Evaluation of patients presenting to a multidisciplinary lymphatic centre

A recent study has found no lymphedema in more than a third of patients presenting to a multidisciplinary lymphatic centre. Although lymphatic imaging is done frequently, only a few has undergone surgery.

A total of 2,031 patients (mean age 60 years, BMI 33.6 kg/m², 76 percent female) were included in the analysis. At evaluation, the average duration of edema symptoms was 9.47 years. The most common aetiology was secondary lymphedema (n=1,104, 54 percent), which was often due to cancer (54 percent) or chronic venous disease (23 percent).

Five hundred forty-nine (27 percent) patients underwent lymphatic imaging, with lymphoscintigraphy (83 percent) being the most common, followed by MRI (69 percent). Of these, only 149 (11 percent) underwent surgery.

Patients residing out-of-state were more likely to have longer symptom duration at initial evaluation (12.3 percent vs 9.1 years; p<0.0001) and higher surgical rates (16.6 percent vs 6 percent; p<0.001) than those residing in-state.

“Geographic barriers delayed evaluation and increased surgical intervention, emphasizing the need for broader access to multidisciplinary lymphatic care,” the authors said.

This retrospective review included patients assessed for edema at the BIDMC Lymphatic Center between January 2018 and December 2023. The multidisciplinary team consisted of cardiologist, radiologist, plastic surgeon, and physical therapist.

A RedCap registry was used to obtain data on demographics, clinical characteristics, imaging, and surgeries. The authors then stratified patients by edema aetiology as primary or secondary lymphedema or non-lymphatic edema. They also performed bivariate and geospatial analyses to explore differences across groups and geographic access to care.

“Lymphedema is a prevalent yet underserved condition,” the authors said. “Expanding diagnostic and therapeutic options have increased interest in multidisciplinary care.”