Piyaman Parkpoom, Sitthinamsuwan Panitta, Apichonbancha Sirin, Yodrabum Nutcha
Department of Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Division of Plastic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Sci Rep. 2025 May 3;15(1):15516. doi: 10.1038/s41598-025-00485-6.
The subcutaneous changes of lymphedema, collectively termed "adipose tissue remodeling", comprises adipocyte hypertrophy, inflammatory cell infiltration, fibrosis, etc. To detect these changes, subcutaneous tissue ultrasonography was developed using conventional high-frequency ultrasound (6-18 MHz) to assess 2 parameters: (1) subcutaneous echogenicity (SEG) and (2) subcutaneous echo-free space (SEF). Despite its potential, research on the histopathological associations and clinical applications of this modality remains limited. This study recruited 22 patients with secondary lymphedema involving upper and lower limbs who were undergoing lymphaticovenular anastomosis (LVA). SEG and SEF were graded at 46 surgical sites. While performing LVA, 46 pieces of skin, 46 aggregates of subcutaneous tissue, and 100 segments of collecting lymph vessels were biopsied for pathological evaluation. The results showed that the presence of adipose tissue remodeling associated with progression of SEG and SEF grades. On the other hand, severity of lymphatic vessels showed no association with progression of SEG and SEF grades but surprisingly showed an inverse trend with the presence of adipose tissue remodeling. SEG grade, SEF grade and clinical stage (ISL) show similarly high sensitivity for detecting adipose tissue remodeling, but none of them show sufficient specificity. The application of subcutaneous tissue ultrasonography is suitable for screening of the adipose tissue remodeling.
淋巴水肿的皮下改变，统称为“脂肪组织重塑”，包括脂肪细胞肥大、炎性细胞浸润、纤维化等。为检测这些改变，采用传统高频超声（6 - 18兆赫）开发了皮下组织超声检查，以评估两个参数：（1）皮下回声性（SEG）和（2）皮下无回声间隙（SEF）。尽管有其潜力，但关于这种检查方式的组织病理学关联和临床应用的研究仍然有限。本研究招募了22例接受淋巴管静脉吻合术（LVA）的上下肢继发性淋巴水肿患者。在46个手术部位对SEG和SEF进行分级。在进行LVA时，对46块皮肤、46块皮下组织团块和100段集合淋巴管进行活检以进行病理评估。结果显示，脂肪组织重塑的存在与SEG和SEF分级的进展相关。另一方面，淋巴管的严重程度与SEG和SEF分级的进展无关，但令人惊讶的是，与脂肪组织重塑的存在呈相反趋势。SEG分级、SEF分级和临床分期（ISL）在检测脂肪组织重塑方面显示出同样高的敏感性，但它们均未显示出足够的特异性。皮下组织超声检查的应用适用于脂肪组织重塑的筛查。
