Lymphology (LYMPHOLOGY )

Publisher: International Society of Lymphology

Description

The journal Lymphology, the official organ of the Society, is published quarterly. The journal contains original articles, editorials, abstracts, and information regarding the Society. It publishes papers and special symposia dealing with clinical and basic studies of the lymphatic system and related fields. Original ideas, bold hypotheses, historical reflections, and exciting observations are printed in the column "Lymphspiration".

  • Impact factor
    1.02
    Show impact factor history
     
    Impact factor
  • 5-year impact
    1.09
  • Cited half-life
    0.00
  • Immediacy index
    0.23
  • Eigenfactor
    0.00
  • Article influence
    0.33
  • Website
    Lymphology website
  • Other titles
    Lymphology
  • ISSN
    0024-7766
  • OCLC
    1756333
  • Material type
    Periodical
  • Document type
    Journal / Magazine / Newspaper

Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: There is no consensus on the definition of Breast Cancer Related Lymphedema of the arm (BCRL) because there are no agreed standards in measurement methods and diagnostic criteria. The main objective of this study is to compare mobile infrared optoelectronic volumetry with a Perometer with two commonly used methods for the evaluation of arm volume in patients with different degrees of BCRL. Bilateral arm volumes of eighty participants, with and without clinical BCRL, were calculated with a mobile Perometer, by water displacement, and with circumferential measurements, integrated in the frustrum, single frustrum, and disc model method. The ICC of the Perometer was between 0.997 and 0.999. The frustrum and disc model method produced the largest volume measurements and water displacement the smallest, while Perometer measures were in between. On average, volume of the dominant arm was found to be 2.2% higher than the non-dominant arm in the healthy control group, cautioning for intra- patient differences between both arms when comparing ipsilateral to contralateral arm for the diagnosis of BCRL with a threshold value. Future research would likely benefit from the use of the Perometer compared to the other arm volume evaluation tools for BCRL, and further, the single frustrum method should not be used for volume estimations of edematous arms.
    Lymphology 09/2013; 46(3):132-43.
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    ABSTRACT: Graduated compression stockings have been advocated for prevention of lymphedema after inguinal lymph node dissection (ILND) although scientific evidence of their efficacy in preventing lymphedema is lacking. The primary objective of this study was to assess the efficacy of class II compression stockings for the prevention of lymphedema in cancer patients following ILND. Secondary objectives were to investigate the influence of stockings on the occurrence of wound complications and genital edema, health-related quality of life (HRQoL) and body image. Eighty patients (45 with melanoma, 35 with urogenital tumors) who underwent ILND at two specialized cancer centers were randomly allocated to class II compression stocking use for six months or to a usual care control group. Lymphedema of the leg and genital area, wound complications, HRQoL, and body image were assessed at regular intervals prior to and up to 12 months after ILND. No significant differences were observed between groups in the incidence of edema, median time to the occurrence of edema, incidence of genital edema, frequency of complications, HRQoL, or body image. Based on the results of the current study, routine prescription of class II graduated compression stockings after ILND should be questioned and alternative prevention strategies should be considered.
    Lymphology 09/2013; 46(3):120-31.
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    ABSTRACT: Lymphoscintigraphy is a safe and reliable technique for investigating lymphedema. However, interpretation of delayed planar conventional imaging may be questionable due to the superimposition of soft tissues. Therefore, the aim of this retrospective study was to evaluate the contribution of single photon emission computed tomography/computed tomography (SPECT/CT) to lymphoscintigraphic investigation in a selected population with abnormal interstitial activity. Forty one patients with lower limb lymphedema either primary (n=17) or secondary (n=5), or associated with chronic venous insufficiency (n=19) underwent lymphoscintigraphy according to a standard protocol. SPECT/CT imaging that started immediately after planar imaging covered the part of the lower limbs with the most significant interstitial activity. The CT images were also analyzed separately to identify the typical honeycomb pattern of lymphedema. SPECT/CT identified additional abnormalities in vessels and soft tissues in 19 patients (46%). The additional information, primarily related to dermal collateralization of flow, dermal backflow, lymphangioma, and lymphorrhea, aided in understanding the physiopathology of edema and may have influenced management in 35 patients (85%). The honeycomb appearance of the soft tissues was noted on CT in most patients (90%). This study suggests that SPECT/CT is a promising addition to planar imaging in lymphoscintigraphic investigations of lymphedema.
