|  Gaps in the Field of Lymphatic Research  |  2026–27 Update  |  2
CLINICAL GAPS
1. Early Diagnosis
One of the most frustrating aspects of caring for 
patients living with lymphatic disease is the relative 
lack of highly sensitive and specific non-invasive  
tests and blood biomarkers. Without these  
essential diagnostic tools, a delay in diagnosis is 
inevitable and often results in increased morbidity  
and mortality. 
Imaging:
• An urgent need in novel non-invasive imaging 
techniques and devices.
• A need for further investigation of proposed 
techniques: 
■ Fat-weighted whole-body MRI (e.g., Lipedema–fat  
to water ratio is greater than obesity)
■ Water-weighted MRI of soft tissue
■ Standardized sodium 23NA-MRI
■ MR Lymphangiogram techniques
■ Non-tracer MRL sensitive to edema and vascular 
morphology
■ Procedure for comparative analysis of ICG imaging 
of lymphatic vessels
■ Other—PET? Functional MRI?
There is a clinical need for development of non-
invasive imaging of lymphatic physiology to aid 
diagnosis and understanding of all lymphatic diseases, 
including lymphedema and  lipedema (e.g., non-invasive 
MRL, anatomical and sodium MRI, spectrometry MRI).
Biomarkers: 
• Development of non-invasive assessment for 
genotyping of somatic mutations that are safer  
than biopsy (i.e., circulating free DNA).
• Novel biomarkers utilizing bodily fluids (urine,  
cyst fluid, pleural effusions, edematous fluid, saliva, 
and blood).
Omics: 
Transcriptomics, proteomics and metabolomics, and 
microbiome studies:
• Define transcriptional machinery of lymphangiogenic 
pathways.
• Characterizing the role of the lymphatic vasculature 
in immune activation (outside lymphoid organs).
• Developing therapeutic lymphangiogenesis concepts.
• In solid organ transplants, would competent 
lymphatics enhance graft health?
• In breast cancer patients, can preemptive and 
targeted therapy safely accelerate lymphatic repair?
• Single Cell RNA techniques and atlas mapping
• How does the microbiome affect lymphatic health?
Lymphatic research has experienced a near explosion of 
activity in recent years, as awareness of the importance of 
lymphatic mechanisms to the continuum of human biology 
and disease has grown. This ‘lymphatic continuum’ now easily 
encompasses cardiovascular disease, respiratory inflammation, 
obesity, autoimmune disease, and chronic transplant rejection, 
among many other pathologic conditions. An exponential 
growth in technological tools for research has made possible  
a similar growth in our comprehension of the molecular 
regulatory processes that govern the normal development 
and function of the lymphatic system.
—Stanley Rockson, M.D., LE&RN Co-Founder, 
Allan and Tina Neill Professor of Lymphatic Research and  
Medicine at Stanford University School of Medicine
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