Validity of ultrasound-guided identification of dilated lymphatic vessels to detect early breast cancer-related lymphedema

Background: Early detection of breast cancer–related lymphedema (BCRL) is critical for timely intervention and prevent progression, but diagnostic modalities are limited. We assessed the validity of ultrasound-guided identification of dilated lymphatic vessels to detect early BCRL. Methods: Retrospective observational study of 300 female patients evaluated for suspected BCRL in lymphedema center in April of 2019 and March of 2023. All patients underwent gold standard to detect BCRL, indocyanine green (ICG) lymphography, staged by the MD Anderson grading system and ultrasound-guided identification of dilated lymphatic vessels (UIDL) from the proximal one‑third of the upper arm to the distal one‑third of the forearm circumferentially. The association between UIDL, with cut-off of ≧ 0.5 mm in diameter, and detected early BCRL by ICG lymphography were evaluated. Results: In total, 264 (88 %) cases were detected as BCRL by ICG lymphography. UIDL’s area under curve was 0.89 (95% CI: 0.84-0.94), with sensitivity of 86.2%, specificity of 91.7%, positive predictive value of 98.4 %, and negative predictive value of 53.2 %. Conclusions: UIDL showed high sensitivity and specificity to detect early BCRL. This method may serve as a widely available, noninvasive screening tool during post-treatment surveillance.