    Lymphology 09/2013; 46(3):106-19.
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    ABSTRACT: In acute pancreatitis (AP), inflammatory cells and products disseminated in abdominal lymph and blood induce systemic inflammation. Interruption of abdominal lymph flow, and thereby reduction of lymphatic dissemination, could alter the course of the disease. Therefore, we investigated whether thoracic duct ligation (TDL) in a rat model of cerulein-induced AP results in reduced lung damage as a marker for reduction of systemic dissemination through the lymphatic system. Thirty-four male rats were assigned to TDL (TDL-rats, n=8), AP (AP-rats, n=8), TDL+AP (TDL+AP-rats, n=9) or sham TDL (Ctr-rats, n=9) groups. TDL and sham TDL were established first. Two days later, AP was induced in AP- and TDL+AP-rats by a series of subcutaneous injections of cerulein. Vehicle was injected in the same manner in Ctr- and TDL-rats as controls. Rats were sacrificed six hours after the end of the serial injections. Histological examination showed that AP-induced damage to the pancreas and ileum were similar in AP- and TDL+AP-rats whereas lung damage was less severe in TDL+AP-rats than in AP-rats. Assays demonstrated that: hepatic and pulmonary myeloperoxidase activities were increased in AP-rats but not in the TDL+AP-rats; more Il-6 was found in AP-rat than TDL+AP-rat lungs; and lung-lavage fluid from AP-rats yielded more angiopoietin-2 than TDL+AP-rats. In conclusion, prior TDL in the rat attenuates lung damage in acute pancreatitis.
    Lymphology 09/2013; 46(3):144-9.
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    ABSTRACT: Risk factors for cellulitis in lymphedema (LE) have never been evaluated in controlled studies. The objective of this study was to assess the risk factors for cellulitis in patients with LE using a case-controlled study method. Medical records of patients from November 2009 to September 2011 who met the following criteria were retrieved and analyzed: (a) clinical diagnosis of LE of the limb, (b) aged 18 or above, (c) no food allergy history and (d) no medical diagnosis of cancer metastasis. Overall, there were 179 cases of LE with cellulitis. Each case was matched by age (+/- 5 years) and gender with a patient with LE and without cellulitis for controls. Logistic regression with backward selection procedure was used to identify independent risk factors. The area under the receiver operating characteristics (ROC) curve of the final model was calculated. Independent risk factors for cellulitis in patients with LE were percentage difference in circumference of the limb (adjusted odds ratio (AOR)=1.07, 95% confidence interval (CI)=1.04-1.10), primary LE diagnosis (AOR=3.36, 95% CI=1.37-8.22), food-induced complication experiences (FIE: AOR=6.82, 95% CI=2.82-16.51) and systolic blood pressure (AOR=1.02, 95% CI=1.01-1.04). The area under the curve for the model was 0.80 (95% CI=0.75-0.85, p<0.001). No association was observed with hypertension, diabetes mellitus, body mass index and the duration of LE. This first case-controlled study highlights the important roles of dietary factors, percentage difference in circumference of the limb, and systolic blood pressure for developing cellulitis. The results suggest that controlling the percentage difference in circumference of the limb and systolic blood pressure together with restriction of fatty food and meat consumption may result in a decreased incidence of cellulitis among patients with LE.
    Lymphology 09/2013; 46(3):150-6.
