Enhancing lymphoscintigraphic specificity of lymphoedema diagnosis in patients with lipoedema

This study addresses the diagnostic challenges of identifying lymphoedema in patients with lipoedema using lymphoscintigraphy. Overdiagnosis of lymphoedema in this patient population is frequent and may result in reduced proposed surgical interventions. We retrospectively analyzed clinical data from patients followed for lipoedema, lymphoedema or lipolymphoedema and who underwent lymphoscintigraphy. All patients were assigned a clinical or lymphoscintigraphic diagnosis of lymphoedema and concordance between clinical and lymphoscintigraphic diagnosis was assessed. A modification of lymphoscintigraphic criteria interpretation was proposed to enhance the diagnosis specificity. We included 94 female patients (188 lower limbs). One hundred and thirty-seven limbs presented with signs of lipoedema (137/188; 72.9%) and 42 with clinical signs of lymphoedema (42/188; 22.3%). Overall, 125 limbs presented with a diagnosis of lymphoedema on lymphoscintigraphy (125/188; 66.5%). Using lymphoscintigraphy to diagnose lymphoedema in patients with lipoedema resulted in low specificity (38.3%). By adjusting the interpretation criteria of the lymphoscintigraphic anomalies, we could achieve a specificity of 80.85%, reducing the risk of overdiagnosing lymphoedema in patients with lipoedema. This study contributes to the ongoing efforts to optimize the assessment and management of patients with lipoedema and potential lymphatic involvement, by modifying the interpretation of lymphoscintigraphic criteria.