Kung, Theodore A.

AbstractBackgroundIn recent years, magnetic resonance imaging lymphangiography (MRL) has emerged as a way to predict if patients are candidates for lymphedema surgery, particularly lymphovenous anastomosis (LVA). Our goal was to conduct a systematic review of the literature on the use of MRL for preoperative planning in lymphedema surgery. We hypothesized that MRL could add valuable information to the standard preoperative evaluation of lymphedema patients.MethodsOn February 17, 2020, we conducted a systematic review of the PubMed/MEDLINE, Cochrane Clinical Answers, and Embase databases, without time frame or language limitations, to identify articles on the use of MRL for preoperative planning of lymphedema surgery. We excluded studies that investigated other applications of magnetic resonance imaging, such as lymphedema diagnosis and treatment evaluation. The primary outcome was the examination capacity to identify lymphatic anatomy and the secondary outcome was the presence of adverse effects.ResultsOf 372 potential articles identified with the search, nine studies fulfilled the eligibility criteria. A total of 334 lymphedema patients were enrolled in these studies. Two studies compared MRL findings with those of other standard examinations (indocyanine green lymphography [ICG‐L] or lymphoscintigraphy). No adverse effects due to MRL were reported. A study shown that MRL had higher sensitivity to detect lymphatic vessel abnormalities compared with lymphoscintigraphy and a statistically higher chance of successful LVA was observed when the results of MRL agreed with those of ICG‐L (p < .001).ConclusionsMRL could be useful for preoperative planning in lymphedema surgery. The scientific evidence has been limited, so further studies with greater numbers of patients and cost analysis are necessary to justify the addition of MRL to current preoperative protocols.

Controversy exists regarding the influence of breast cancer–related lymphedema (BCRL) in the development of peripheral neuropathies. Our aim was to evaluate the association of secondary lymphedema with peripheral neuropathies in patients with breast cancer. We performed a systematic review by querying PubMed, EMBASE, Ovid Medline and Epub Ahead of Print, In-Process & Other Non-Indexed Citations, and Cochrane Central Register of Controlled Trials databases. The keywords “lymphedema” AND (“neuropathy” OR “carpal tunnel syndrome” OR “cubital tunnel syndrome” OR “neuropathic pain”) and synonyms in titles and abstracts were used to perform the search. Seventeen articles met the inclusion criteria. Discrepancies were found in studies that analyzed whether a cause-effect association exists between carpal tunnel syndrome (CTS) and secondary lymphedema. No evidence indicated that lymphedema predisposes to developing peripheral neuropathies such as CTS or brachial plexopathy. No studies found an association between patients with breast cancer at risk of or with lymphedema and the development or worsening of CTS. Carpal tunnel release can be safely performed in patients with BCRL. Neuropathic pain worsens with lymphedema, and treatment seems to improve the pain. Our study did not find enough evidence to conclude that BCRL is associated with the development of peripheral neuropathies. Carpal tunnel release is a safe procedure that can be performed in patients with BCRL and does not influence the development or worsening of lymphedema. Neuropathic pain seems to worsen after development of lymphedema, and treatment has been found to improve neuropathic pain.