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    ABSTRACT: We sought to develop a formula to quantify breast cancer-related lymphedema (BCRL) after bilateral breast surgery, which functions independently of the contralateral arm and accounts for fluctuations in patient weight. Perometer arm measurements from 265 unilateral breast surgery patients were analyzed. We assessed the relationship between change in patient weight and contralateral arm volume and developed a weight-adjusted volume change formula (WAC). The WAC formula and previously-established RVC formula were compared for classification of BCRL (> or = 10% volume increase) in unilateral breast surgery patients. We then evaluated BCRL incidence using the WAC formula in 225 bilateral mastectomy patients. Change in patient weight and contralateral arm volume demonstrated an approximately linear relationship. Weight-adjusted arm volume change (WAC) was therefore calculated as WAC = (A2*W1)/(W2*A1) - 1 where A1 is pre-operative and A2 is post-operative arm volume, and W1, W2 are the patient's corresponding weights. In the unilateral analysis, there was no significant difference in number of patients classified as having BCRL using the RVC and WAC formulas (p = 0.65). In bilateral mastectomy patients 11.1% (25/225) developed BCRL, defined as > or = 10% WAC. Independent risk factors for lymphedema included axillary lymph node dissection (ALND) and higher pre-operative BMI (p<0.05). Use of this weight-adjusted arm volume change formula should be of value for quantification of BCRL after bilateral breast surgery.
    Lymphology 06/2013; 46(2):64-74.
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    ABSTRACT: Advances in bioelectrical impedance analysis (BIA) permit the assessment of lymphedema by directly measuring lymph fluid changes. The objective of the study was to examine the reliability, sensitivity, and specificity of cross-sectional assessment of BIA in detecting lymphedema in a large metropolitan clinical setting. BIA was used to measure lymph fluid changes. Limb volume by sequential circumferential tape measurement was used to validate the presence of lymphedema. Data were collected from 250 women, including healthy female adults, breast cancer survivors with lymphedema, and those at risk for lymphedema. Reliability, sensitivity, specificity and area under the ROC curve were estimated. BIA ratio, as indicated by L-Dex ratio, was highly reliable among healthy women (ICC=0.99; 95% CI = 0.99 - 0.99), survivors at-risk for lymphedema (ICC=0.99; 95% CI = 0.99 - 0.99), and all women (ICC=0.85; 95% CI = 0.81 - 0.87); reliability was acceptable for survivors with lymphedema (ICC=0.69; 95% CI = 0.54 to 0.80). The L-Dex ratio with a diagnostic cutoff of >+7.1 discriminated between at-risk breast cancer survivors and those with lymphedema with 80% sensitivity and 90% specificity (AUC=0.86). BIA ratio was significantly correlated with limb volume by sequential circumferential tape measurement. Cross-sectional assessment of BIA may have a role in clinical practice by adding confidence in detecting lymphedema. It is important to note that using a cutoff of L-Dex ratio >+7.1 still misses 20% of true lymphedema cases, it is important for clinicians to integrate other assessment methods (such as self-report, clinical observation, or perometry) to ensure the accurate detection of lymphedema.
    Lymphology 06/2013; 46(2):85-96.
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    ABSTRACT: Post-mastectomy chronic lymphedema as a complication of breast cancer treatment is primarily managed with Complete Decongestive Therapy (CDT). We examined various factors for correlating with results of Phase I CDT treatment in controlling the upper extremity lymphedema. Study population consisted of patients with lymphedema referred to the Lymphedema Clinic of the Iranian Breast Cancer Research Center for control of arm edema. After obtaining the demographic and clinical data, patients were treated with CDT for 2 - 3 weeks. One hundred and thirty seven patients (mean age +/- SD; 53.5 +/- 10 years) were studied. In 48.7% of patients, the affected arm was the dominant limb. Fifty percent of patients experienced lymphedema during the first year after surgery, and mean duration of lymphedema was 35 +/- 43 months. Mean volume reduction was 43% +/- 14.87% (p = 0.03). There was a significant relationship between the percent of volume reduction and initial lymphedema volume (p=0.003) as well as duration of lymphedema (p=0.002). Our results demonstrate that Phase I CDT treatment is very effective for post mastectomy lymphedema, and particularly if it is provided in earlier stages of disease. In addition, CDT also has an important role in reducing clinical symptoms and improving limb function. In the appropriate setting, Phase I CDT has been an effective method of controlling post mastectomy lymphedema in this Iranian population.
