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Alpaslan M, Fastré E, Mestre S, van Haeringen A, Repetto GM, Keymolen K, Boon LM, Belva F, Giacalone G, Revencu N, Sznajer Y, Riches K, Keeley V, Mansour S, Gordon K, Martin-Almedina S, Dobbins S, Ostergaard P, Quere I, Brouillard P, Vikkula M. Pathogenic variants in HGF give rise to childhood-to-late onset primary lymphoedema by loss of function. Hum Mol Genet 2024; 33:1250-1261. [PMID: 38676400 PMCID: PMC11227619 DOI: 10.1093/hmg/ddae060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 03/01/2024] [Accepted: 03/19/2024] [Indexed: 04/28/2024] Open
Abstract
Developmental and functional defects in the lymphatic system are responsible for primary lymphoedema (PL). PL is a chronic debilitating disease caused by increased accumulation of interstitial fluid, predisposing to inflammation, infections and fibrosis. There is no cure, only symptomatic treatment is available. Thirty-two genes or loci have been linked to PL, and another 22 are suggested, including Hepatocyte Growth Factor (HGF). We searched for HGF variants in 770 index patients from the Brussels PL cohort. We identified ten variants predicted to cause HGF loss-of-function (six nonsense, two frameshifts, and two splice-site changes; 1.3% of our cohort), and 14 missense variants predicted to be pathogenic in 17 families (2.21%). We studied co-segregation within families, mRNA stability for non-sense variants, and in vitro functional effects of the missense variants. Analyses of the mRNA of patient cells revealed degradation of the nonsense mutant allele. Reduced protein secretion was detected for nine of the 14 missense variants expressed in COS-7 cells. Stimulation of lymphatic endothelial cells with these 14 HGF variant proteins resulted in decreased activation of the downstream targets AKT and ERK1/2 for three of them. Clinically, HGF-associated PL was diverse, but predominantly bilateral in the lower limbs with onset varying from early childhood to adulthood. Finally, aggregation study in a second independent cohort underscored that rare likely pathogenic variants in HGF explain about 2% of PL. Therefore, HGF signalling seems crucial for lymphatic development and/or maintenance in human beings and HGF should be included in diagnostic genetic screens for PL.
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Affiliation(s)
- Murat Alpaslan
- Human Molecular Genetics, de Duve Institute, University of Louvain, Avenue Hippocrate 74, Brussels 1200, Belgium
| | - Elodie Fastré
- Human Molecular Genetics, de Duve Institute, University of Louvain, Avenue Hippocrate 74, Brussels 1200, Belgium
| | - Sandrine Mestre
- Department of vascular medicine, Hospital Saint-Eloi, University Hospital of Montpellier, Avenue Augustin Fliche 80, Montpellier 34090, France
| | - Arie van Haeringen
- Leiden University Medical Center, Albinusdreef 2, Leiden 2333, the Netherlands
| | - Gabriela M Repetto
- Clinica Alemana Universidad del Desarrollo, Av Plaza 680, Las Condes, Lo Barnechea, Región Metropolitana 7710167, Chile
| | - Kathelijn Keymolen
- Clinical Sciences, Research Group Reproduction and Genetics, Centre for Medical Genetics, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, Brussels 1090, Belgium
| | - Laurence M Boon
- Center for Vascular Anomalies, Division of Plastic Surgery, Cliniques Universitaires Saint-Luc, University of Louvain, Avenue Hippocrate 10, Brussels 1200, Belgium
| | - Florence Belva
- Department of Lymphatic Surgery, AZ Sint-Maarten Hospital, VASCERN PPL European Reference Centre, Liersesteenweg 435, Mechelen 2800, Belgium
| | - Guido Giacalone
- Department of Lymphatic Surgery, AZ Sint-Maarten Hospital, VASCERN PPL European Reference Centre, Liersesteenweg 435, Mechelen 2800, Belgium
| | - Nicole Revencu
- Center for Human Genetics, Cliniques Universitaires Saint-Luc, University of Louvain, Avenue Hippocrate 10, Brussels 1200, Belgium
| | - Yves Sznajer
