Background: Ultrasound investigation potentials in lymphedema are still to be fully used in everyday practice. Aim
of the present study was to report the sonographic characterization of the dermo-epidermal complex (DEC) and of the
subcutaneous (SUBC) tissue, assessing the feasibility of a related mapping, in upper limb secondary lymphedema.
Methods: In this retrospective study 287 patients affected by monolateral upper limb post-mastectomy
lymphedema (M5/F282; mean age 64±4.24) were enrolled and scanned by ultrasound, considering the healthy
contralateral limb as control. In order to standardize the assessment, the limb was divided in sectors: 4 anterior,
4 posterior below the elbow, 4 anterior and 4 posterior above the elbow, plus the hand. DEC and SUBC regions
B-mode appearance were reported, both in the healthy and in the pathological arms. DEC thickness was
measured and compared among the same sectors of the healthy and pathological limbs.
Results: DEC and SUBC sonographic appearance was differentiated in fluid and sclerotic. DEC included
a third category characterized by differentiation loss. The different sectors showed significantly different
lymphatic involvement in the affected limb. In the comparison with the contralateral unaffected segments a
significantly thicker DEC was reported in the forearm affected by lymphedema (P<0.005), while no significant
difference was reported at the arm level.
Conclusions: Traditional ultrasonography can provide a secondary upper limb lymphedema characterization
with related mapping and useful data for a better lymphatic physiopathology understanding and for a properly
addressed therapeutic protocol
