70 Navigating Lymphedema: The Impact of Indocyanine Green Lymphography (ICG_L) on Personalized Therapy Outcomes in Patients With Breast Cancer (BC)

Publication
Article
Miami Breast Cancer Conference® Abstracts Supplement41st Annual Miami Breast Cancer Conference® - Abstracts
Volume 38
Issue 4
Pages: 81

Navigating Lymphedema: The Impact of Indocyanine Green Lymphography (ICG_L) on Personalized Therapy Outcomes in Patients With Breast Cancer (BC)

Navigating Lymphedema: The Impact of Indocyanine Green Lymphography (ICG_L) on Personalized Therapy Outcomes in Patients With Breast Cancer (BC)

Background

Conventional methods of diagnosing and monitoring breast cancer–related lymphedema (BCRL) through tape arm measurements and bioimpedance screening have been utilized in routine clinical practice, while both techniques are acknowledged to have their respective strengths and limitations in therapy management and follow-up. However, there is a growing interest in more advanced diagnostic tools that can detect early lymphatic changes before they manifest clinically.

In this study, we aim to elucidate the role of indocyanine green lymphography (ICG_L) in the early diagnosis of BCRL among high-risk BC survivors and evaluate the efficacy of personalized physical therapy interventions informed by ICG_L findings.

Methods

From October 2018 to December 2021, we enrolled patients in our early detection and prevention program. Eligible participants had undergone axillary lymph node dissection (ALND), received regional/nodal irradiation therapy, or had lymphedema symptoms. All patients underwent ICG_L for the diagnosis of lymphedema and to initiate personalized comprehensive compression lymphedema therapy.

Results

Among 154 BC survivors at high risk for BCRL, 184 arms were evaluated with ICG_L. The mean (SD) age of the patients was 54.7 (11.9) years. A significant number of patients were overweight (49 patients [31.8%] ) or obese (73 patients [47.4% = ]). While the majority (106 patients [68.8% = ]) had undergone a mastectomy, 96 patients (52.2% = ) had an axillary lymph node dissection, and 61 patients (40% = ) underwent a contralateral mastectomy. Regional/nodal irradiation therapy was given to 87 patients (56.5%). In all, 73.4% of the patients presented episodic lymphedema symptoms varied, with episodic swelling being predominant in 29.9% (n = 55) of the arms, pain and altered sensation noted in 32.6% (n = 60), decreased range of movement found in another 30.4% (n = 56), and tightness or heaviness reported by 10.3% (n = 19). Remarkably, a small 3.8% (n = 7) had a history of upper extremity cellulitis.

Initial ICG_L analysis on admission revealed that 57.1% (n = 105) of the arms had no lymphedema with patent lymphatics and optimal lymphatic flow. In contrast, 22.3% (n = 41) were considered to have stage 1 lymphedema, 17.9% (n = 33) were at stage 2, and 2.7% (n = 5) of the arms were at stage 3. Tailored comprehensive lymphedema treatment for those diagnosed with ICG_L is based on a combination of self-care measures, personalized compression therapies, and physiotherapy. Patients were monitored for a median duration of 27 months (range, 14-58 months). At last visit, 4.3% (n = 8) of the patients presented with clinical lymphedema.

Conclusion

Although longer follow-up is needed, these results suggest that early diagnosis with ICG_L and preventive tailored treatment enhance clinical outcomes, potentially preventing clinical lymphedema in up to 94.7% of high-risk patients for BCRL.

Articles in this issue

48 The Era ‘or Error’ of Second Localization Procedures
48 The Era ‘or Error’ of Second Localization Procedures
49 The Influence of Race on Complications in Breast Conservation Surgery: A Single Institution Study
49 The Influence of Race on Complications in Breast Conservation Surgery: A Single Institution Study
51 Ductal Carcinoma In Situ With Microinvasion on Biopsy—What Are the Predictors of Upstaging?
51 Ductal Carcinoma In Situ With Microinvasion on Biopsy—What Are the Predictors of Upstaging?
52 UK Experience of Non-Radioisotope, Non-Magnetic Guided Breast Wide Local Excision and Sentinel Node Biopsy
52 UK Experience of Non-Radioisotope, Non-Magnetic Guided Breast Wide Local Excision and Sentinel Node Biopsy
53 The Utility of Sentinel Lymph Node Biopsy in High-Grade Ductal Carcinoma In Situ
53 The Utility of Sentinel Lymph Node Biopsy in High-Grade Ductal Carcinoma In Situ
54 The Evaluation of Expression Levels of CXCR4, CXCL12, and LASP1 Genes in Peripheral Blood Samples of Breast Cancer Patients
54 The Evaluation of Expression Levels of CXCR4, CXCL12, and LASP1 Genes in Peripheral Blood Samples of Breast Cancer Patients
55 Language as a Barrier to Deep Inspiration Breath Hold (DIBH) Radiation Therapy for Left  Breast Cancer
55 Language as a Barrier to Deep Inspiration Breath Hold (DIBH) Radiation Therapy for Left Breast Cancer
56 Predictive Factors Correlating With Pathologic Complete Response Rates in Racially Diverse, Minority Populations Receiving Neoadjuvant Therapy for HR+/HER2– Breast Cancer
56 Predictive Factors Correlating With Pathologic Complete Response Rates in Racially Diverse, Minority Populations Receiving Neoadjuvant Therapy for HR+/HER2– Breast Cancer
57 Addressing Barriers to Identifying Patients With HER2-Low Metastatic Breast Cancer in a Large Community Oncology Practice
57 Addressing Barriers to Identifying Patients With HER2-Low Metastatic Breast Cancer in a Large Community Oncology Practice
58 Prospective Longitudinal Assessment of Financial Toxicity Among Breast Cancer Patients
58 Prospective Longitudinal Assessment of Financial Toxicity Among Breast Cancer Patients
59 Acceptability of Microbiome Sampling-Based Surgical Oncology Research in Minority Breast Cancer Patients
59 Acceptability of Microbiome Sampling-Based Surgical Oncology Research in Minority Breast Cancer Patients
60 Racial Disparities in Hospitalization Outcomes Among Women With Metastatic Breast  Cancer in the United States by Palliative Care Utilization
60 Racial Disparities in Hospitalization Outcomes Among Women With Metastatic Breast Cancer in the United States by Palliative Care Utilization
61 High-Risk Screening Compliance in Women Diagnosed With Breast Cancer and a History of Thoracic Radiation Prior to Age 30
61 High-Risk Screening Compliance in Women Diagnosed With Breast Cancer and a History of Thoracic Radiation Prior to Age 30
62 The Impact of Genomic Assays on Breast Cancer Systemic Therapy Treatment Decisions in a Mostly Black Patient Population
62 The Impact of Genomic Assays on Breast Cancer Systemic Therapy Treatment Decisions in a Mostly Black Patient Population
63 Choice Architecture Bias in Genetic Counseling of Breast Cancer Patients
63 Choice Architecture Bias in Genetic Counseling of Breast Cancer Patients
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