Innovative tools for screening and diagnosis

Unfortunately, some cancer treatments, including chemotherapy, surgery and radiotherapy make some people at high risk (up to 40%) for developing lymphedema. As swelling of an affected limb is in fact a clinical feature of an established lymphedema, We believe that screening for early signs of lymphedema offers the best prevention of developing lymphedema following cancer treatment. Indeed, when early signs of lymphedema are detected on lymph-fluoroscopy, supra-microsurgery can be performed timely before lymphedema becomes clinically apparent and before lymphatic vessels have deteriorated.

Lymphofluoroscopy or lymphography is a dynamic examination to map the lymphatics with use of subcutaneously injected fluorescent dye, called indocyanine green (ICG). The ICG binds to a protein (albumin), which is taken up into the lymphatics and transported with the lymphatic fluid. Lymph-fluoroscopy also provides information on the function of the lymphatics by measuring the speed of the lymphatic transport.

In normal lymphatics, the ICG is quickly (in seconds-minutes) transported through the lymphatic system resulting in the visualisation of a normal linear pattern. In lymphedema however, the normal flow of lymphatic fluid is interrupted which generates an increased pressure within the lymphatics. This leads to further damage of the vessels and makes that lymph fluid leakes out into the surrounding tissue; this pattern is called dermal backflow.

Lymphofluoroscopy is used for screening, diagnosis and treatment of lymphedema.