Introduction We aimed to evaluate the predictive value of semiquantitative lymphoscintigraphy in patients who underwent lymphovenous anastomosis (LVA) for lower extremity lymphedema (LEL).

Methods We retrospectively reviewed patients with LEL who underwent preoperative lymphoscintigraphy and LVA. From the lymphoscintigraphy, the transport index in 120 min (TI₁₂₀) and 240 min (TI₂₄₀) were respectively calculated by visual assessment of 5 criteria: lymphatic transport kinetics, distribution pattern, time to appearance of lymph nodes, visualization of lymph nodes, and visualization of vessels. The volume differential (VD) between the affected and the contralateral unaffected lower extremities (LEs) was calculated and the volume differential reduction at 1 (VDR₁), 3 (VDR₃), and 6 months (VDR₆) were respectively calculated to evaluate the postoperative outcome.

Results In total, 46 patients were included. According to Campisi’s stage, the majority of patients (76%) had stage III disease. In the lymphoscintigraphy, the mean TI₁₂₀ and TI₂₄₀ of 46 affected LEs were 26.8±11.4 and 25.9±11.3, respectively. The mean preoperative VD was 26±14% (range, 2–59). Campisi’s stage increased with BMI, TI, and preoperative VD. There were significant positive correlations of TI with BMI and preoperative VD, respectively (p<0.05). In postoperative assessment, the mean VDR₁, VDR₃, and VDR₆ were 60±99% (range, -9–526), 78±121% (range, 5–572), and 74±116% (range, -92–499), respectively. There was significant negative correlation between preoperative VD and each VDR (p<0.05). Both TI₁₂₀ and TI₂₄₀ showed significant negative correlation with VDR₃ and VDR₆ (p<0.05), although not VDR₁.

Conclusion/Implications This study suggests that semiquantitative lymphoscintigraphy using TI can be valuable as an effective tool for assessment of preoperative severity.