In this February Issue, Campisi and colleagues present "Rationale for Study of the Deep Subfascial Lymphatic Vessels During Lymphoscintigraphy for the Diagnosis of Peripheral Lymphedema". This manuscript proposes a standardized comprehensive 2-compartment lymphoscintigraphy protocol including imaging superficial and deep lymphatic vessels. Segmental lymphoscintigraphy was performed on 258 participants with lymphedema. Their transport indexes (TI) were calculated to categorize the flow of the superficial and deep vessels as normal (<10) or pathological (≥10). The scores from 248 patients (48 unilateral arm, 86 unilateral leg, 114 bilateral leg) were tested with a 3-way analysis of variance to establish the relationship between affected limb, deep or superficial pathways, and primary or secondary lymphedema. The relationship between clinical presentation and TI was also investigated.
Primary and secondary lymphedema patients had similar patterns of lymphoscintigraphic lymphatic abnormalities. Patients with unilateral clinical edema can have bilateral TI abnormalities. Most patients (88%–98%) had either the deep subfascial vessels alone, or both the superficial and deep vessels involved with a pathological TI.
Authors concluded that a 2-compartment lymphoscintigraphy approach can accurately detect lymphatic flow abnormalities in patients with limb swelling. As most patients had deep lymphatic vessel abnormalities, inclusion of these vessels in the lymphoscintigraphic diagnostic protocol is recommended.