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lymphoscintigraphy

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Lymphoscintigraphy

HOW DO YOU GET DIAGNOSED WITH LYMPHEDEMA?

IS THERE A "TEST" FOR LYMPHEDEMA?

There is a question that is asked continuously in the online groups I am a member of is, “Is there a test that can be done to accurately determine whether or not you have lymphedema?”

Yes, there is. It us called lymphoscintigraphy. In this procedure a radioactive substance is injected between the toes into the swollen limb. The substance then travels and is tracked through the lymphatic system until it reaches the lymphatic obstruction. The radiologist can then tell exactly where the lymphatic obstruction is located. It is considered by many to be the gold standard for radiological tests for lymphatic mapping, lymphedema diagnoses, lymphedema treatment plans and for many cancers, including breast cancer, melanoma, Merkel cell, prostate, colon cancer, melanoma and more.

Lymphedema therapists are using the procedure more and more as it is a method to understand the healthy remaining lymphatic flow patterns in lymphedema patients. This enable the therapist to “customize” a person treatment program.

It is safe because it is minimally invasive. It is accurate and from this test, the lymphedema can be classified by type, hyperplasia, hypoplasia, or absence of lymphatics.

There are only two downsides to the test. It has to be done separately for each limb that is affected and it won't pick up the deeper lymphatics. These deeper lymphatics are responsible for the transport of about 10% of the bodies fluid.

This is another in our series on helping prevent lymphedema. Hopefull, these pages will assist patient with the knowledge the need to prevent arm, or leg lymphedema as a result of cancer biopsy.

TESTING FOR LYMPHEDEMA - LYMPHATIC OBSTRUCTIONS

LYMPHOSCINTIGRAPHY

DEFINITION: A method used to identify the sentinel node (the first draining lymph node near a tumor). A radioactive substance that can be taken up by lymph nodes is injected at the site of the tumor, and a doctor follows the movement of this substance on a computer screen. Once the lymph nodes that have taken up the substance are identified, they can

LYMPHOSCINTIGRAPHY - The Procedure

Lymphatic mapping is the first of this three-part investigation. No anesthetic is required for this component of the assessment. It is performed in the Department of Nuclear Medicine by the surgeon and a medical physicist. The procedure is carefully explained to the patient who then lies on the imaging table with the appropriate anatomical site exposed. The surgeon injects 0.4mll (20 mega Becquerels) of technetium (Tc 99) unfiltered sulfur colloid intradermally in to four quadrants (0.1ml each) around the melanoma scar.

The patient is then positioned under the scanner (Figure 1) and dynamic images obtained (Figure 2). This early phase dynamic scanning shows the lymphatic channels and the sentinel node(s) as they appear in sequence. This is carried out for 20 minutes. The patient is then asked to walk about in the hospital for approximately one hour.

A late phase scanning of the basin is done ninety minutes after the injection

INTRADERMAL BLUE DYE INJECTION

This is done on the operating table in theatre while the patient is under anesthesia (if general anesthesia is used) or before the local anesthetic infiltration. Vital blue dye (0.1 ml) is injected in to each of four quadrants around the melanoma scar (Figure 4). The surgeon scrubs and gowns while the operation site is prepared, thus, allowing time for the dye to reach the sentinel lymph node via the afferent lymphatics. This process takes 10-20 minutes in the lower limb and up to 30 minutes in the upper limb. Society of Nuclear Medicine

MR Lymphangiography at 3.0 T: Correlation with Lymphoscintigraphy.

April 2012

Notohamiprodjo M, Weiss M, Baumeister RG, Sommer WH, Helck A, Crispin A, Reiser MF, Herrmann KA.

Source

Department of Clinical Radiology, Clinic of Nuclear Medicine, and Division of Plastic-, Hand-, Micro-Surgery, Department of Surgery, University Hospitals Munich, Campus Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany.

Abstract

Purpose: To prospectively compare findings of magnetic resonance (MR) lymphangiography with those of lymphoscintigraphy, evaluate the pattern and delay of lymphatic drainage, compare typical findings, and investigate discrepancies between the techniques.

Materials and Methods: This prospective study was performed according to the Declaration of Helsinki and was approved by the local ethics committee. Thirty consecutive patients with uni- or bilateral lymphedema and lymph vessel transplants of the lower extremities were examined with 3.0-T fat-saturated three-dimensional gradient-echo MR after gadopentetate dimeglumine injection. Results of all examinations were correlated with corresponding results of lymphoscintigraphy examinations.