- Center for Human Genetics, Cliniques Universitaires Saint-Luc, University of Louvain, Avenue Hippocrate 10, Brussels 1200, Belgium
| | - Katie Riches
- University Hospitals of Derby and Burton NHS Foundation Trust, Uttoxeter Rd, Derby DE22 3NE, United Kingdom
| | - Vaughan Keeley
- University Hospitals of Derby and Burton NHS Foundation Trust, Uttoxeter Rd, Derby DE22 3NE, United Kingdom
- University of Nottingham Medical School, Nottingham, East Block, Lenton, Nottingham NG7 2UH, United Kingdom
| | - Sahar Mansour
- Cardiovascular and Genomics Research Institute, St. George's University of London, Blackshaw Rd, London SW17 0QT, United Kingdom
- South West Thames Regional Centre for Genomics, St. George's Universities Hospitals NHS Foundation Trust, Blackshaw Rd, London SW17 0QT, United Kingdom
| | - Kristiana Gordon
- Cardiovascular and Genomics Research Institute, St. George's University of London, Blackshaw Rd, London SW17 0QT, United Kingdom
- Dermatology and Lymphovascular Medicine, St. George's Universities NHS Foundation Trust, Blackshaw Rd, London SW17 0QT, United Kingdom
| | - Silvia Martin-Almedina
- Cardiovascular and Genomics Research Institute, St. George's University of London, Blackshaw Rd, London SW17 0QT, United Kingdom
| | - Sara Dobbins
- Cardiovascular and Genomics Research Institute, St. George's University of London, Blackshaw Rd, London SW17 0QT, United Kingdom
| | - Pia Ostergaard
- Cardiovascular and Genomics Research Institute, St. George's University of London, Blackshaw Rd, London SW17 0QT, United Kingdom
| | - Isabelle Quere
- Department of vascular medicine, Hospital Saint-Eloi, University Hospital of Montpellier, Avenue Augustin Fliche 80, Montpellier 34090, France
| | - Pascal Brouillard
- Human Molecular Genetics, de Duve Institute, University of Louvain, Avenue Hippocrate 74, Brussels 1200, Belgium
| | - Miikka Vikkula
- Human Molecular Genetics, de Duve Institute, University of Louvain, Avenue Hippocrate 74, Brussels 1200, Belgium
- WELBIO Department, WEL Research Institute, Avenue Pasteur, 6, Wavre 1300, Belgium
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Alpaslan M, Mestré-Godin S, Lay A, Giacalone G, Helaers R, Adham S, Kovacsik H, Guillemard S, Mercier E, Boon L, Revencu N, Brouillard P, Quere I, Vikkula M. Ureteropelvic junction obstruction with primary lymphoedema associated with CELSR1 variants. J Med Genet 2023; 60:1161-1168. [PMID: 37225411 DOI: 10.1136/jmg-2023-109171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 05/07/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Primary lymphoedema (PL) is a chronic, debilitating disease caused by developmental and functional defects of the lymphatic system. It is marked by an accumulation of interstitial fluid, fat and tissue fibrosis. There is no cure. More than 50 genes and genetic loci have been linked to PL. We sought to study systematically cell polarity signalling protein Cadherin Epidermal Growth Factor Laminin G Seven-pass G-type Receptor 1 (CELSR1) variants linked to PL. METHODS We investigated 742 index patients from our PL cohort using exome sequencing. RESULTS We identified nine variants predicted to cause CELSR1 loss of function. Four of them were tested for nonsense-mediated mRNA decay, but none was observed. Most of the truncated CELSR1 proteins would lack the transmembrane domain, if produced. The affected individuals had puberty/late-onset PL on lower extremities. The variants had a statistically significant difference in penetrance between female patients (87%) and male patients (20%). Eight variant carriers had a kidney anomaly, mostly in the form of ureteropelvic junction obstruction, which has not been associated with CELSR1 before. CELSR1 is located in the 22q13.3 deletion locus of the Phelan-McDermid syndrome. As variable renal defects are often seen in patients with the Phelan-McDermid syndrome, CELSR1 may be the long-sought gene for the renal defects. CONCLUSION PL associated with a renal anomaly suggests a CELSR1-related cause.
