Indocyanine Green Lymphography Screening of Breast Cancer-Related Lymphedema: A Two-Year Prospective Cohort Study after Axillary Lymph Node Dissection

Background: /Objectives: Breast cancer-related lymphedema (BCRL) is one of the major morbidity in breast cancer. Since lymphedema treatment is difficult, especially once it progresses, screening and early detection should be prioritized to prevent the progression. This study used indocyanine green lymphography (ICG-L) as a sensitive diagnostic tool for BCRL screening after axillary lymph node dissection (ALND). Methods: This prospective cohort study included breast cancer patients who underwent ALND from October 2022 to October 2024 at Dharmais National Cancer Hospital. ICG-L was performed to diagnose BCRL. Our study outcome was a 2-year BCRL cumulative incidence and ICG-L stage distribution. Results: This study included 69 patients with a mean body mass index of 26.3±5.1 kg/m2. The median (IQR) of dissected lymph nodes was 18 (14-21), with the number of lymph node metastases 2 (0-10). Forty-six patients (66.7%) were in the locally advanced stage and 42 (60.9%) received radiotherapy. Based on ICG-L, our 2-year BCRL cumulative incidence was 58.0% (45.2-71.4). A total of 25 patients (71.4%) who had BCRL experienced symptoms, with heaviness (60%) and swelling (48%) being the most common signs. The upper extremity lymphedema index increase of > 10 % was only found in 11 (31.4%) patients. Most patients were in ICG-L stage II, as shown in 18 (51.4%) subjects. Conclusions: ICG-L was able to detect early BCRL more frequently. This finding showed its sensitivity as a screening method and that it should be used in preventive BCRL management.