Use of Indocyanine green (ICG) lymphography in early detection of lymphedema and response assessment of compression therapy following axillary dissection in breast cancer patients, a prospective interventional study

Upper limb lymphedema is a common complication following breast cancer treatment.  Patient’s quality of life is severely affected. Subclinical lymphedema identification is great help for early treatment and may decrease the chance that the disease will progress to a chronic late stage. Lymphedema can be effectively treated with early identification, resulting in higher success rates and potential cost savings. Incidence of lymphedema varies from 5.6% to 63.4%.

 The symptoms of early lymphedema may indicate a sub-clinical lymphatic system disorder without a significant increase in arm circumference. This initial dysfunction can be detected through complementary tests such as indirect lymphography or indocyanine green (ICG) lymphography.

 Indocyanine Green (ICG) lymphography is now commonly used to visualize the lymphatic system. Initially, it was used for breast sentinel node biopsy. Its application extends to lymphoedema diagnosis and mapping lymphatic vessels prior to lymphovenous anastomosis (LVA) surgery. ICG lymphography is a newer technique , has higher specificity and sensitivity than lymphoscintigraphy. It has the advantage of having quick pathological visualization of superficial lymph flow in real time, without any radiation exposure.  It can reliably and accurately diagnose, track, and stage the severity of lymphedema, ranging from sub clinical or early lymphedema to more advanced cases.