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Assessing breast lymphoedema following breast cancer treatment using indocyanine green lymphography

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Abstract

Purpose

Breast lymphoedema is a largely unrecognised survivorship issue for women following breast cancer treatment. While a few objective methods have previously been applied to assess breast lymphoedema, none are capable of imaging breast lymphatics or identifying lymphatic morphological changes indicative of breast lymphoedema. The purpose of this study was to determine if indocyanine green (ICG) lymphography, a validated assessment technique in breast cancer-related lymphoedema), can visualise breast lymphatics and identify breast lymphoedema. Additionally, ICG lymphography was utilised to investigate lymphatic drainage pathways of the affected breast following breast-conserving therapy.

Methods

Twenty female participants (10 breast lymphoedema and 10 healthy controls) were recruited for this pilot study. All underwent a medical history, physical breast assessment, tissue dielectric constant measures of breast water content, and ICG lymphography.

Results

ICG lymphography identified lymphatic morphological changes in all breast lymphoedema participants (dermal backflow patterns = 10, collateral lymphatic drainage = 9) and none in the control group. The dominant lymphatic drainage pathway to the ipsilateral axilla was observed in all control participants but in only four breast lymphoedema participants. Collateral drainage pathways in the breast lymphoedema group were to: parasternal (6/10); contralateral axilla (4/10); intercostal (3/10); and clavicular (2/10) regions.

Conclusion

These findings suggest ICG lymphography, through the identification of morphological lymphatic changes, is a potential qualitative objective assessment technique for breast lymphoedema. Furthermore, in this group of breast lymphoedema patients it identified changes to the normal drainage pathway of the breast. Understanding these changes will have implications for clinical management.

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Abbreviations

BCRL:

Breast cancer-related lymphoedema

BCT:

Breast-conserving therapy

BMI:

Body mass index

ICG:

Indocyanine green

MLD:

Manual lymphatic drainage

TDC:

Tissue dielectric constant

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Acknowledgements

This research is supported by an Australian Government Research Training Program (RTP) scholarship and the Macquarie University ALERT research program.

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Authors and Affiliations

  1. Australian Lymphoedema Education Research and Treatment Program (ALERT), Department of Clinical Medicine, Faculty of Medicine, Health and Human Sciences, Macquarie University, Level 1, 75 Talavera Rd, Sydney, NSW, Australia

    Asha Heydon-White, Hiroo Suami, John Boyages & Louise Koelmeyer

  2. Icon Cancer Centre, Sydney, NSW, Australia

    John Boyages

  3. Department of Health Professions, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia

    Karen C. Peebles

Authors
  1. Asha Heydon-White
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  2. Hiroo Suami
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  3. John Boyages
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  4. Louise Koelmeyer
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  5. Karen C. Peebles
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Corresponding author

Correspondence to Asha Heydon-White.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study involving human participants were conducted in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards and approved by Macquarie University Human Research Ethics Committee (Reference Number 5201800263).

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Informed consent was obtained from all individual participants included in this study.

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Heydon-White, A., Suami, H., Boyages, J. et al. Assessing breast lymphoedema following breast cancer treatment using indocyanine green lymphography. Breast Cancer Res Treat 181, 635–644 (2020). https://doi.org/10.1007/s10549-020-05661-y

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  • DOI: https://doi.org/10.1007/s10549-020-05661-y

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