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Affiliation(s)
- Murat Alpaslan
- Human Molecular Genetics, de Duve Institute, Brussels, Belgium
| | - Sandrine Mestré-Godin
- Department of vascular medicine, CHU Montpellier, Montpellier, France
- IDESP - Institut Desbrest d'Épidémiologie et de Santé Publique, Montpellier, France
| | - Aurélie Lay
- Department of vascular medicine, CHU Montpellier, Montpellier, France
| | - Guido Giacalone
- Department of Lymphatic Surgery, VASCERN PPL European Reference Centre, General Hospital Sint-Maarten, Mechelen, Belgium
| | - Raphaël Helaers
- Human Molecular Genetics, de Duve Institute, Brussels, Belgium
| | - Salma Adham
- Department of vascular medicine, CHU Montpellier, Montpellier, France
- IDESP - Institut Desbrest d'Épidémiologie et de Santé Publique, Montpellier, France
| | - Hélène Kovacsik
- Department of vascular medicine, CHU Montpellier, Montpellier, France
| | - Sophie Guillemard
- Department of Nuclear Medicine, Montpellier Regional Cancer Institute, Montpellier, France
| | - Erick Mercier
- IDESP - Institut Desbrest d'Épidémiologie et de Santé Publique, Montpellier, France
- Hematology Laboratory, University Hospital Centre Nimes, Nimes, France
| | - Laurence Boon
- Human Molecular Genetics, de Duve Institute, Brussels, Belgium
- Center for Vascular Anomalies, Division of Plastic Surgery, VASCERN VASCA European Reference Centre, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Nicole Revencu
- Center for Vascular Anomalies, Division of Plastic Surgery, VASCERN VASCA European Reference Centre, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | | | - Isabelle Quere
- Department of vascular medicine, CHU Montpellier, Montpellier, France
- IDESP - Institut Desbrest d'Épidémiologie et de Santé Publique, Montpellier, France
| | - Miikka Vikkula
- Human Molecular Genetics, de Duve Institute, Brussels, Belgium
- WELBIO, WEL Research Institute, Wavre, Belgium
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Bourgeois P, Roman MM, Schweicher J, Lavoisier P, Maquet P, Karler C, Lizewski M, Fouarge A, Cuylits N, del Marmol V, Leduc O. Lymphatic Alterations Under Tattoos: Preliminary Reports of One Observational Study. CLINICAL, COSMETIC AND INVESTIGATIONAL DERMATOLOGY 2023; 16:257-265. [PMID: 36733347 PMCID: PMC9888301 DOI: 10.2147/ccid.s393038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 12/22/2022] [Indexed: 01/28/2023]
Abstract
Background The number of people within the European population having at least one tattoo has increased notably and with it the number of tattoo-associated clinical complications. The injected inks are known to be removed by the lymphatic vessels and can be found in the draining lymph nodes. Aim of the Study To report our observations on the lymphatic drainages seen under tattoos using near infrared fluorescence imaging of these lymphatic vessels after the injection of indocyanine green. Material and Methods Indocyanine green was injected intradermally at the basis of the 20 tattooed area(s) in 19 subjects (nine women and ten men; mean age = 28.6). Ten subjects had only black tattoos (six upper limbs and four lower limbs), five (two upper limbs and three lower limbs) black and white tattoos and five multi-colored tattooed limbs (four lower limbs and one upper limb). Results The imaging exams revealed alterations in eight individuals, seven of whom had tattoos on their lower limbs. Furthermore, the imaging results showed that the abnormalities might be related to the tattooed limb, the tattoo extent and colour. Conclusion Alterations of the cutaneous lymphatic channels are frequently observed under tattooed territories. Their causal factors should be more precisely studied in future works and these lymphatic alterations should be considered in tattooed patients when using similar imaging techniques for therapeutic and surgical assessments.
