Validity of Ultrasound-Guided Identification of Dilated Lymphatic Vessels to Detect Early Breast Cancer-Related Lymphedema

Abstract Early detection of breast cancer-related lymphedema (BCRL) is critical for timely intervention and preventing progression, but diagnostic modalities are limited. We assessed the validity of ultrasound-guided identification of dilated lymphatic vessels (UIDL) to detect early BCRL. A retrospective, observational study with 300 female patients evaluated for suspected BCRL in a lymphedema center between April 2019 and March 2023. All patients underwent gold standard to detect BCRL, indocyanine green (ICG) lymphography, staged by the MD Anderson grading system, and UIDL from the proximal one-third of the upper arm to the distal one-third of the forearm circumferentially. The association between UIDL, with a cutoff of ≥0.5 mm in diameter, and the detection of early BCRL by ICG lymphography was evaluated. In total, 264 (88%) cases were detected as BCRL by ICG lymphography. UIDL's area under the curve was 0.89 (95% CI: 0.84–0.94), with sensitivity of 86.2%, specificity of 91.7%, positive predictive value of 98.4%, and negative predictive value of 53.2%. UIDL showed high sensitivity and specificity in detecting early BCRL. This method may serve as a widely available, non-invasive screening tool during posttreatment surveillance.