Fluorescence Imaging Capabilities in Secondary Lymphedema Following Comprehensive Treatment of Malignant Neoplasms: A Case Series

Background. Secondary upper limb lymphedema is a complication of multimodal treatment for malignant neoplasms associated with damage to the regional lymphatic system. Indocyanine green (ICG) fluorescence lymphography enables real-time visualization of superficial lymphatic vessels and assessment of lymphatic drainage patterns. However, data on fluorescence patterns in secondary lymphedema of different oncological etiologies and their clinical significance remain limited. Objective. To evaluate the diagnostic potential of ICG fluorescence lymphography for detecting and characterizing lymphatic drainage abnormalities in female patients with secondary upper limb lymphedema following multimodal treatment for malignant neoplasms. Materials and Methods. A case series of 10 female patients with secondary upper limb lymphedema following treatment for breast cancer (n = 7), melanoma (n = 2), and cutaneous squamous cell carcinoma (n = 1) was analyzed. The duration of lymphedema before examination ranged from 3 months to 2–3 years. All patients underwent ICG fluorescence lymphography. Results. Fluorescence lymphography revealed four lymphatic drainage patterns: a linear pattern and three types of dermal backflow, namely splash, stardust, and diffuse patterns. The characteristics and extent of fluorescence abnormalities reflected the underlying alterations in lymphatic drainage. Visualization of preserved lymphatic collectors enabled identification of their anatomical location and potential sites for lymphovenous anastomosis. Conclusion. ICG fluorescence lymphography enabled characterization of lymphatic drainage abnormalities and visualization of preserved superficial lymphatic collectors. The findings demonstrated the potential utility of this technique for assessing lymphatic dysfunction, individualizing treatment strategies, and facilitating preoperative planning of lymphovenous anastomosis.