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Affiliation(s)
- Pierre Bourgeois
- Service of Dermatology, Hospital Erasme, Université Libre de Bruxelles, Brussels, Belgium,Services of Nuclear Medicine, HIS-IZZ Hospitals, Université Libre de Bruxelles, Brussels, Belgium,Multi-Disciplinary Clinic of Lymphology, Institute Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium,Service of Vascular Surgery, HIS-IZZ Hospitals, Université Libre de Bruxelles, Brussels, Belgium,Correspondence: Pierre Bourgeois, Department of Dermatology, University Hospital Erasme, Université Libre de Bruxelles, 808, route de Lennik, Brussels, 1070, Belgium, Tel +32495201906, Email
| | - Mirela Mariana Roman
- Department of Mammo-Pelvic Surgery, Institute Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Justine Schweicher
- Unité de lympho-phlébologie, Haute Ecole Bruxelles-Brabant, Haute Ecole Robert Schuman, Brussels, Belgium
| | - Pauline Lavoisier
- Unité de lympho-phlébologie, Haute Ecole Bruxelles-Brabant, Haute Ecole Robert Schuman, Brussels, Belgium
| | - Philippe Maquet
- Unité de lympho-phlébologie, Haute Ecole Bruxelles-Brabant, Haute Ecole Robert Schuman, Brussels, Belgium
| | - Clarence Karler
- Department of Anesthesia-Algologia, Hospital Moliere, Université Libre de Bruxelles, Brussels, Belgium
| | - Mateusz Lizewski
- Service of Plastic, Reconstructive and Aesthetic Surgery, Hospital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Alessandro Fouarge
- Service of Plastic, Reconstructive and Aesthetic Surgery, Hospital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Nicolas Cuylits
- Service of Plastic, Reconstructive and Aesthetic Surgery, Hospital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Véronique del Marmol
- Service of Dermatology, Hospital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Olivier Leduc
- Unité de lympho-phlébologie, Haute Ecole Bruxelles-Brabant, Haute Ecole Robert Schuman, Brussels, Belgium
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Bourgeois P, Leduc O. Value of one additional injection at the root of the limb in the lymphoscintigraphic evaluation and management of primary and secondary lower-limb lymphedemas. PLoS One 2021; 16:e0253900. [PMID: 34242254 PMCID: PMC8270164 DOI: 10.1371/journal.pone.0253900] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 06/16/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction The classical lymphoscintigraphic investigations of lower-limb lymphatic edema [LLLE] sometimes reveal either no or few lymph nodes [LNs] at the root of the limb[s] and/or in the abdomen. The aim of the present paper is to report the results of performing one additional injection at the root of the edematous limb[s] to force the visualization of the LNs and/or to demonstrate the collateral lymphatic pathways in such patients. Methods and findings We retrospectively reviewed our database and found 99 patients [44 primary LLLE with 47 limbs injected and 55 with LLLE secondary to treatments for cancer with 64 limbs injected] where such an additional injection had been performed. In the 43 LLLE patients where no LNs were seen at the end of the classical exam [15 primary LLLE and 28 secondary LLLE], the extra injection showed lymphatic drainage toward LN[s] in all except 3 and when at least one LN was seen, the injection showed lymphatic drainage in every case toward the same ipsilateral [inguinal and/or iliac] LNs [as shown by the classical injection] and/or toward additional LNs. In 40.7% of patients, we observed one or more additional lymphatic pathways: prepubic superficial lymphatic vessels [LV] crossing the midline anteriorly toward contralateral inguinal LNs in 21 [18.9%], “posterior” LV [toward contralateral inguinal LNs and/or ipsi- or contralateral lumbo-aortic and/or para-renal LNs] in 14 [12.6%], but deep LV toward the ipsilateral common iliac LNs passing between the gluteal muscles in 32 [28.8%]. Conclusion Our work pinpoints one limitation of classical bipedal radionuclide lymphangiography. In patients with primary and secondary LLLE where inguinal and/or iliac LNs cannot be seen on bipedal radionuclide lymphangiography, this additional injection reveals the true lympho-nodal status and shows unexpected collateral lymphatic pathways in 40% of cases. Such information is of the utmost importance in LLLE management and its acquisition is consequently recommended in these patients.
