Indocyanine green lymphography-guided personalized conservative management recommendations in breast cancer-related upper limb lymphedema: a retrospective study

Purpose: Breast cancer-related upper limb lymphedema (BCRL), once established, requires lifelong self-management. Indocyanine green lymphography (ICGL) imaging is an approach used to visualize lymphatics to diagnose, stage, and guide lymphedema treatment. The impact of ICGL-based personalized conservative management on clinical outcomes (extracellular fluid measured by Lymphedema index [L-Dex] units) is unknown. This study aimed to explore the changes in strategies for BCRL management and clinical outcomes for 3 months following ICGL imaging.

Methods: Data from 20 female adults with BCRL who underwent ICGL imaging at the Australian Lymphedema Education Research and Treatment Center clinic at Macquarie University were included in this study. Data related to the ICGL findings, personalized conservative recommendations, and objective outcome measures were extracted. Data were analyzed retrospectively.

Results: Conservative recommendations post-ICGL were significantly different in the number of strategies from the pre-ICGL (median [IQR] = 6 [2] vs. 3 [6], p < 0.001). Likewise, the number of compression garments and types of fabric (flat knit) prescribed were significantly higher following ICGL, and these changes were largely maintained by participants at 3 months. There were positive influences of ICGL-guided conservative management changes on bioimpedance spectroscopy, indicating improvements in lymphedema severity.

Conclusion: ICGL-guided personalized conservative recommendations often led to changes in participants' management, resulting in positive clinical outcomes.