Results of both techniques were separately reviewed in consensus by a radiologist and a nuclear physician, who rated delay and pattern of drainage, number of enhancing levels, and quality of conspicuity of the depiction of lymph nodes and lymph vessels. Sensitivity and specificity were calculated by using combined results of both techniques and clinical presentation findings as reference standard. Correlation was calculated with weighted κ coefficients.

Results: Weak lymphatic drainage at lymphoscintigraphy correlated with lymphangiectasia at MR lymphangiography (13 of 33 affected extremities). Lymph vessels were clearly visualized with MR lymphangiography (five of 24 affected extremities), while they were not detectable with lymphoscintigraphy. Depiction of inguinal lymph nodes was clearer with lymphoscintigraphy (five of 60 extremities). Correlation of both techniques was excellent for delay (κ = 0.93) and pattern (κ = 0.84) of drainage, good for depiction of lymph nodes (κ = 0.67) and number of enhancing levels (κ = 0.77), and moderate for depiction of lymph vessels (κ = 0.50). Sensitivity and specificity for delay and pattern of drainage were concordant, whereas MR lymphangiography showed a higher sensitivity for lymph vessel abnormalities (100% vs 79%) and lower specificity for lymph node abnormalities (78% vs 100%).

Conclusion:Imaging findings of MR lymphangiography and lymphoscintigraphy show a clear concordance. With lymphoscintigraphy, better visualization of inguinal lymph nodes was achieved, whereas with MR lymphangiography, better depiction of lymph vessels and morphologic features of lymph vessel abnormalities were achieved.

PubMed

Classification of lymphoscintigraphy and relevance to surgical indication for lymphaticovenous anastomosis in upper limb lymphedema.

Dec 2011

Mikami T, Hosono M, Yabuki Y, Yamamoto Y, Yasumura K, Sawada H, Shizukuishi K, Maegawa J.

Source

Department of Plastic and Reconstructive Surgery, Yokohama City University Hospital, Yokohama, Japan. zeong3@mac.com

Abstract

Upper limb lymphedema that develops after breast cancer surgery causes physical discomfort and psychological distress, and it can require both conservative and surgical treatment. Lymphaticovenous anastomosis has been reported to be an effective treatment; however the disease severity criteria that define indications for this treatment remain unclear. Here, we examined lymphoscintigraphic findings in 78 patients with secondary upper limb lymphedema and classified them into 5 major types (Type I-V) and 3 subtypes (Subtype E, L, and 0). Results revealed that this classification is related to the clinical stage scale of the International Society of Lymphology. Based on intraoperative examination findings in 20 of the 78 patients, lymphatic pressure is likely to be further elevated in Type II-V cases which are characterized by the presence of dermal back flow. Therefore, lymphaticovenous anastomosis should be considered as a treatment option for lymphedema in Type II-V cases. Furthermore, there are only limited lymph vessel sites usable for lymphaticovenous anastomosis in more severe lymphedema types [Types IV and Type V (which is characterized by dermal backflow only in the hand)]. The findings in Type IV-V cases suggest that therapeutic strategies for severe upper limb lymphedema need further consideration.

PubMed

Popliteal node visualization during standard pedal lymphoscintigraphy for a swollen limb indicates impaired lymph drainage.

2011 Dec

Burnand KM, Glass DM, Sundaraiya S, Mortimer PS, Peters AM. Source Department of Nuclear Medicine, Royal Sussex County Hospital, Brighton, Sussex Medical School, Audrey Emerton Bldg, Eastern Rd, Brighton BN2 5BE, United Kingdom.

Abstract

OBJECTIVE: The objective of our study was to examine the frequency and significance of visualization of popliteal nodes during lymphoscintigraphy for the investigation of lower extremity swelling.

MATERIALS AND METHODS: Technetium-99m-labeled nanocolloid was injected subcutaneously in the first web spaces of both feet of 204 consecutive patients (69 males, 135 females; age range, 11-79 years) undergoing routine, clinically indicated lymphoscintigraphy; imaging was performed 5, 45, and 150 minutes after injection. The patients were asked not to undertake any vigorous exercise between the injection and completion of imaging.