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Affiliation(s)
- Pierre Bourgeois
- Services of Nuclear Medicine, Institute Jules Bordet and HIS-IZZ Hospitals, Université Libre de Bruxelles, Brussels, Belgium
- Service of Dermatology, Hospital Erasme, Université Libre de Bruxelles, Brussels, Belgium
- Multi-disciplinary Clinic of Lymphology, Institute Jules Bordet and Hospital Erasme, Université Libre de Bruxelles, Brussels, Belgium
- Service of Vascular Surgery, HIS-IZZ Hospitals, Université Libre de Bruxelles, Brussels, Belgium
- * E-mail:
| | - Olivier Leduc
- Multi-disciplinary Clinic of Lymphology, Institute Jules Bordet and Hospital Erasme, Université Libre de Bruxelles, Brussels, Belgium
- Department of Occupational and Environmental Physiology, Lympho-phlebology Unit, Haute Ecole HE2B ISEK, Université Libre de Bruxelles, Brussels, Belgium
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Mukenge S, Jha SK, Catena M, Manara E, Leppänen VM, Lenti E, Negrini D, Bertelli M, Brendolan A, Jeltsch M, Aldrighetti L. Investigation on the role of biallelic variants in VEGF-C found in a patient affected by Milroy-like lymphedema. Mol Genet Genomic Med 2020; 8:e1389. [PMID: 32592340 PMCID: PMC7507552 DOI: 10.1002/mgg3.1389] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 05/22/2020] [Accepted: 06/01/2020] [Indexed: 12/21/2022] Open
Abstract
Background Milroy‐like disease is the diagnostic definition used for patients with phenotypes that resemble classic Milroy disease (MD) but are negative to genetic testing for FLT4. In this study, we aimed at performing a genetic characterization and biochemical analysis of VEGF‐C variations found in a female proband born with congenital edema consistent with Milroy‐like disease. Methods The proband underwent next‐generation sequencing‐based genetic testing for a panel of genes associated with known forms of hereditary lymphedema. Segregation analysis was performed on family members by direct sequencing. In vitro studies were performed to evaluate the role of a novel identified variant. Results Two VEGF‐C variations were found in the proband, a novel p.(Ser65Arg) and a pathogenic c.148‐3_148‐2delCA, of paternal and maternal origin, respectively. Functional characterization of the p.(Ser65Arg) variation in vitro showed alterations in VEGF‐C processing. Conclusions Our findings reveal an interesting case in which biallelic variants in VEGF‐C are found in a patient with Milroy‐like lymphedema. These data expand our understanding of the etiology of congenital Milroy‐like lymphedema.
