When considering treatment for lymphedema, one of the most important steps is understanding how lymphatic fluid is actually flowing inside the body.

Lymphoscintigraphy is internationally recognized as the gold standard imaging test for diagnosing lymphedema.

It provides a comprehensive, whole-limb assessment of lymphatic function, including lymphatic transport delay, dermal backflow, and compensatory pathways—information that cannot be obtained from physical examination alone.

 

On this page, Lymphedema Clinic Tokyo introduces a highly respected peer-reviewed study by Dr. Jiro Maegawa and colleagues, which explores the relationship between lymphoscintigraphy imaging patterns and lymphaticovenular anastomosis (LVA), a minimally invasive microsurgical treatment for lymphedema.

This research demonstrates how specific lymphoscintigraphy patterns may help clinicians better understand surgical feasibility and treatment planning, while emphasizing that imaging findings should always be interpreted within a broader clinical context.

At Lymphedema Clinic Tokyo, we actively incorporate these evidence-based concepts into daily practice.

By combining lymphoscintigraphy with ultrasound, ICG lymphography, and careful clinical evaluation, we tailor treatment strategies that may include conservative therapy, same-day LVA surgery, or a thoughtful combination of both, depending on each patient’s condition and goals.

 

This page is designed to help international patients better understand:

What lymphoscintigraphy results mean

How scientific research supports treatment decision-making

Why personalized evaluation is essential in lymphedema care

and to provide reliable, transparent information for those considering consultation in Tokyo.

🔷 Research Overview

A Recommended Study for Patients with Lymphedema

Choosing the most appropriate treatment for lymphedema begins with a clear understanding of how lymph fluid is flowing inside the body.

Lymphoscintigraphy is internationally recognized as the gold standard diagnostic imaging modality for lymphedema, providing a comprehensive overview of lymphatic flow, stagnation, and compensatory pathways. It plays a crucial role in clinical decision-making worldwide.

On this page, we introduce an important peer-reviewed study that examines the relationship between lymphoscintigraphic findings and lymphaticovenular anastomosis (LVA)—a minimally invasive microsurgical procedure for lymphedema.

This is a study that we at Lymphedema Clinic Tokyo strongly respect and recommend to patients seeking an evidence-based understanding of their condition.

 

 

🔷 What Does This Study Show?

This research analyzed patients with lower-extremity lymphedema and classified lymphoscintigraphy findings into five distinct patterns (Type I–V) based on lymphatic flow characteristics such as:

Delayed lymphatic transport

Dermal backflow

Collateral lymphatic pathways

Residual tracer accumulation in the foot

 

The authors then examined how these imaging patterns were associated with the feasibility and outcomes of LVA surgery, including the number of lymphatic-to-venous anastomoses that could be safely performed.

One key finding was that patients with moderate lymphatic congestion and dermal backflow (Type III) tended to have a higher number of successful anastomoses, suggesting that imaging patterns may help surgeons anticipate surgical complexity and plan treatment strategies more carefully.

Importantly, the study does not claim that imaging patterns alone determine outcomes, but rather emphasizes their role in supporting individualized treatment planning.

 

 

🔷 Our Perspective at Lymphedema Clinic Tokyo

We believe that diagnostic imaging should never exist in isolation.

Its true value lies in how it helps patients and clinicians make informed, realistic, and personalized decisions together.

At Lymphedema Clinic Tokyo, we routinely incorporate lymphoscintigraphy into our diagnostic process, alongside:

Clinical symptoms and daily functional impact

Ultrasound and indocyanine green (ICG) lymphography

The condition and depth of lymphatic vessels

Each patient’s goals, lifestyle, and medical background

 

Based on this comprehensive evaluation, we may recommend:

Conservative treatment (compression therapy, skincare, exercise)

Lymphaticovenular anastomosis (LVA) as a same-day microsurgical procedure

Or a carefully balanced combination of both approaches

We do not believe in one-size-fits-all treatment.

Instead, we use scientific evidence—such as the insights provided by this study—to guide thoughtful, patient-centered care.

 

 

🔷 Respect for the Authors and Their Contribution

The lead author, Dr. Jiro Maegawa, is a highly respected pioneer in the field of lymphedema surgery and research.

We deeply admire his long-standing commitment to advancing scientific understanding of lymphatic disorders and translating research findings into meaningful clinical practice.

This study has influenced not only academic discussions but also real-world clinical decision-making, including how we explain diagnostic results to our patients.

 

 

🔷 Reference (Original Research Article)

Maegawa J, et al.

Relationship between lymphoscintigraphic findings and lymphaticovenular anastomosis in lower extremity lymphedema.

Microsurgery, 2014.

This article is available through medical journal platforms and may be helpful for patients who wish to explore the scientific background of their diagnosis and treatment options.

https://onlinelibrary.wiley.com/doi/abs/10.1002/micr.20772

 

 

🔷 Other Research We Introduce

At Lymphedema Clinic Tokyo, we regularly review and introduce carefully selected international research that we believe is valuable for patients with lymphedema.

