Reliability of Clinical Signs to Diagnose Lower Limb Lymphedema in Comparison to Immediate and Delayed Near Infrared Fluoroscopic Lymphangiography

Document Type : Original Article

Authors

1 Lecturer of Vascular Surgery, Faculty of Medicine, Port Said University, Egypt

2 Lecturer of Radiology, Faculty of Medicine, Alexandria University, Egypt

3 Assistant Professor of Vascular surgery, Faculty of medicine, Kafr El-Shikh University, Egypt

Abstract

Objective: Diagnosis of lower limb lymphedema depends on clinical signs in most health organization. One of
the recent investigational tools for lymphedema diagnosis is near infrared fluoroscopy lymphangiogram. The aim
of our study was to evaluate the accuracy of clinical signs in lymphedema diagnosis in comparison to fluoroscopic
lymphangiography. Also, to know the value of immediate and delayed lymphangiography in clinically diagnosed
lymphedema patients.
Patients and methods: Prospective Cohort study of 44 patients with 73 lower limbs swelling. All patients assessed
by history, clinical examination. Body mass index has been measured. Immediate and delayed findings (After 24
hours) of near infrared lymphography of subcutaneous injection of Indocyanine Green has been documented.
Results: The sensitivity and specificity of clinical signs in predicting fluoroscopic -confirmed lymphedema were
77% and 58% respectively. The overall accuracy was 69 %. Forty six out of 73 limb swellings showed the classical
clinical signs of lymphedema. Twenty five of them showed normal lymphatic pattern by immediate fluoroscopy.
One half of this group showed changes of images of fluorescent lymphangiography after 24 hours of injection into
dermal backflow pattern. The sensitivity of clinical signs in predicting lymphedema was 77%, specificity was 58%.
The overall accuracy was 69%.
Conclusions: These results would suggest clinical signs of lymphedema unreliable in making a correct diagnosis
of lymphedema in about one third of pateints. Also, we cannot rely on immediate lymphangiographic fluoroscopy
to exclude lymphedema.

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