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Affiliation(s)
- Sylvain Mukenge
- Department of Surgery, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), San Raffaele Scientific Institute, Milan, Italy
| | - Sawan K Jha
- Translational Cancer Biology Program, Biomedicum Helsinki, University of Helsinki, Helsinki, Finland
| | - Marco Catena
- Department of Surgery, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), San Raffaele Scientific Institute, Milan, Italy
| | | | | | - Elisa Lenti
- Department of Experimental Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), San Raffaele Scientific Institute, Milan, Italy
| | - Daniela Negrini
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | | | - Andrea Brendolan
- Department of Experimental Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), San Raffaele Scientific Institute, Milan, Italy
| | - Michael Jeltsch
- Translational Cancer Biology Program, Biomedicum Helsinki, University of Helsinki, Helsinki, Finland.,Wihuri Research Institute, Helsinki, Finland
| | - Luca Aldrighetti
- Department of Surgery, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), San Raffaele Scientific Institute, Milan, Italy
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Sadeghi R, Ravari H. Lymphoscintigraphy in the Management of Lymphatic Disorders. Clin Nucl Med 2020. [DOI: 10.1007/978-3-030-39457-8_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Maccauro M, Villa G, Manzara A, Follacchio GA, Manca G, Tartaglione G, Chondrogiannis S, Mango L, Rubello D. Lymphoscintigraphy for the evaluation of limb lymphatic flow disorders: Report of technical procedural standards from an Italian Nuclear Medicine expert panel. Rev Esp Med Nucl Imagen Mol 2019. [DOI: 10.1016/j.remnie.2019.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Lymphoscintigraphy for the evaluation of limb lymphatic flow disorders: Report of technical procedural standards from an Italian Nuclear Medicine expert panel. Rev Esp Med Nucl Imagen Mol 2019; 38:335-340. [PMID: 31196709 DOI: 10.1016/j.remn.2019.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 02/19/2019] [Accepted: 02/21/2019] [Indexed: 11/21/2022]
Abstract
Lymphoscintigraphy represents the "gold standard" for diagnosis of lymphedema, but an important limitation is the lack of procedural standardization. The aim of this Italian expert panel was to provide a procedural standard for lymphoscintigraphy in the evaluation of lymphatic system disorders. Topic anaesthetic gels containing lidocaine should be avoided. Patients should remove compressive dressings. Total recommended activity for 99mTc-nanocolloid administration in adults is 74MBq, or 37MBq per limb and per investigated compartment, in single or multiple aliquots. 2-3 subcutaneous injections should be performed (II-III±I interdigital space of each hand/foot), avoiding intravascular injection. Deep lymphatic system of lower limbs should be evaluated in presence of dermal back-flow or lymphatic stasis (1-2 subfascial administrations in retro-malleolar or plantar region). Planar images should be acquired from injection site to liver with whole-body or serial static acquisitions 20' and 90' after subcutaneous administration. Additional information on lymphatic pathways is obtained after a quick and/or prolonged exercise protocol. SPECT/CT is recommended to study the thoracic, abdominal and pelvic territories. When required, deep lymphatic system of lower limbs should be evaluated with static acquisition 90' after subfascial administration. The report should describe administration and imaging procedure, exercise protocol, qualitative and semi-quantitative analysis (wash-out rate, transport index), potential sources of error. Due to the essential role fulfilled by lymphoscintigraphy in clinical management of primary and secondary lymphedema, an effort for the standardization of this technique should be made to provide the clinicians with a homogeneous and reliable technical methodology.
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Belgrado JP. Reply to "Near-Infrared Fluorescence Lymphatic Imaging to Reconsider Occlusion Pressure of Superficial Lymphatic Collectors in Upper Extremities of Health Volunteers: Facts and/or Artifacts" by Pierre Bourgeois and Romain Barbieux. Lymphat Res Biol 2017; 15:109-113. [PMID: 28323567 DOI: 10.1089/lrb.2016.0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jean-Paul Belgrado
- Lymphology Research Unit, Université Libre de Bruxelles , Bruxelles, Belgium
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Belgrado JP, Vandermeeren L, Vankerckhove S, Valsamis JB, Malloizel-Delaunay J, Moraine JJ, Liebens F. Near-Infrared Fluorescence Lymphatic Imaging to Reconsider Occlusion Pressure of Superficial Lymphatic Collectors in Upper Extremities of Healthy Volunteers. Lymphat Res Biol 2016; 14:70-7. [PMID: 27167187 PMCID: PMC4926199 DOI: 10.1089/lrb.2015.0040] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND There are very little scientific data on occlusion pressure for superficial lymphatic collectors. Given its importance in determining the transport capacity of lymphatic vessels, it is crucial to know its value. The novel method of near-infrared fluorescence lymphatic imaging (NIRFLI) can be used to visualize lymphatic flow in real time. The goal of this study was to see if this method could be used to measure the lymphatic occlusion pressure. METHODS We observed and recorded lymph flow in the upper limb of healthy volunteers through a transparent cuff using near-infrared fluorescence lymphatic imaging. After obtaining a baseline of the lymph flow without pressure inside the cuff, the cuff was inflated by increments of 10 mm Hg starting at 30 mm Hg. A NIRFLI guided manual lymphatic drainage technique named "Fill & Flush Drainage Method" was performed during the measurement to promote lymph flow. Lymphatic occlusion pressure was determined by observing when lymph flow stopped under the cuff. RESULTS We measured the lymphatic occlusion pressure on 30 healthy volunteers (11 men and 19 women). Mean lymphatic occlusion pressure in the upper limb was 86 mm Hg (CI ±3.7 mm Hg, α = 0.5%). No significant differences were found between age groups (p = 0.18), gender (p = 0.12), or limb side (p = 0.85). CONCLUSIONS NIRFLI, a transparent sphygmomanometer cuff and the "Fill and Flush" manual lymphatic drainage method were used to measure the lymphatic occlusion pressure in 30 healthy humans. That combination of these techniques allows the visualization of the lymph flow in real time, while ensuring the continuous filling of the lymph collectors during the measurement session, reducing false negative observations. The measured occlusion pressures are much higher than previously described in the medical literature.