    Lymphology 06/2013; 46(2):97-104.
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    ABSTRACT: The present study was aimed at observing both the damage and change process undergone in lymphatic collectors in obstructive extremity lymphedema. Forty-five patients with obstructive extremity lymphedema who had been examined with magnetic resonance lymphangiography (MRL) were enrolled in the study. Among this group, 36 were diagnosed with secondary lymphedema of the lower extremity and 9 exhibited upper extremity lymphedema after mastectomy. Morphological damage as a result of obstruction of collecting lymph vessels was recorded and analyzed. Obvious damage to the lymph vessels was found in all of the 36 lower extremity lymphedema cases with different lengths of history, including vessel disruption in 21 and lymphatic regeneration in 15. Lymphatic damage occurred in the anterior tibial area of the lower leg in almost every case. In 9 cases with upper extremity lymphedema, collecting lymphatic disruption and lymph tracer leakage was seen in multiple patterns. Imaging displayed that ruptured lymph collectors healed spontaneously or regenerated into a segment of the lymphatic network. The present study provided real-time images of collecting lymphatic vessels in obstructive lymphedema. These were seen to have undergone disruption, displayed lymphorrhoea, and/or lymphatic regeneration. In addition, the images suggest that the anterior tibial lymphatic is the weak point of the lymphatic pathway in the lower limb.
    Lymphology 06/2013; 46(2):56-63.
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    ABSTRACT: Pleural fluid effusion particularly chylothorax is a relatively rare occurrence in the newborn, but when it occurs it is often life-threatening. In this article, we describe and illustrate the morphologic features of the visceral and parietal pleura including pleural lymphatics and the physiology and pathophysiology of pleural fluid balance. The role and function of the lymphatic system in controlling the volume and composition of pleural liquid are detailed and a conceptual scheme presented. Finally, the crucial role of inadequate lymphatic drainage (either functional overload from an imbalance in Starling forces or mechanical insufficiency from lymphatic dysplasia) is emphasized.
    Lymphology 06/2013; 46(2):75-84.
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    ABSTRACT: Colorectal cancer (CRC) is a frequently observed malignant neoplasm that is a leading cause of cancer death despite recent advances in treatment and research. The role of lymphangiogenesis in CRC development is a source of controversy in current research. We undertook this study to examine the relationship between lymphatic microvessel density (LMVD) and the overall survival (OS) or disease free survival (DFS) of CRC using meta-analysis of recent studies. PubMed and Embase databeases were searched and nine relevant studies including 799 total patients were included. Six studies including 575 patients focused on overall survival (OS) and 3 studies with 224 patients focused on disease free survival (DFS). We performed a meta-analysis to estimate the prognostic role of lymphatic microvessel density by combining separately estimated hazard ratios. A remarkable correlation between LMVD and DFS was observed in pooled analyses using a fixed-effect model (HR 2.29; 95% CI 1.11, 3.48). LMVD and OS showed a pooled HR value of 1.02 (95% CI 0.71,1.33), indicating no significant correlation between LMVD and OS. There was no evidence for significant heterogeneity or publishing bias in both DFS and OS (I2 = 0.0%, P = 0.861; I2 = 48.1%, P = 0.086, respectively). A close relationship was observed between LMVD and DFS, though no correlation between LMVD and OS was apparent. The current meta-analysis suggests that LMVD may be a poor prognostic factor for CRC patients. However, these results should be regarded cautiously and future confirmatory studies are necessary.
    Lymphology 03/2013; 46(1):42-51.
