema. Through stretching, call up maneuvers are used to stimulate lymphangion reflex contraction and, therefore, lymphatic function. The aim was to describe the presence of areas and pathways of collateral lymphatic drainage under basal conditions and to determine, using Indocyanine Green (ICG) lymphography, whether an increase in these pathways occurs after 30 min of manual lymphatic stimulation with only call up maneuvers according to the Leduc Method®®. In this prospective analytical study (pretest–posttest), the frequency of presentation of areas and collateral lymphatic pathways was analyzed in 19 patients with secondary lymphedema of the upper limb after breast cancer using an infrared camera. Analyses were completed at three time points: after ICG injection, at baseline (pretest), and after the application of MLD (post-test). The Leduc Method maneuvers were applied to the supraclavicular and axillary nodes, chest, back, Mascagni, and Caplan pathways. The areas visualized in the pretest continued to be visible in the posttest. Additional pathways and fluorescent areas were observed after the maneuvers. The McNemar test showed statistical significance (p = 0.008), the odds ratio was infinite, and the Cohen’s g value was equal to 0.5. Manual stimulation by call up maneuvers increased the observation frequency of areas and collateral lymphatic pathways. Therefore, ICG lymphography appears to be a useful tool for bringing out the routes of collateral bypass in secondary lymphoedema after cancer treatment.

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Manual Lymphatic Drainage and Active Exercise Effects on Lymphatic Function Do Not Translate Into Morbidities in Women Who Underwent Breast Cancer Surgery

Archives of Physical Medicine and Rehabilitation ◽

10.1016/j.apmr.2016.06.024 ◽

2017 ◽

Vol 98 (2) ◽

pp. 256-263 ◽

Cited By ~ 1

Author(s):

Mariana Maia Freire de Oliveira ◽

Maria Salete Costa Gurgel ◽

Maria Teresa Pace do Amaral ◽

Bárbara Juarez Amorim ◽

Celso Darío Ramos ◽

...

Keyword(s):

Breast Cancer ◽

Lymphatic Drainage ◽

Cancer Surgery ◽

Breast Cancer Surgery ◽

Manual Lymphatic Drainage ◽

Lymphatic Function

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Manual Lymphatic Drainage in Blood Circulation of Upper Limb With Lymphedema After Breast Cancer Surgery

Journal of Manipulative and Physiological Therapeutics ◽

10.1016/j.jmpt.2017.02.009 ◽

2017 ◽

Vol 40 (4) ◽

pp. 246-249 ◽

Cited By ~ 2

Author(s):

Raquel Michelini Guerero ◽

Lais Mara Siqueira das Neves ◽

Rinaldo Roberto de Jesus Guirro ◽

Elaine Caldeira de Oliveira Guirro

Keyword(s):

Breast Cancer ◽

Upper Limb ◽

Blood Circulation ◽

Lymphatic Drainage ◽

Cancer Surgery ◽

Breast Cancer Surgery ◽

Manual Lymphatic Drainage

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Manual lymphatic drainage guided by real-time indocyanine green lymphography in breast cancer-related lymphedema

Archives of Plastic Surgery ◽

10.5999/aps.2020.01823 ◽

2021 ◽

Vol 48 (2) ◽

pp. 239-240

Author(s):

Pedro Ciudad ◽

Samyd S. Bustos ◽

Antonio J. Forte ◽

Maria T. Huayllani ◽

Oscar J. Manrique ◽

...

Keyword(s):

Breast Cancer ◽

Indocyanine Green ◽

Real Time ◽

Lymphatic Drainage ◽

Manual Lymphatic Drainage ◽

Breast Cancer Related Lymphedema

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Differences in lymph drainage between swollen and non-swollen regions in arms with breast-cancer-related lymphoedema

Clinical Science ◽

10.1042/cs1010131 ◽

2001 ◽

Vol 101 (2) ◽

pp. 131-140 ◽

Cited By ~ 35

Author(s):

A. W. B. STANTON ◽

W. E. SVENSSON ◽

R. H. MELLOR ◽

A. M. PETERS ◽

J. R. LEVICK ◽

...