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Affiliation(s)
- Jean-Paul Belgrado
- Lymphology Research Unit, Université libre de Bruxelles, Bruxelles, Belgium
- Clinique de Lymphologie, Université libre de Bruxelles, Bruxelles, Belgium
- BEAMS (Bio, Electro, and Mechanical Systems), Université libre de Bruxelles, Bruxelles, Belgium
| | - Liesbeth Vandermeeren
- Lymphology Research Unit, Université libre de Bruxelles, Bruxelles, Belgium
- Clinique de Lymphologie, Université libre de Bruxelles, Bruxelles, Belgium
- Plastic and Reconstructive Surgery Department, Université libre de Bruxelles, Bruxelles, Belgium
| | - Sophie Vankerckhove
- Lymphology Research Unit, Université libre de Bruxelles, Bruxelles, Belgium
- Clinique de Lymphologie, Université libre de Bruxelles, Bruxelles, Belgium
| | - Jean-Baptiste Valsamis
- Lymphology Research Unit, Université libre de Bruxelles, Bruxelles, Belgium
- Clinique de Lymphologie, Université libre de Bruxelles, Bruxelles, Belgium
- BEAMS (Bio, Electro, and Mechanical Systems), Université libre de Bruxelles, Bruxelles, Belgium
| | | | - Jean-Jacques Moraine
- Lymphology Research Unit, Université libre de Bruxelles, Bruxelles, Belgium
- Research Unit in Cardiorespiratory Physiology, Université libre de Bruxelles, Bruxelles, Belgium
| | - Fabienne Liebens
- Clinique de Lymphologie, Université libre de Bruxelles, Bruxelles, Belgium
- Breast Clinic, CHU St. Pierre, Bruxelles, Belgium
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Devoogdt N, Van den Wyngaert T, Bourgeois P, Lambrechts M, Van Kampen M, De Groef A, Geraerts I, Neven P, Vergote I, Tjalma W, Christiaens MR, Stroobants S. Reproducibility of lymphoscintigraphic evaluation of the upper limb. Lymphat Res Biol 2014; 12:175-84. [PMID: 25144836 DOI: 10.1089/lrb.2013.0034] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Although reproducibility studies are missing, a lymphoscintigraphic evaluation of the upper limb is often used in routine practice to diagnose lymphedema and in clinical research, for example, to investigate the effect of a physical treatment. Therefore, the aim of the present study was to investigate the reproducibility of the lymphoscintigraphic evaluation of the upper limb. METHODS AND RESULTS In breast cancer patients, 20 lymphoscintigraphic evaluations of the upper limb were performed on two test occasions with an interval of 1 week. (99m)Tc nanocol was injected subcutaneously in the hand. A standardized protocol was applied. In the early phase, two static images of the injection places were taken and in between dynamic images of both axilla during 40 min (15 min rest, 15 min squeezing a ball, and 15 min rest). After a break of 70 min, a static image of the injection places and of the axilla was made. At the end, a partial whole body image was acquired. A strong reproducibility was found for the following quantitative variables (ICC 0.75 to 0.85): change of uptake in axilla during the break; change of extraction from hands during the break; and extraction and uptake in the late phase. The other quantitative variables (i.e., extraction form the hands in the early phase, time of arrival, accumulation rate, and uptake in axilla in the early phase) had weak to moderatie reproducibility (ICC 0.07 to 0.70). All qualitative variables (i.e., number of lymph nodes in the axilla, upper arm and elbow/lower arm, gradation of lymph collectors in upper or lower arm and of dermal backflow, and presence of lymph collaterals) had strong to very strong reproducibility (ICC 0.76 to 1.00). CONCLUSION A lymphoscintigraphy of the upper limb is a reproducible imaging tool to assess lymph transport quantitatively and qualitatively.
