Lymphology最新文献

Lymphadenopathy is associated with lymph node abnormal size or consistency due to many causes. We employed the deep convolutional neural network ResNet-34 to detect and classify CT images from patients with abdominal lymphadenopathy and healthy controls. We created a single database containing 1400 source CT images for patients with abdominal lymphadenopathy (n = 700) and healthy controls (n = 700). To train, test, and cross-validate the ResNet-34 classifier to detect specific lesions, we first resized and normalized all images. Then, we randomly divided the 1400 images into 88 groups of 16, and the classifier was trained to identify and label lesions using automatic volume delineation 3D reconstruction of target areas. The ResNet-34 had a diagnostic accuracy with receiver operating characteristic (ROC) curves of the true-positive rate versus the false-positive rate with the area under the curve (AUC) of 0.9957 and 1.00 for abdominal lymphadenopathy and healthy control CT images, respectively. This accuracy implied identical high sensitivity and specificity values of 99.57 % and 100% for the two groups. The added effect of ResNet-34 is a success rate of 99.57% and 100% for classifying random CT images of the two groups, with an overall accuracy of 99.79% in the testing subset for detecting and classifying lymph node lesions. Based on this high classification precision, we believe the output activation map of the final layer of the ResNet-34 is a powerful tool for the accurate diagnosis of lymph node lesions of abdominal lymphadenopathy from CT images.

2025-26 marks 60 years since the founding of the discipline of Lymphology. Landmarks in the history of the discipline are chronicled highlighting seminal contributions of ISL members. As we look back to celebrate and commemorate our history and the explosive growth of the field, a trifecta of international conferences, all significantly contributed to by the ISL, are planned as we simultaneously look forward to the bright future of the ISL and the discipline of Lymphology.

In Memoriam for Iwona Swedborg a lymphology pioneer and participant in the founding of the Swedish Society of Lymphology; 1936-2024.

Accurate quantitative assessments are crucial to understanding development of diseases and their effective treatments. Various validated perimetry and volumetry measurement methods for patients with lymphedema exist and each has its own advantages and limitations and choosing the right instrument is essential. PeriKit® (PK) is a new measurement device that requires validation. This single-blind, cross-sectional study compared three assessment methods for perimetry and volumetry of the lower limb: conventional tape measure (CTM); optoelectronic infrared volumeter (Perometer®) (OS) as the gold standard); and PK. Correlation coefficients between measurements were "strong" to "very strong". The ICC of the lower limb was the highest for PK (0.995), followed by the CTM (0.986) and the OS (0.974). PK had the lowest dispersion of results for all segments. Despite its poor reliability, CTM is widely used because of its low cost and portability. The OS is simple, ergonomic, and doesn't require calibration, but suffers from imperfections such as the absence of distal extremities (i.e. feet, hands, fingers, etc.) as well as cost. PK has succeeded in reducing many of the problems associated with measurement thanks to its standardized methodology which offers high repeatability. PK can replace OS and CTM, but OS or CTM can't replace PeriKit® because they are more dispersed and less accurate.

Contractile function of the collecting lymphatic vessels depend on smooth muscle cells, one-way valves, surrounding tissues, and regulation by the autonomic nervous system. The potentially deleterious effects of the Fontan procedure and elevated central venous pressure on lymphatic function leading to life-threatening complications are described. Presented at the 2023 ISL International Congress of Lymphology, Genoa, Italy in a special symposium on central and regional lymphatic system in health and disease.

The reported incidence of lymphedema varies greatly among women treated for breast cancer, making counselling for surgery challenging. This study assessed the incidence of lymphedema in patients undergoing mastectomy and free flap reconstruction using robust, quantifiable, and replicable diagnostic criteria. Data on limb circumference, limb volume, and reported symptoms was collected prospectively pre-operatively, post operatively, and at 2 years. All patients undergoing skin sparing mastectomy with axillary node clearance and immediate free tissue breast reconstruction between 2009 and 2018 were included. We followed 113 patients to 2-year follow-up. The prevalence of patients meeting two identifying criteria was highest in the immediate post-operative period at 11%, falling to 4% at 2 years. The proportion of patients meeting three criteria remained static from the post-operative period to two years at 7%, though the incidence declined over that period. All the patients with three identifying criteria post-operatively and at two years had received either chemotherapy or chemotherapy and radiotherapy. Clear diagnostic criteria are important for the accurate assessment and study of post operative lymphedema. It is possible that free tissue transfer could reduce the incidence of or delays the onset of lymphedema in patients undergoing mastectomy and axillary clearance.

Breast lymphedema is a common sequela of breast conservation that delays healing and reduces quality of life. No rigorous classification system exists for this condition. We explored approaches for classifying breast lymph-edema based on breast ultrasound, physical exam, and patient-reported outcomes. We enrolled 80 patients from two institutions. Each site enrolled 30 invasive breast cancer patients treated with breast conservation and radiotherapy, and 10 control patients evaluated for benign breast complaints. All patients underwent bilateral breast ultrasound to measure dermal thickness and were assessed for physical signs of breast lymphedema. Patients reported quality of life impacts on standard questionnaires. We derived breast lymphedema classifiers using (1) a simple ultrasound-based metric of dermal thickness difference, and (2) a multiparameter machine learning classifier based on dermal thickness difference, physical exam, and patient-reported impacts. Ultrasound-defined breast lymphedema was present in 72% (95% CI: 59 to 82%) of invasive breast cancer patients. The multiparameter classifier identified three distinct patient groups: one with little evidence of breast lymph-edema, and two with increasingly severe breast lymphedema. A simple ultrasound-based measure and a novel multiparameter classifier both show promise for rigorous classification of breast lymphedema and warrant further development in larger patient cohorts.

Over the past decade, there has been a resurgence of interest in the thoracic duct and central lymphatic system and its disorders, stimulated by advances in interventional magnetic resonance imaging techniques and urgent challenges in the clinical management of lymphatic malformations and lymphatic complications from congenital heart disease. The following chapter reprinted here written shortly after the formal founding of the discipline of lymphology and the International Society of Lymphology, describes early efforts, and also suggests future directions now being revisited and others yet to be explored (1).

The lymphatic system is composed of lymphatic vessels that connect lymphatic organs and play a critical role in draining lymph fluid from the intracellular environment. Disruptions in this system can lead to defects in lymphatic development and lymphedema which is characterized by chronic inflammation and fluid accumulation in tissues, finally resulting in swelling, pain, and fibrosis. If caused by genetic variants, this condition is referred to as primary lymphedema. This study explores the genetic basis of primary lymphedema in an Italian cohort retrospectively analyzing sequencing data and focusing specifically on genes involved in the HGF/MET signaling pathway. This pathway is crucial for lymphangiogenesis and lymphatic function, but the involved genes miss a clear association with lymphedema in clinical practice. The analysis identified 8 variants in three key genes, namely HGF, MET, and CBL, among 8 unrelated patients. Seven of these variants have never been reported in literature as associated with lymphedema. We performed molecular modeling studies to evaluate the effect of the three identified missense variants in MET, supporting the pathogenicity of two of them. The identification of these variants supports the significance of alterations in HGF/MET signaling pathway as possible causes of primary lymphedema.

In Memoriam for Jacques Aime Gruwez who was the third president of the ISL March 24, 1927-July 9, 2024.