Application of indocyanine green lymphography in the diagnosis and treatment of secondary upper extremity lymphedema: a systematic review

Background: Lymphedema is a chronic progressive disease that impairs patients’ physical and psychological health. This study aimed to conduct a systematic review of the application of indocyanine green (ICG) lymphography for the diagnosis and treatment of secondary upper extremity lymphedema. Methods: We searched PubMed for studies on ICG lymphography for secondary upper extremity lymphedema that were published until April 2024. The quality of included studies was assessed according to the Joanna Briggs Institute Review’s Manual. Qualitative synthesis using only descriptive statistics was performed. Results: Of the 523 articles screened, 32 met the eligibility criteria. Most of the studies were observational (4 cohort studies and 28 case series). For this review, 1,869 patients with secondary lymphedema and 112 volunteers were identified. ICG lymphography for diagnostic imaging of secondary lymphedema was reported to have a sensitivity of 89.5% and a specificity of 85.7% and was particularly useful for the diagnosis of early lymphedema. A severity staging system based on ICG lymphography images for secondary lymphedema was also reported. In the lymphaticovenous anastomosis (LVA) surgery, ICG lymphography was helpful in detecting functional lymphatic vessels preoperatively and in localizing lymphatic vessels and assessing LVA patency intraoperatively, thereby facilitating smaller skin incision and shorter operating time. Conclusions: ICG lymphography has a great value in the diagnosis and treatment of secondary upper extremity lymphedema.