Lymphatic mapping

Erika van der Mescht, a physiotherapist, explains what lymphatic mapping is and how it assists in early intervention of lymphatic disease.

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What is lymphatic mapping?

Lymphatic mapping, aka fluoroscopy guided lymphoedema mapping, is one of the latest developments in the diagnostics and treatment of lymphoedema which has been boosted by the help of near-infrared imaging (NIR). 

NIR can identify and visualise, in real time, the superficial lymphatic collectors allowing for the observation of dermal rerouting, dermal backflow, and the functional lymphatic pathways. In simple terms, the therapist can view the lymphatic system thereby gaining valuable knowledge of your lymphatic system and find the best drainage pathways for a more effective treatment. 

The therapist is now able to perform the best manual lymphatic drainage (MLD) techniques that are specific to you, thereby enhancing and improving the overall results. 

Lymphatic mapping is performed using a photodynamic eye as a NIR camera. The photodynamic eye together with Verdye (ICG) allows the lymphatics to be observed in real time. The ICG is used at 100^th of the dose that is used in other surgeries, (angiology and ophthalmology). It’s not a new medicine, it’s only a much smaller dose of a well-known substance, injected sub-dermally. This procedure is covered by a few medical aids. 

What is seen during the mapping?

We look for normal, healthy valvular flow of the lymphatic vessels and further identify abnormal lymphatic flow patterns. 

What are the benefits?

• According to these abnormal lymphatic adaptations, your therapist will adjust your lymph drainage pathways to have more effective treatment. 
• The report will guide the therapist of what changes need to be made to get you the most comfortable and effective compression garments if indicated.  
• The possibility for lymphatic surgery is assessed and referred if needed.
• The basics of self-lymphatic drainage that your body would benefit from the most will be explained.
• A comprehensive report of the mapping will be given to ensure that any medical professional involved with your care can understand your lymphatic pathways. 

The benefits to your medical team

• If you need future surgery, suggestions on what could possibly be done to prevent further damage to the lymphatic system can be given. 
• Knowing where the lymphatic vessels are functioning could help the nursing staff understand when and where to avoid procedures like IV treatments, blood pressure assessments, etc. 

Better management of lymphatic disease

We now have an improved understanding of the lymphatic pathways and their drainage abilities. Lymphatic mapping has enhanced therapists’ technique regarding hand contact positions, movements, and pressure that are most effective in draining the lymphatic pathways.

Early identification of lymphoedema is crucial in the advanced treatment of swelling. Research has found that radiation and certain surgical procedures can result in the development of swelling in the affected areas. 

Screening the affected areas before swelling is noticed will give information to optimise treatment early, and is crucial in preventing the long-term and more serious side effects.

A screening programme in cancer patients can recognise the presence of lymphoedema and result in early intervention of lymphoedema. This is done by the means of initial screening directly before and after treatment which can include surgery and/or radiation. These screenings can be repeated as needed depending on what is seen initially for 24 months.

Lymphoedema is a chronic condition and early recognition ensures that the symptoms are managed early often before visual changes have occurred. Screening can prevent the deterioration of lymphoedema in the affected area.