Does lymphoscintigraphy have a role in the diagnosis and management of lipedema?

Lipedema is a chronic and progressive connective tissue disorder characterized by symmetric accumulation of adipose tissue, predominantly in the lower limbs, often associated with pain, easy bruising, and reduced response to lifestyle interventions. Despite increasing recognition, the condition remains frequently misdiagnosed or mistaken for obesity or lymphedema. To investigate the role of lymphoscintigraphy in the diagnostic and therapeutic management of patients with clinically confirmed lipedema and assess its potential utility in detecting associated lymphostatic disorders. A retrospective observational study was conducted on 108 patients clinically diagnosed with lipedema between January 2019 and August 2023. Among them, 31 patients underwent lymphoscintigraphy due to suspected mixed pathology or surgical candidacy. Data on lymphatic involvement were collected and analyzed to determine correlations with clinical staging. In 58% of the selected cases, lymphoscintigraphy revealed no detectable lymphatic abnormalities. Of these, approximately 70% showed latent compensatory lymphatic patterns. The remaining 39% had confirmed alterations of the superficial and/or deep lymphatic system, suggesting a mixed clinical picture (lipo-lymphedema) with potential surgical contraindications. Lymphoscintigraphy is not essential for routine diagnosis of lipedema, which remains clinical. However, it is valuable in identifying cases with coexisting lymphostatic components and guiding surgical decisions. These findings support a multidisciplinary and individualized approach to diagnosis and treatment.