P30. Nonlinear ICG Lymphography Findings: An Indication for Lymphatic Surgery?

PURPOSE: Approximately two thirds of patients will not develop breast cancer-related lymphedema (BCRL) after axillary lymph node dissection (ALND). We recruited volunteer female breast cancer survivors at least 2 years after ALND without a history of BCRL for lymphedema surveillance measures and lymphatic imaging. METHODS: Female breast cancer survivors treated with ALND without a BCRL diagnosis were recruited and treatment records were obtained. Volunteers underwent bilateral limb volume measurements by perometry and bilateral bioimpedance measures with L-dex to exclude BCRL. Lymphatic imaging in the affected arm was performed with ICG lymphography and SPECT/CT lymphoscintigraphy. Relative limb volume difference (%), affected arm L-dex score, nonlinear anatomy on ICG, and dermal backflow on lymphoscintigram were recorded. RESULTS: Twenty consecutive volunteers completed the study. The median time from surgery was 11.2 years and a median of 13.5 axillary lymph nodes were removed. In the affected arm, the median relative limb volume difference was 2.2% and the median L-dex score was -0.4. Abnormal, nonlinear ICG signs in the affected arm were visualized in 70% of volunteers. Dermal backflow in the affected arm was visualized on SPECT/CT lymphoscintigraphy in zero volunteers. CONCLUSION: We observed abnormal, nonlinear ICG signs in the absence of dermal backflow on SPECT/CT lymphoscintigraphy in 70% (14/20) of volunteers without BCRL at least 2 years after ALND. Nonlinear ICG signs may commonly develop after ALND without clinical detection. Nonlinear ICG signs in the absence of positive lymphedema surveillance measures or dermal backflow on SPECT/CT lymphoscintigraphy do not warrant surgical intervention.