Ultra-High frequency ultrasound imaging of lymphatic channels correlates with their histological features: A step forward in lymphatic surgery.
Journal
Journal of plastic, reconstructive & aesthetic surgery : JPRAS
ISSN: 1878-0539
Titre abrégé: J Plast Reconstr Aesthet Surg
Pays: Netherlands
ID NLM: 101264239
Informations de publication
Date de publication:
Sep 2020
Sep 2020
Historique:
received:
22
10
2019
revised:
23
03
2020
accepted:
09
05
2020
pubmed:
28
6
2020
medline:
18
11
2020
entrez:
28
6
2020
Statut:
ppublish
Résumé
Indocyanine green (ICG) lymphography gained widespread acceptance as a gold standard in lymphatic surgery, although this imaging modality has several limitations. Ultrasound is progressively emerging as a powerful tool in LVA preoperative planning, as it expands the available knowledge for both lymphatic channels and recipient venules. The purpose of this study is to evaluate the accuracy of ultrahigh frequency ultrasound (UHFUS) in detecting the lymphatic vessels and in evaluating their degeneration status, including wall and lumen characteristics, compared with direct histology observation. From May 2018 to November 2018, 26 consecutive patients affected by extremities lymphedema who underwent LVA were prospectively assessed. For each patient, we evaluated the lymphatic vessels suitable for LVA by UHFUS preoperatively, intraoperatively, and by histology. Qualitative and quantitative data of lymphatic channels were analyzed for each evaluation including lymphatic outer diameter, inner diameter, and wall thickness. Quantitative outcome analysis after LVA was also performed. On a total of 26 patients, 14 were upper limb lymphedema (ULL) and 12 lower limb lymphedema (LLL). All cases were secondary lymphedema. The qualitative and the quantitative analysis showed significant correlation and agreement between ultrasound and histological measurements. UHFUS preoperative and intraoperative analysis of lymphatic channel strongly correlates with their histology. By coupling this high detailed information on lymphatic channels with the ability to dynamically study preoperative recipient venules, UHFUS represents the quintessence in lymphatic surgery, and it should be considered as the new gold standard in the preoperative planning of LVA. Level of Evidence II (diagnostic).
Sections du résumé
BACKGROUND
BACKGROUND
Indocyanine green (ICG) lymphography gained widespread acceptance as a gold standard in lymphatic surgery, although this imaging modality has several limitations. Ultrasound is progressively emerging as a powerful tool in LVA preoperative planning, as it expands the available knowledge for both lymphatic channels and recipient venules. The purpose of this study is to evaluate the accuracy of ultrahigh frequency ultrasound (UHFUS) in detecting the lymphatic vessels and in evaluating their degeneration status, including wall and lumen characteristics, compared with direct histology observation.
PATIENTS AND METHODS
METHODS
From May 2018 to November 2018, 26 consecutive patients affected by extremities lymphedema who underwent LVA were prospectively assessed. For each patient, we evaluated the lymphatic vessels suitable for LVA by UHFUS preoperatively, intraoperatively, and by histology. Qualitative and quantitative data of lymphatic channels were analyzed for each evaluation including lymphatic outer diameter, inner diameter, and wall thickness. Quantitative outcome analysis after LVA was also performed.
RESULTS
RESULTS
On a total of 26 patients, 14 were upper limb lymphedema (ULL) and 12 lower limb lymphedema (LLL). All cases were secondary lymphedema. The qualitative and the quantitative analysis showed significant correlation and agreement between ultrasound and histological measurements.
CONCLUSIONS
CONCLUSIONS
UHFUS preoperative and intraoperative analysis of lymphatic channel strongly correlates with their histology. By coupling this high detailed information on lymphatic channels with the ability to dynamically study preoperative recipient venules, UHFUS represents the quintessence in lymphatic surgery, and it should be considered as the new gold standard in the preoperative planning of LVA. Level of Evidence II (diagnostic).
Identifiants
pubmed: 32591265
pii: S1748-6815(20)30228-X
doi: 10.1016/j.bjps.2020.05.053
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1622-1629Informations de copyright
Copyright © 2020 Elsevier Ltd. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of Competing Interest None.