📌 List of recommended research articles

https://www.english-mominoki-shinryosho.net/research/

(You can find the full list at the bottom of this page.)

 

 

🔷 In Closing

Living with lymphedema often raises many questions:

What does my imaging result really mean?

Am I a candidate for surgery?

What treatment approach is right for my life—not just my diagnosis?

Our role is not simply to offer procedures, but to help you understand your condition and choose your path with confidence.

If you would like to discuss your imaging results or explore personalized treatment options, we would be honored to support you.

Editorial Responsibility: Makoto Mihara, Yohei Iwanaga

【Frequently Asked Questions (FAQ)】

Lymphoscintigraphy and Lymphedema Treatment

 

 

Q1. What is lymphoscintigraphy, and why is it important for lymphedema?

Lymphoscintigraphy is a nuclear medicine imaging test that visualizes how lymph fluid flows through the lymphatic system.

A small amount of tracer is injected into the skin, and its movement is tracked over time.

It is internationally recognized as the gold standard diagnostic test for lymphedema, as it provides a global overview of lymphatic function that cannot be assessed by physical examination alone.

 

 

Q2. What information does lymphoscintigraphy provide?

This test helps clinicians understand:

Whether lymphatic flow is delayed or obstructed

Where lymph fluid accumulates or stagnates

How the body compensates through collateral lymphatic pathways

The presence and extent of dermal backflow

In other words, it shows how your lymphatic system is functioning internally, not just how the limb looks from the outside.

 

 

Q3. What is the focus of the research introduced on this page?

The study examines the relationship between lymphoscintigraphy imaging patterns and lymphaticovenular anastomosis (LVA), a microsurgical procedure used to treat lymphedema.

The authors classified lymphoscintigraphy findings into five patterns (Type I–V) and analyzed how these patterns relate to:

Surgical feasibility

The number of lymphatic-to-venous connections that can be created

This helps clinicians better anticipate treatment strategies.

 

 

Q4. Does the imaging pattern determine whether I can have LVA surgery?

No.

Imaging patterns alone do not determine eligibility for surgery.

The study shows trends and associations, not absolute rules.

At Lymphedema Clinic Tokyo, treatment decisions are based on a comprehensive evaluation, including:

Lymphoscintigraphy

Ultrasound and ICG lymphography

Severity of symptoms and daily functional impact

Individual goals and lifestyle

Imaging supports decision-making—it does not replace personalized clinical judgment.

 

 

Q5. Why does the study suggest that some patients may be better candidates for LVA?

The study found that patients with moderate lymphatic congestion and dermal backflow tended to have a higher number of successful anastomoses.

This suggests that, in some cases, functional lymphatic vessels may still be identifiable and usable for microsurgery.

However, the study also emphasizes that careful planning and technique are essential, especially in more advanced cases.

 

 

Q6. How does Lymphedema Clinic Tokyo use this research in practice?

We actively use the concepts presented in this study when interpreting lymphoscintigraphy results.

At Lymphedema Clinic Tokyo, we combine:

Scientific evidence from international research

Advanced diagnostic imaging

Extensive clinical experience in conservative therapy and LVA

to create individualized treatment plans, rather than applying a one-size-fits-all approach.

 

 

Q7. Is LVA surgery always recommended if imaging looks favorable?

No.

Even when imaging suggests that LVA may be feasible, surgery is never recommended automatically.

Some patients achieve good symptom control with conservative therapy alone, while others benefit from a combination of conservative treatment and microsurgery.

Our priority is to recommend what is safe, realistic, and appropriate for each individual patient.

 

 

Q8. Can patients read the original research article themselves?

Yes.

Although the article is written for medical professionals, motivated patients may find it helpful to understand the scientific background behind diagnostic imaging and treatment planning.

Reference:

Maegawa J, et al.

Relationship between lymphoscintigraphic findings and lymphaticovenular anastomosis in lower extremity lymphedema.

Microsurgery, 2014.

 

 

Q9. Are there other research studies recommended by your clinic?

Yes.

We regularly review and introduce selected international research that we believe is valuable for patients with lymphedema.

 

📌 List of recommended research articles

https://www.english-mominoki-shinryosho.net/research/

(The full list is available at the bottom of the page.)

 

 

【Our Message】

Living with lymphedema often raises important questions:

What does my imaging result really mean?

Am I a candidate for surgery?

What treatment approach fits my life best?

At Lymphedema Clinic Tokyo, we help patients from around the world understand their condition through evidence-based diagnostics and personalized treatment planning, combining conservative therapy and same-day LVA surgery when appropriate.

 

If you are considering consultation or would like to discuss your diagnostic results, we would be pleased to support you.

▶ Learn about online consultations and international patient care

▶ Contact Lymphedema Clinic Tokyo for personalized guidance

https://www.english-mominoki-shinryosho.net/for-inernational-patients/