{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T21:54:13Z","timestamp":1792533253239,"version":"4.5.0"},"reference-count":31,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,10,26]],"date-time":"2021-10-26T00:00:00Z","timestamp":1635206400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,10,26]],"date-time":"2021-10-26T00:00:00Z","timestamp":1635206400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Precise staging of breast cancer-related lymphedema (BCRL) is important to guide treatment-decision making. Recent studies have suggested staging of BCRL using indocyanine green lymphangiography (ICG-L) based on the extent of lymphatic injury and dermal backflow patterns. Currently, the benefits of ICG-L compared to conventional clinical staging are unknown. For this study, we included 200 patients with unilateral BCRL. All BCRL patients were staged using ICG-L and clinical exam. The amounts of excess arm volume, fat mass and lean mass were compared between stages using Dual Energy X-Ray Absorptiometry. Multivariate regression models were used to adjust for confounders. For each increase in the patient's ICG-L stage, the excess arm volume, fat mass and lean mass was increased by 8, 12 and 6.5 percentage points respectively (\n                    <jats:italic>P<\/jats:italic>\n                    \u2009&lt;\u20090.001). For each increase in the patient's clinical ISL stage, the volume was increased by 3.5 percentage points (\n                    <jats:italic>P<\/jats:italic>\n                    \u2009&lt;\u20090.05), however no statistically significant difference in the lean and fat mass content of the arm was observed for ascending stages. However, the residual plots showed a high degree of variance for both ICG-L and clinical staging. This study found that ICG-L staging of BCRL was superior to clinical staging in forecasting BCRL excess arm volume, fat mass, and lean mass. However, there was a high degree of variance in excess arm volume, fat mass, and lean mass within each staging system, and neither the ICG-L nor clinical staging forecasted perfectly.\n                  <\/jats:p>","DOI":"10.1038\/s41598-021-00396-2","type":"journal-article","created":{"date-parts":[[2021,10,26]],"date-time":"2021-10-26T06:02:49Z","timestamp":1635228169000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":34,"title":["Indocyanine green lymphangiography is superior to clinical staging in breast cancer-related lymphedema"],"prefix":"10.1038","volume":"11","author":[{"given":"Mads Gustaf","family":"J\u00f8rgensen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne Pernille","family":"Hermann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anette Riis","family":"Madsen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steffanie","family":"Christensen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jens Ahm","family":"S\u00f8rensen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,10,26]]},"reference":[{"issue":"6","key":"396_CR1","doi-asserted-by":"publisher","first-page":"500","DOI":"10.1016\/S1470-2045(13)70076-7","volume":"14","author":"T DiSipio","year":"2013","unstructured":"DiSipio, T., Rye, S., Newman, B. & Hayes, S. Incidence of unilateral arm lymphoedema after breast cancer: a systematic review and meta-analysis. Lancet Oncol. 14(6), 500\u2013515 (2013).","journal-title":"Lancet Oncol."},{"issue":"5","key":"396_CR2","doi-asserted-by":"publisher","first-page":"594","DOI":"10.1097\/SAP.0000000000001537","volume":"81","author":"MG J\u00f8rgensen","year":"2018","unstructured":"J\u00f8rgensen, M. G. et al. Quantification of chronic lymphedema in a revised mouse model. Ann. Plast. Surg. 81(5), 594\u2013603 (2018).","journal-title":"Ann. Plast. Surg."},{"key":"396_CR3","unstructured":"The diagnosis and treatment of peripheral lymphedema: 2020 consensus document of the international society of lymphology. Lymphology. 2020."},{"issue":"2","key":"396_CR4","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1089\/lrb.2020.0005","volume":"19","author":"R Sierla","year":"2021","unstructured":"Sierla, R., Dylke, E. S., Shaw, T., Poon, S. & Kilbreath, S. L. Clinician assessment of upper limb lymphedema: an observational study. Lymphat. Res. Biol. 19(2), 159\u2013164 (2021).","journal-title":"Lymphat. Res. Biol."},{"issue":"10","key":"396_CR5","doi-asserted-by":"publisher","first-page":"1778","DOI":"10.1016\/j.ejso.2019.06.009","volume":"45","author":"M Abbaci","year":"2019","unstructured":"Abbaci, M., Conversano, A., De Leeuw, F., Laplace-Builh\u00e9, C. & Mazouni, C. Near-infrared fluorescence imaging for the prevention and management of breast cancer-related lymphedema: a systematic review. Eur. J. Surg. Oncol. 45(10), 1778\u20131786 (2019).","journal-title":"Eur. J. Surg. Oncol."},{"issue":"5","key":"396_CR6","doi-asserted-by":"publisher","first-page":"1305","DOI":"10.1097\/PRS.0b013e3182a4d626","volume":"132","author":"DW Chang","year":"2013","unstructured":"Chang, D. W., Suami, H. & Skoracki, R. A prospective analysis of 100 consecutive lymphovenous bypass cases for treatment of extremity lymphedema. Plast Reconstr. 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Preoperative planning of lymphaticovenous anastomosis: the use of magnetic resonance lymphangiography as a complement to indocyanine green lymphography. J. Plast Reconstr. Aesthetic. Surg. 72(6), 884\u2013891 (2019).","journal-title":"J. Plast Reconstr. Aesthetic. Surg."},{"key":"396_CR17","doi-asserted-by":"publisher","first-page":"25575","DOI":"10.1002\/jso.25575","volume":"9","author":"H Kajita","year":"2019","unstructured":"Kajita, H. et al. Photoacoustic lymphangiography. J. Surg. Oncol. 9, 25575 (2019).","journal-title":"J. Surg. Oncol."},{"issue":"1","key":"396_CR18","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1038\/s41523-021-00276-y","volume":"7","author":"MG J\u00f8rgensen","year":"2021","unstructured":"J\u00f8rgensen, M. G., Toyserkani, N. M., Hansen, F. G., Bygum, A. & S\u00f8rensen, J. A. The impact of lymphedema on health-related quality of life up to 10 years after breast cancer treatment. 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