RESULTS: No popliteal nodes were visualized in 29 patients in whom there was no evidence of lymphedema on clinical or lymphoscintigraphic examination (group 1). Unilateral or bilateral popliteal nodes were visualized in 10 of 39 patients (25.6%) with clinical evidence of lymphedema but normal lymphoscintigraphy findings (group 2) (p < 0.005 vs group 1). In 136 patients with clinical evidence of lymphedema and abnormal lymphoscintigraphy findings (group 3), unilateral or bilateral popliteal nodes were visualized in 59 (43.4%) (p < 0.0001 vs group 1). Popliteal nodes were visualized in 40 of 73 limbs with “dermal backflow” (54.8%) and 42 of 335 limbs without dermal backflow (12.5%) (p < 0.0001).

CONCLUSION: Popliteal node visualization after subcutaneous foot web space injection is an important sign of abnormal lymphatic function in patients with clinical lymphedema of the lower extremities.

Am Journal of Roentgenology

Lymphoscintigraphy Defines New Lymphatic Pathways from Cutaneous Melanoma Site: Clinical Implications and Surgical Management

2011

Marone U, Aloj L, Di Monta G, Caracò C.

Source

Department of Surgery “Melanoma, Soft Tissues, Head and Neck, Skin Cancers”, National Cancer Institute of Naples, 80131 Naples, Italy.

Abstract

Sentinel lymph node biopsy is commonly applied as staging procedure of regional lymph nodes in patients with cutaneous melanoma. Dynamic lymphoscintigraphy defines the lymphatic pathways from a primary melanoma site and allows to identify the node receiving lymphatic drainage from the primary tumor, which is the sentinel lymph node. In rare cases, lymphoscintigraphy shows sites of lymphatic drainage in nonclassical basins never described in the past when lymphatic drainage was considered only according to the anatomical proximity of the tumor primary site. These peculiar sentinel nodes, so-called “uncommon/interval” nodes, must be surgically removed because they may contain micrometastatic disease and may be the only site of nodal involvement.

PubMed

Intradermal lymphoscintigraphy at rest and after exercise: a new technique for the functional assessment of the lymphatic system in patients with lymphoedema.

Nucl Med Commun. 2010 Mar

Tartaglione G, Pagan M, Morese R, Cappellini GA, Zappalà AR, Sebastiani C, Paone G, Bernabucci V, Bartoletti R, Marchetti P, Marzola MC, Naji M, Rubello D.

aUnit of Nuclear Medicine, Cristo Re Hospital bUnit of Medical and Dermatologic Oncology cUnit of Oncological Rehabilitation, Istituto Dermopatico dell'Immacolata, IDI-IRCCS dUnit of Medical Oncology, Sant'Andrea Hospital, Rome eDepartment of Nuclear Medicine, PET Centre, Radiology, Medical Physics, Santa Maria della Misericordia Hospital, Rovigo, Italy fDepartment of Nuclear Medicine, Hammersmith Hospital, London, UK.

AIM: The aim of this study was to evaluate the effect of implementing a new technique, intradermal injection lymphoscintigraphy, at rest and after muscular exercise on the functional assessment of the lymphatic system in a group of patients with delayed or absent lymph drainage.

METHODS: We selected 44 patients (32 women and 12 men; 15 of 44 with upper limb and 29 of 44 with lower limb lymphoedema). Thirty of 44 patients had bilateral limb lymphoedema and 14 of 44 had unilateral disease; 14 contralateral normal limbs were used as controls. Twenty-three patients had secondary lymphoedema after lymphadenectomy and the remaining 21 had idiopathic lymphoedema. Each of the 44 patients was injected with 50 MBq (0.3-0.4 ml) of Tc-albumin-nanocolloid, which was administered intradermally at the first interdigital space of the affected limb. Two planar static scans were performed using a low-energy general-purpose collimator (acquisition matrix 128×128, anterior and posterior views for 5 min), and in which drainage was slow or absent, patients were asked to walk or exercise for 2 min. A postexercise scan was then performed to monitor and record the tracer pathway and the tracer appearance time (TAT) in the inguinal or axillary lymph nodes.

