Assessing breast cancer-related breast lymphoedema using indocyanine green lymphography

Breast lymphoedema is a potential complication for women undergoing breast-conserving therapy for breast cancer. It is characterised by chronic swelling and tissue changes in the breast, which can cause discomfort, increased susceptibility to cellulitis, and negatively impact the sufferer's quality of life. Despite this breast lymphoedema remains under-recognised and under-reported. This can be attributed, at least in part, to the lack of a standardised assessment method. This thesis explores breast lymphoedema, specifically the current methods available to assess this condition and proposes a new method of assessment, indocyanine green (ICG) lymphography. ICG lymphography is a validated assessment method for breast cancer-related arm lymphoedema. However, its use in breast lymphoedema has not been examined. Therefore, a pilot study recruiting two groups of participants (10 healthy controls, and 10 breast lymphoedema participants) was undertaken to determine if ICG lymphography could be utilised as an assessment method for this condition. Additionally, ICG lymphography was used to map the lymphatic drainage pathways of the breast in both participant groups to determine if these drainage pathways are altered following breast conserving therapy. In this pilot study, ICG lymphography detected morphological changes to the lymphatic vasculature diagnostic of lymphoedema (dermal backflow and collateral lymphatic drainage) in all breast lymphoedema participants and none of the healthy control participants. Furthermore, lymphatic drainage pathways of the breast differed between the two groups. In the healthy control group lymph drained exclusively to the ipsilateral axilla region. In the breast lymphoedema group lymph drained to the: i) parasternal (6/10); ii) ipsilateral axilla (4/10); iii) contralateral axilla (4/10); iv) intercostal (3/10) and v) clavicular (2/10) regions. These findings support the use of ICG lymphography in the assessment of breast lymphoedema. Additionally, understanding the lymphatic drainage pathways of the breast will have clinical implications for breast lymphoedema management. This pilot study serves to direct future research that examines the role of ICG lymphography not only in the assessment of breast lymphoedema but its diagnosis, management, and monitoring.