Prognostic Value of Lymphoscintigraphy and SPECT/CT After Vascularized Lymph Node Transfer in Lymphedema Patients

This study aimed to evaluate the prognostic value of postoperative lymphoscintigraphy and SPECT/CT in assessing clinical outcomes in lymphedema patients undergoing vascularized lymph node transfer (VLNT).

Lymphedema patients who underwent VLNT between March 2019 and September 2023 were included in the study. All patients underwent postoperative lymphoscintigraphy 12 months after surgery. In addition to lymphoscintigraphy, SPECT/CT was performed during the later phase of the study period. Patient demographics, clinical stage, recipient site, and lymph node flap type, and lymphoscintigraphic findings were recorded and analyzed in relation to clinical outcomes.

Among the 57 extremities of 55 patients, postoperative lymphoscintigraphy showed positive radiotracer uptake in transferred lymph nodes in 31 extremities (54.4%). There were significantly higher rates of both subjective symptom improvement (77.4% vs 38.5%, P = 0.003) and Taiwan lymphoscintigraphy staging (TLS) grade improvement (55.6% vs 9.1%, P < 0.001) among patients with uptake compared with those without uptake. In addition, the frequency of cellulitis was significantly decreased in the uptake group ( P = 0.010) but not in the non-uptake group ( P = 0.211). A subset of 24 patients underwent SPECT/CT in addition to lymphoscintigraphy. Lymphoscintigraphic assessment revealed that 70% of patients with uptake achieved TLS grade improvement ( P = 0.006). Spearman rank correlation analysis demonstrated a significant positive correlation between TLS grade improvement and SUV max (correlation coefficient = 0.463, P = 0.045).

Lymphoscintigraphy with SPECT/CT may serve as a valuable prognostic tool for evaluating surgical outcomes following VLNT in lymphedema treatment.