ICG-FL is a relatively new lymph flow testing method developed by Unno et al. in Japan and is widely used worldwide for its effectiveness, simplicity, and low invasiveness. Using ICG as a contrast medium, lymph flow can be visualized from the body surface using an ICG characteristic of emitting fluorescence when it receives infrared rays. An infrared camera, such as the PDE neo (Hamamatsu Photonics, Co. Ltd., Hamamatsu, Japan), is needed to delineate fluorescence imaging; however, the device is not so expensive, is relatively compact and mobile, and does not require radiation control. ICG-FL is applied to not only diagnose but also determine the surgical site and postoperative evaluation. …. ICG-FL can be implemented relatively easily without selecting the institution or place compared to lymphoscintigraphy and can be easily applied for the screening of and regular evaluations of lymphedema.

In 2018, Shinaoka et al. conducted a questionnaire survey on the state of lymphedema imaging examinations in medical institutions in the field of orthopedic surgery in Japan; the survey results showed that ICG-FL was performed at 77% of institutions,9) and at present, it is believed that ICG-FL is performed at even more institutions. Despite this, ICG-FL is still not covered by health insurance in Japan, and tests are presumably performed at patients’ own cost, using research funds, or at the expense of hospitals, which is impeding the widespread availability of ICG-FL in general medical institutions. To address this situation, Akita et al. conducted an investigator-led multicenter phase III trial to evaluate the usefulness of ICG-FL for the treatment of lymphedema and provided evidence that ICG-FL is useful for the diagnosis and treatment of lymphedema.10) Under such circumstances, ICG-FL should be covered by health insurance as soon as possible for the development of lymphedema care in Japan.


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