Dynamic Indocyanine Green (ICG) Lymphography for Breast Cancer-Related Arm Lymphedema

BACKGROUND: Lymph transportation capacity is a critical function maintaining fluid circulation. After breast cancer treatments, lymph obstruction at the axilla leads to abnormal lymph circulation, resulting in lymph pump dysfunction. As well as lymph circulation, lymph pump function is important for lymphedema evaluation. METHODS: We assessed and analyzed lymph transportation capacity of 15 breast cancer-related arm lymphedema patients using dynamic indocyanine green (ICG) lymphography. RESULTS: ICG velocity and transit time could evaluate lymph pump function; ICG velocity decreases and transit time increases as the lymphedema severity stage progresses. Measurement of ICG velocity required 3 minutes after the dye injection, whereas that of transit time took more than 1 hour in severe cases. CONCLUSIONS: ICG velocity can be easily obtained and is recommended for evaluation of lymph pump function. Dynamic ICG lymphography, which evaluates both lymph pump function and circulation, plays an important role in comprehensive assessment of lymphedema pathophysiology.