RESULTS: The postexercise scans showed that (i) 21 limbs (15 lower and six upper limbs) had accelerated tracer drainage and tracer uptake in the inguinal and/or axillary lymph nodes. Two-thirds of these showed lymph stagnation points; (ii) 27 limbs had collateral lymph drainage pathways; (iii) in 11 limbs, there was lymph drainage into the deeper lymphatic channels, with unusual uptake in the popliteal or antecubital lymph nodes; (iv) six limbs had dermal backflow; (v) three limbs did not show lymph drainage (TAT=not applicable). TAT=15+/-3 min, ranging from 12 to 32 min in limbs with lymphoedema versus 5+/-2 min, ranging from 1 to 12 min in the contralateral normal limbs (P<0.001).

CONCLUSION: Intradermal injection lymphoscintigraphy gives a better imaging of the lymph drainage pathways in a shorter time, including cases with advanced lymphoedema. In some patients with lymphoedema, a 2-min exercise can accelerate tracer drainage, showing several compensatory mechanisms of lymph drainage. The effect of the exercise technique on TAT and lymphoscintigraphy findings could result in a more accurate functional assessment of lymphoedema patients.

Nuclear Medicine

Lymphoscintigraphy in angiomyomatous hamartomas and primary lower limb lymphedema

Clin Nucl Med. 2009 Jul

Bourgeois P, Dargent JL, Larsimont D, Munck D, Sales F, Boels M, De Valck C. Department of Nuclear Medicine, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium. pierre.bourgeois@bordet.be

Key Words: angiomyomatous hamartoma, lymphedema, lower limb, lymphadenitis, lymphoscintigraphy

PURPOSE: Angiomyomatous hamartoma (AH) of the lymph node is a rare vascular benign disease of unknown etiology with a predisposition for the lymph nodes of the inguinal area. Only 18 cases have been described up to now in the literature and the disorder was reported to be associated with lymphedema or swelling of the ipsilateral limb in 4 patients. However, scintigraphic investigation of the lymphatic system in these patients was reported in only 2 cases.

MATERIAL AND METHODS: Five patients where the biopsy of inguinal nodes for suspected lymphadenitis led to the diagnosis of angiomyomatous hamartoma were investigated using lymphoscintigraphic techniques (1 girl aged 15; 1 boy aged 9 at the time of first biopsy and 11 at the time of the second one; and 3 men aged 30, 50, and 57). The operated limb was lymphedematous in 3 and 1 developed lymphedema after biopsy. The fifth patient developed a contralateral lymphedema after his second nodal biopsy.

RESULTS: In all cases, lymphoscintigraphic investigation of the limbs showed extensive lymph node abnormalities on the operated side and in 4 cases on the opposite side. CONCLUSIONS: These observations support not only the hypothesis that lymphatic disturbance was involved in the pathogenesis of these tumors but also the proposition that lymphoscintigraphy should be performed in cases of inguinal lymphadenitis of unknown origin to diagnose the underlying situation of latent lymphedema.

Lippincott, Williams & Wilkins

Diagnosis of an early (latent) stage of secondary lymphedema of the arm - a necessary condition for its successful treatment

Wald M.1, Křížová H.2 1Department of Surgery, 2nd Medical School, Charles University, Prague, Czech Republic 2Department of Nuclear Medicine, 2nd Medical School, Charles University, Prague, Czech Republic 4th Annual Meeting of European Society of Surgery, Krakow, Dec.3-6, 2000 published in Przeglad lekarski 2000, Vol. 57 Suppl.5/2000, přednáška 56, pp. 116 - ISSN 0033-2240 510 KA (19-13-3)-(2-12-2)

Secondary lymphedema development as a consequence of complex therapy for breast cancer occurs in up to 40% patients, often appearing after many years. More than 10% of lymphedemas appear 3 years after surgery or radiotherapy. It is rather common, that once a surgical wound is healed, the patient is not subject to the follow up by surgeon anymore. Although an oncologist permanently dispensarizes the patient, with respect to the severity of a primary disease he usually does not pay special attention to the complaints signaling already a latent form of lymphedema with the threat of its future progression. Thus, we often deal with advanced stages of secondary lymphedema which are therapeutically difficult to treat. The authors consider a lymphoscintigraphy a simple noninvasive method of objectivization of the homolateral upper limb lymphatic system transporting capacity. This method is able to reveal even clinically silent (latent) lymphedema stages.

