CLASSIFICATION OF LYMPHOSCINTIGRAPHY AND RELEVANCE TO SURGICAL INDICATION FOR LYMPHATICOVENOUS ANASTOMOSIS IN UPPER LIMB LYMPHEDEMA

Abstract

Upper limb lymphedema that developsafter breast cancer surgery causes physicaldiscomfort and psychological distress, and itcan require both conservative and surgicaltreatment. Lymphaticovenous anastomosis hasbeen reported to be an effective treatment;however the disease severity criteria thatdefine indications for this treatment remainunclear. Here, we examined lymphoscintigraphicfindings in 78 patients with secondaryupper limb lymphedema and classified theminto 5 major types (Type I-V) and 3 subtypes(Subtype E, L, and 0). Results revealed thatthis classification is related to the clinicalstage scale of the International Society ofLymphology. Based on intraoperativeexamination findings in 20 of the 78 patients,lymphatic pressure is likely to be furtherelevated in Type II-V cases which are characterizedby the presence of dermal back flow.Therefore, lymphaticovenous anastomosisshould be considered as a treatment option forlymphedema in Type II-V cases. Furthermore,there are only limited lymph vessel sites usablefor lymphaticovenous anastomosis in moresevere lymphedema types [Types IV and TypeV (which is characterized by dermal back flowonly in the hand)]. The findings in Type IV-Vcases suggest that therapeutic strategies forsevere upper limb lymphedema need furtherconsideration.