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

Abstract

Objective: Diagnosis of lower limb lymphedema depends on clinical signs in most health organization. One ofthe recent investigational tools for lymphedema diagnosis is near infrared fluoroscopy lymphangiogram. The aimof our study was to evaluate the accuracy of clinical signs in lymphedema diagnosis in comparison to fluoroscopiclymphangiography. Also, to know the value of immediate and delayed lymphangiography in clinically diagnosedlymphedema patients.Patients and methods: Prospective Cohort study of 44 patients with 73 lower limbs swelling. All patients assessedby history, clinical examination. Body mass index has been measured. Immediate and delayed findings (After 24hours) 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 were77% and 58% respectively. The overall accuracy was 69 %. Forty six out of 73 limb swellings showed the classicalclinical 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 intodermal 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 diagnosisof lymphedema in about one third of pateints. Also, we cannot rely on immediate lymphangiographic fluoroscopyto exclude lymphedema.