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    ABSTRACT: Secondary lymphedema is one of the sequella of cancer treatment that in inadequately understood. The purpose of the present study is to investigate lymphedema formation and to explore the escape routes for excess interstitial fluid using lymphadenectomy in a rat model. In twelve Wistar rats, lymph nodes in the right inguinal and popliteal fossas were completely removed and lymph vessels carefully ligated. After operation, treated hind limbs were evaluated by indocyanine green lymphography and circumferential measurement. Both evaluations were performed from day 3 to ten weeks. Approximately 2 to 3 weeks after operation, a network-like pattern of the fluorescent signal appeared around the surgical site which then transitioned into a linear pattern in the lower abdomen. Videorecordings identified fluorescent flow moving from the lower abdomen to the ipsilateral axillary lymph node and in some rats, the network-like pattern was also observed to pass transversely over the suprapubic region to the contralateral inguinal lymph nodes. The network-like pattern on the lower abdomen and the linear pattern to the axillary fossa were seen continuously to the end of observation. Circumferential measurements of the treated hind limbs increased initially and then declined over time. This imaging system may be useful to detect early changes in lymphatic flow before swelling occurs and further study is needed.
    Lymphology 03/2013; 46(1):12-9.
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    ABSTRACT: Despite the development of minimal access dissection techniques, use of superficial groin dissection alone, and other recommendations to reduce morbidity in melanoma treatment, the incidence of lymphedema is still significant. The purpose of the current study was to assess the efficacy of microsurgical methods to limit the morbidity of inguinal lymphadenectomy. We conducted a retrospective review of patients who underwent groin dissection for melanoma treatment from February 2006 to April 2009. A total of 59 melanoma patients with positive groin lymph nodes comprised 18 patients (T-group) with melanoma in the trunk and 41 patients (E-group) who had melanoma in an extremity and currently have lymphedema. The T-group patients underwent primary prevention of lymphedema with microsurgical lymphatic-venous anastomoses (LVA) performed simultaneously with groin dissection. The E-group patients underwent LVA to treat the secondary lymphedema after an accurate oncological and lymphological assessment. Limb volume measurements and lymphoscintigraphy were performed pre- and postoperatively to assess short and long term outcome. No lymphedema occurred after microsurgical primary preventive approach in the T- group. Significant (average 80% reduction of pre-op excess volume) reduction of lymphedema resulted after microsurgical treatment for secondary leg lymphedema. Post-operative lymphoscintigraphy in 35 patients demonstrated patency of microsurgical anastomoses in all cases with an average follow-up of 42 months. Study results demonstrate that microsurgical LVA primary prevention prevented lymphedema after inguinal lymphadenectomy in the T-group patients. In addition, lymphatic-venous multiple anastomoses proved to be a successful treatment for clinical lymphedema with particular success if treated at the early stages.
    Lymphology 03/2013; 46(1):20-6.
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    ABSTRACT: A project of the American Lymphedema Framework Project (ALFP), this review seeks to examine the policy and economic impact of caring for patients with lymphedema, a common side effect of cancer treatment. This review is the first of its kind undertaken to investigate, coordinate, and streamline lymphedema policy initiatives in the United States with potential applicability worldwide. As part of a large scale literature review aiming to systematically evaluate the level of evidence of contemporary peer-reviewed lymphedema literature (2004 to 2011), publications on care delivery models, health policy, and economic impact were retrieved, summarized, and evaluated by a team of investigators and clinical experts. The review substantiates lymphedema education models and clinical models implemented at the community, health care provider, and individual level that improve delivery of care. The review exposes the lack of economic analysis related to lymphedema. Despite a dearth of evidence, efforts towards policy initiatives at the federal and state level are underway. These initiatives and the evidence to support them are examined and recommendations for translating these findings into clinical practice are made. Medical and community-based disease management interventions, taking on a public approach, are effective delivery models for lymphedema care and demonstrate great potential to improve cancer survivorship care. Efforts to create policy at the federal, state, and local level should target implementation of these models. More research is needed to identify costs associated with the treatment of lymphedema and to model the cost outlays and potential cost savings associated with comprehensive management of chronic lymphedema.