Keyword(s):

Breast Cancer ◽

Regional Differences ◽

Removal Rate ◽

Lymphatic Drainage ◽

Lymph Flow ◽

Lymph Drainage ◽

Lymphatic Function ◽

Γ Radiation ◽

Image Width ◽

Proximal Forearm

Recent research indicates that the pathophysiology of breast-cancer-related lymphoedema (BCRL) is more complex than simple axillary lymphatic obstruction as a result of the cancer treatment. Uneven distribution of swelling (involvement of the mid-arm region is common, but the hand is often spared) is puzzling. Our aim was to test the hypothesis that local differences in lymphatic drainage contribute to the regionality of the oedema. Using lymphoscintigraphy, we measured the removal rate constant, k (representing local lymph flow per unit distribution volume, VD), for 99mTc-labelled human immunoglobulin G in the oedematous proximal forearm, and in the hand (finger web) in women in whom the hand was unaffected. Tracer was injected subcutaneously, and the depot plus the rest of the arm was monitored with a γ-radiation camera for up to 6 h. VD was assessed from image width. Contralateral arms served as controls. k was 25% lower in oedematous forearm tissue than in the control arm (BCRL, -0.070±0.026%·min-1; control, -0.093±0.028%·min-1; mean±S.D.; P = 0.012) and VD was greater. In the non-oedematous hand of the BCRL arm, k was 18% higher than in the control hand (BCRL, -0.110±0.027%·min-1; control, -0.095±0.028%·min-1; P = 0.057) and 59% higher than forearm k on the BCRL side (P = 0.0014). VD did not differ between the hands. Images of the BCRL arm following hand injection showed diffuse activity in the superficial tissues, sometimes extending almost to the shoulder. A possible interpretation is that the hand is spared in some patients because local lymph flow is increased and diverted along collateral dermal routes. The results support the hypothesis that regional differences in surviving lymphatic function contribute to the distribution of swelling.

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Fluid Shifts Induced by Physical Therapy in Lower Limb Lymphedema Patients

Journal of Clinical Medicine ◽

10.3390/jcm9113678 ◽

2020 ◽

Vol 9 (11) ◽

pp. 3678 ◽

Cited By ~ 1

Author(s):

Bianca Brix ◽

Gert Apich ◽

Andreas Roessler ◽

Christian Ure ◽

Karin Schmid-Zalaudek ◽

...

Keyword(s):

Physical Therapy ◽

Plasma Volume ◽

Bioelectrical Impedance ◽

Impedance Analysis ◽

Lymphatic Drainage ◽

Whole Body ◽

Fluid Composition ◽

Manual Lymphatic Drainage ◽

Complete Decongestive Therapy ◽

Fluid Shifts

Complete decongestive therapy (CDT), a physical therapy including manual lymphatic drainage (MLD) and compression bandaging, is aimed at mobilizing fluid and reducing limb volume in lymphedema patients. Details of fluid shifts occurring in response to CDT are currently not well studied. Therefore, we investigated fluid shifts before, during and after CDT. Thirteen patients (3 males and 10 females, aged 57 ± 8.0 years, 167.2 ± 8.3 cm height, 91.0 ± 23.4 kg weight) diagnosed with stage II leg lymphedema participated. Leg volume, limb and whole-body fluid composition (total body water (limbTBW/%TBW), extracellular (limbECF/%ECF) and intracellular (limbICF/%ICF fluid), as well as ECF/ICF and limbECF/limbICF ratios were determined using perometry and bioelectrical impedance spectroscopy. Plasma volume, proteins, osmolality, oncotic pressure and electrolytes were assessed. Leg volume (p < 0.001), limbECF (p = 0.041), limbICF (p = 0.005) and limbECF/limbICF decreased over CDT. Total leg volume and limbTBW were correlated (r = 0.635). %TBW (p = 0.001) and %ECF (p = 0.007) decreased over time. The maximum effects were seen within one week of CDT. LimbICF (p = 0.017), %TBW (p = 0.009) and %ICF (p = 0.003) increased post-MLD, whereas ECF/ICF decreased due to MLD. Plasma volume increased by 1.5% post-MLD, as well as albumin and the albumin-to-globulin ratio (p = 0.005 and p = 0.049, respectively). Our results indicate that physical therapy leads to fluid shifts in lymphedema patients, with the greatest effects occurring within one week of therapy. Fluid shifts due to physical therapy were also reflected in increased plasma volume and plasma protein concentrations. Perometry, in contrast to bioelectrical impedance analysis, does not seem to be sensitive enough to detect small fluid changes caused by manual lymphatic drainage.

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