Ultrasonography for classifying lymphatic sclerosis types and deciding optimal sites of lymphatic-venous anastomosis in lymphoedema patients

Publication date: Available online 15 June 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Makoto Mihara, Hisako Hara, Yoshihisa Kawakami
We have previously categorised the degree of degeneration of the collecting lymphatic vessels into four types: normal, ectasis, contraction and sclerosis type (NECST classification). Here, we evaluated the collective lymphatic vessels in lymphoedema-affected limbs using ultrasonography. In step 1, we investigated 110 lymphatic vessels from 25 patients with lymphoedema, who underwent lymphatic-venous anastomosis (LVA) following preoperative ultrasonography. We classified the lymphatic vessels using the NECST classification via intraoperative microscopic observation. Postoperatively, we evaluated the preoperative ultrasonographic images and identified the lymphatic vessels. In step 2, we investigated 79 lymphatic vessels from 17 patients. We performed ultrasonography and detected the lymphatic vessels preoperatively and compared the results with the intraoperative findings. This study is not blinded. In step 1, normal-type lymphatic vessels were observed as spicular and flat hypo-echoic lesions on ultrasonography. Ectasis type appeared as a rounded hypo-echoic region and coloured on Doppler imaging once in 20 to 30 s. Contraction type indicated small hypo-echoic region in the centre of the hyper-echoic ellipse. Sclerosis type demonstrated a hyper-echoic ellipse without lumen, similar to fibrotic tissues. In step 2, among 79 lymphatic vessels found intraoperatively, 65 (82.3%) were detected on ultrasonography and 37 (46.8%) were accurately diagnosed according to the NECST classification criteria preoperatively. All lymphatic vessels detected on ultrasonography were found intraoperatively. Collecting lymphatic vessels could be observed with ultrasonography in lymphoedema-affected limbs. Depending on the degree of collective lymphatic vessel sclerosis—corresponding to the NECST classification—various findings such as spicular, rounded, hyper-echoic and the like were presented. Moreover, we can decide optimal sites of LVA preoperatively.