In addition, it is possible to assemble data from SPECT-CT LSG in the form of images, similar to images obtained via plain LSG. This modality provides three-dimensional live images of lymph flow, unlike cadaveric studies that provide only anatomical information on the lymphatic system 14. Recently, we have used single photon emission computed tomography-computed tomography (SPECT-CT) LSG for the diagnosis of lymphoedema. Although a correlation was suspected between the location of DBF, severity of lymphoedema, and the positive rate of the lymph nodes around the clavicle in an LSG study in 2011, the underlying mechanism has not been investigated in previous research 10. Conversely, the number of patients in whom lymph nodes around the clavicle can be identified by LSG decreases as the severity increases 10. Conditions affecting the collecting lymph duct tend to deteriorate from the proximal region hence, the lymphoedema becomes increasingly severe as the DBF appears and progresses distally 13. Dermal back flow (DBF) on LSG images refers to the phenomenon of lymph back flow from the collecting lymph duct to the dermis 11, 12. A correlation has previously been reported between the clinical stage and the types of images acquired by LSG in patients with secondary upper limb lymphoedema 10. Some modalities, such as lymphoscintigraphy (LSG), which is recommended by the International Society of Lymphology, and near-infrared fluorescent lymphography with indocyanine green, are considered effective for the diagnosis of lymphoedema 8, 9. in 2013, 21.4% of breast cancer patients have upper limb lymphoedema, 28.2% of patients who undergo axillary lymph node dissection develop upper limb lymphoedema, and 5.6% of patients who undergo sentinel lymph node biopsy develop upper limb lymphoedema 7.Īlthough clinical history and physical examination are important in the diagnosis of lymphoedema, there are no distinct diagnostic criteria. According to a meta-analysis by DiSipio et al. In developed countries, breast cancer typically precedes the onset of secondary upper limb lymphoedema. Primary lymphoedema is congenital or of unknown origin, whereas secondary lymphoedema is caused by infection, trauma, or cancer treatment 2, 5, 6. Lymphoedema is classified into primary and secondary types, on the basis of the cause and presence of underlying disease. Patients suffer both physically and mentally during the clinical course of the disease, and the economic burden is not negligible 1, 3, 4. Lymphoedema is caused by dysfunction of the lymphatic system that leads to pathological retention of fluid and solutes 1, 2. These findings demonstrate the features of lymphoedema pathology and the functional anatomy and physiology of the lymphatic system without the need for cadaver dissection. As the severity of lymphoedema increased, the DBF appeared more distally in the upper limb and the flow into the lymph nodes around the clavicle decreased, whereas the lymph flow pathways in the muscle layer became dominant. A significant positive correlation was found between the dermal back flow (DBF) type and the visualization of lymph nodes around the clavicle ( p = 0.000266), the type of lymph flow pathways and the visualization of lymph nodes around the clavicle ( p = 0.00963), and the DBF type and the lymph flow pathway (p = 0.00766). We observed lymph flow pathways in the subcutaneous and muscle layers of the upper limbs. In this study, we examined the pathology of lymphoedema using single photon emission computed tomography-computed tomography lymphoscintigraphy (SPECT-CT LSG), a new technique that provides 3-dimensional information on lymph flow. Although conventional lymphoscintigraphy is a useful technique to diagnose the severity of lymphoedema, the resultant data are two-dimensional. However, there are no distinct diagnostic criteria for lymphoedema. Diagnosis is primarily based on clinical features. Secondary upper limb lymphoedema is usually caused by lymphatic system dysfunction.
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