Graham Schwarz, MD

Dermatology & Plastic Surgery Institute


Pilot Award

Predicting Onset of Breast Cancer Related Lymphedema with Indocyanine Green Lymphangiography Using a Machine Learning Approach

Lymphedema following breast cancer treatment (BCRL) is a critical problem with long-term functional, aesthetic, and economic implications for patients. Occurring most frequently after axillary lymph node dissection and radiation, lymphedema manifests as progressive swelling of the arm. Early diagnosis can prompt therapeutic measures which can halt or reverse disease progression; however, many cases are diagnosed clinically at an advanced, irreversible stage. More sensitive and specific prognostic tools are needed identify those at risk of developing symptomatic BCRL. Indocyanine green (ICG) lymphangiography is a noninvasive fluorescent imaging technique that allows high-definition visualization of lymphatic architecture and function, increasingly utilized for lymphatic mapping, lymphedema staging, and surgical planning. Injected ICG dye flows linearly and proximally through lymphatic collecting ducts, but as lymphatic dysfunction progresses, lymphatic fluid backs up into the dermis and subcutaneous fat and produces aberrant changes on ICG lymphographic imaging. These changes may occur before clinical symptoms are observed. This study will use advanced machine learning techniques to identify subtle features of post-treatment ICG lymphographic studies associated with progression of lymphatic disease in high-risk, asymptomatic breast cancer patients. We will further use artificial intelligence to create a lymphedema risk-prediction model based on both sequential lymphographic studies and clinical data. Our novel approach aims to provide clinicians with a personalized tool for rapid and precise identification of patients likely to develop symptomatic BCRL. Using patient-specific decision support information from our model, early intervention can be initiated in those found to be particularly vulnerable.


The goal of our study is to identify women who have breast cancer and are at a high risk of developing lymphodema. We want to help them prevent the progression of lymphodema and hopefully reverse it if they are beginning to develop it.