Geometric Lymph Node Staging of Lower Extremity Lymphedema using Lymphoscintigraphy

Lower extremity lymphedema is a common complication following gynecologic cancer treatment. This study examined the relationship between lymphedema severity and lymphatic flow in pelvic lymph nodes, believed to be among the first areas affected post-surgery. A retrospective analysis was conducted on 317 patients with lymphedema, classified into three stages using Geometric Lymph Node Staging (GLNS) based on lymphoscintigraphy results. The correlation between GLNS and International Society of Lymphology (ISL) clinical staging was analyzed, along with reliability testing for GLNS. Subgroup analyses were also performed for different cancer types, including cervical, uterine, ovarian, and vulvovaginal cancers. Among the 36 women evaluated with unilateral lymphedema, a strong correlation was found between ISL staging and GLNS (r = 0.853; P < 0.001), as well as within all subgroups. GLNS demonstrated high inter- and intra-observer reliability. The study concluded that the location of residual lymph nodes correlates with lymphedema severity, suggesting that GLNS via lymphoscintigraphy could be a valuable tool for the early diagnosis and treatment of lymphedema.