    Lymphology 03/2013; 46(1):27-41.
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    ABSTRACT: Lower limb lymphedema is difficult to prevent and diagnose early because its natural history is unclear. Therefore, the aim of this study was to clarify its pathogenesis and to identify risk factors that may lead to early diagnosis. In 29 patients, aged 25 to 74 years with cervical, uterine, or ovarian cancer who underwent pelvic lymphadenectomy, indocyanine green fluorescence lymphangiography was performed with an infrared camera system, and lymph pumping pressure was measured indirectly preoperatively, and one, two, three, and six months postoperatively. Of these 29 patients, 22 (75.9%) completed the examinations. In the non-lymphedema group, the average lymph pumping pressure did not change significantly at postoperative follow-up compared with preoperative values. On the other hand, lymph pumping pressure increased at various time points in five patients who developed early lymphatic changes with dermal diffusion at the level of the proximal femur. An increase in lymph flow path resistance due to pelvic lymphadenectomy resulted in an initial increase in lymph pumping pressure, followed by a subsequent decrease, in the early lymphatic changes group. This trend in the pressure change signifies that the lymph vessels became dysfunctional as they were overwhelmed by the overload condition and this feature may be a clinically useful signal for the early diagnosis of developing lymphedema.
    Lymphology 12/2012; 45(4):165-76.
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    ABSTRACT: The National Institutes of Health Consensus Development Conference on Treatment of Early Stage Breast Cancer in 1990 indicated that breast conserving surgery with radiotherapy is the primary therapy for the majority of women with early stage breast cancer. Despite good aesthetic results, a remarkable number of patients suffer from lymphedema of the operated and irradiated breast. 131 study participants scored 8 subjective symptoms of breast edema on a scale from 0 to 10 and completed the EORTC QLQ-BR23 questionnaire to assess the health related quality of life among breast cancer patients. Incidence of breast edema, up to 5 years following surgery, was 75.5%. There was a significant positive correlation between breast edema and body mass index. Breast edema also correlated significantly with chemotherapy treatment, anti-hormone therapy, age, and all aspects of quality of life, except sexual functioning, sexual enjoyment, and upset by hair loss. There were no significant differences in breast edema related to the post- operative period, the level of nodal dissection, preoperative bra cup size, tumor location and whether the surgery was performed on the dominant side. Despite the benefits of breast conserving surgery and radiotherapy, breast edema is a common complication that lowers quality of life significantly.
    Lymphology 12/2012; 45(4):154-64.
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    ABSTRACT: Although there have been many experimental studies demonstrating that bone marrow-derived mesenchymal stem cells (MSCs) have the potential to differentiate into mesenchymal tissues such as osteocytes, chondrocytes, and adipocytes in vivo and in vitro, little information is available regarding their potential to differentiate into lymphatic endothelial cells. Therefore, we chose to investigate differentiation of MSCs into lymphatic endothelial cells using stimulation with members of the vascular endothelial growth factor (VEGFs) family. Rat MSCs were isolated from bone marrow aspirate of Sprague-Dawley rats as previously described and characterized with flow cytometry for surface markers CD14, CD34, CD29, and CD90. Purified MSCs were plated and cultured in the presence of VEGF-A, VEGF-C, or the combination of both for 10 days. We examined the cells for Prox-1 and LYVE-1 by immunocytochemistry, RT-PCR, and Western blot analysis. Results demonstrated that compared to controls, cell differentiated with VEGF-A, VEGF-C and VEGF-A+VEGF-C expressed Prox-1 and LYVE-1. Our results indicate that MSCs induced by VEGFs are capable of differentiating into lymphatic endothelial-like cells in vitro, and this response has the potential to make them attractive candidates for the development of autologous tissue grafts for future therapy.
    Lymphology 12/2012; 45(4):177-87.
  • Lymphology 12/2012; 45(4):142-3.

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