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Affiliation(s)
- Nele Devoogdt
- 1 Department of Physical Medicine and Rehabilitation, Rehabilitation Sciences, KU Leuven-University of Leuven, and University Hospitals Leuven , Leuven Lymphedema Center, Leuven, Belgium
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Dylke ES, McEntee MF, Schembri GP, Brennan PC, Bailey E, Ward LC, Kilbreath SL. Reliability of a radiological grading system for dermal backflow in lymphoscintigraphy imaging. Acad Radiol 2013; 20:758-63. [PMID: 23570659 DOI: 10.1016/j.acra.2013.01.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 01/14/2013] [Accepted: 01/16/2013] [Indexed: 12/21/2022]
Abstract
RATIONALE AND OBJECTIVES Lymphoscintigraphy may be used for diagnosing secondary lymphedema. Dermal backflow, the presence of radiotracer in dermal lymphatics, is a key clinical feature. Although often reported as present or absent, a scale that assesses the severity of dermal backflow has been previously developed. The aim of this study was to determine the reliability of these two methods of assessment. MATERIALS AND METHODS Sixteen experienced nuclear medicine physicians assessed the quantity of dermal backflow of 57 lymphoscintigraphy scans using a 4-point descriptive scale that was dichotomized for secondary analysis. Each scan included images from four time points for women previously diagnosed with secondary lymphedema (n = 47) and controls (n = 5); five scans were presented twice to examine intraobserver reliability. This was further investigated as 13 physicians viewed the scans again on an Apple iPad2. The physicians rated their confidence in their scoring. Readers were blinded to clinical history. RESULTS Although both the 2- and 4-point scale had moderate interobserver reliability, the reliability of the 2-point scale was slightly higher (4-point: Fleiss κ = .418, standard error [SE] = .008); 2-point: Fleiss κ = .574, SE = .013). Low interobserver reliability was found when only control subjects were considered (Fleiss κ = 0.055, SE = 0.034). Intraobserver reliability of the five repeated images varied from poor to perfect (Cohen κ = .063 to 1.00), whereas moderate to substantial intraobserver reliability (Cohen's κ = .342 to .752) was found when comparing devices. The readers were highly confident of their scores. CONCLUSIONS Overall, moderate intraobserver and interobserver reliability was found for quantifying dermal backflow with both the 2- and 4-point scale.
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Jensen MR, Simonsen L, Karlsmark T, Bülow J. The washout rate of a subcutaneous 99mTc-HSA depot in lower extremity lymphoedema. Clin Physiol Funct Imaging 2011; 32:126-32. [DOI: 10.1111/j.1475-097x.2011.01066.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Jensen MR, Simonsen L, Karlsmark T, Bülow J. Lymphoedema of the lower extremities - background, pathophysiology and diagnostic considerations. Clin Physiol Funct Imaging 2010; 30:389-98. [DOI: 10.1111/j.1475-097x.2010.00969.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Literature Watch. Lymphat Res Biol 2009. [DOI: 10.1089/lrb.2009.7203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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