An early lymphedema pharmacotherapy with perorally administered proteases enables a normalization of the transporting capacity of lymphatic system. Perorally administered proteases (hydrolases) which act systemically, i.e. in the whole organism, brought a significant change into the lymphedema pharmacotherapy. Such preparations are combinations of plant and animal proteases: papain, bromelain, trypsin, chymotrypsin, and pancreatin combined with amylase, lipase, and rutosid (Wobenzym® tbl. and Phlogenzym® tbl.).

Although later stages with lymph congestion and protein precipitation in the interstitium can also be well pharmacologically treated, the function of lymphatic system remains irreversibly impaired.

Mucos.cz

Using Lymphoscintigraphy to Evaluate Suspected Lymphedema of the Extremities

Mariam Moshiri1, Douglas S. Katz1, Marvin Boris2 and Elizabeth Yung1 1 Department of Radiology, Winthrop University Hospital, 259 First St., Mineola, NY 11501. 2 Lymphedema Therapy, 77 Froehlich Farm Blvd., Woodbury, NY 11797. Received June 15, 2001; accepted after revision July 30, 2001. Presented at the annual meeting of the American Roentgen Ray Society, Seattle, April 2001. Address correspondence to D. S. Katz.

Lymphedema is the progressive accumulation of protein-rich fluid in the interstitial spaces of the skin, resulting from an anatomic or functional obstruction of the lymphatic system [1]. Lymphedema of the lower or upper extremities is typically a chronic condition that has several possible causes and that presents considerable physical as well as psychological difficulties for patients [2]. Patients with lymphedema experience extremity swelling, decreased coordination and mobility, and secondary infections. The disorder typically affects the dermis and spares the deeper compartments [3]. At the initial medical evaluation of patients with suspected extremity lymphedema, it is highly desirable for physicians to define the abnormality; to determine whether the suspected abnormality is, in fact, a lymphatic one (Figs. 1A,1B and 2A,2B) before instituting a therapeutic plan; and to establish an objective baseline [3]. The differential diagnosis of suspected extremity lymphedema includes obesity, venous disease, and systemic disease (e.g., hypoalbuminemia) [2]. Lymphoscintigraphy is now the primary imaging modality used in determining a diagnosis in patients with suspected extremity lymphedema. The technique has been refined over the past few decades and has proved reliable and reproducible [2]. The study is noninvasive with no known adverse effects. In addition, the radiation dose received during the examination is low, and the study can be repeated after therapy [3].

Classification of Lymphedema

Various clinical classification systems have been developed to describe the severity of extremity lymphedema [2]. One system [4] classifies lymphedema as stage 1, 2, or 3. Stage 1 is reversible lymphedema, with pitting edema and swelling that decreases when the limb is elevated, and stage 2 is nonpitting edema that does not decrease when the limb is elevated. Stage 3 is lymphostatic elephantiasis, with a huge increase in size of the limb and hardened skin.

Primary lymphedema can be a nonhereditary or a genetic condition; can be unilateral or bilateral; and may present at birth, at puberty, or in adulthood [3]. The onset of edema is usually spontaneous—without a history of trauma, surgery, or radiation therapy [2]—and most often occurs in patients before the ages 30 or 35 years; the lower limbs are more often and more severely affected than the upper extremities [2, 3]. The nonfamilial form is much more common than the familial form. Secondary lymphedema (Figs. 6,7,8,9A,9B,10,11), which is much more common than primary lymphedema, may be caused by therapy for cancer, particularly axillary lymph node dissection and radiation therapy for breast cancer, as well as regional lymph node dissection for melanoma and pelvic lymph node dissection [2, 3]. The disorder can present months or years after the initial injury, and its origin is complex [3]. In the developing world, filariasis and other infections are common causes of secondary lymphedema [3]. In some cases, it may not be possible to categorize patients as having either primary or secondary lymphedema, either by history or by lymphoscintigraphy (Figs. 12A,12B,13,14A,14B,14C,14D). Both primary and secondary lymphedema can progress to chronic inflammation and irreversible perilymphatic fibrosis [1].

Technique of Lymphoscintigraphy

In the most common method used to perform lymphoscintigraphy of the extremities, 74-296 MBq of millipore-filtered 99mTc sulfur colloid suspended in 0.10 mL of saline is injected into the interdigital web spaces between the first and second digits on the patient's right and left lower (or upper) extremities, creating a wheal. Both of the feet (or hands) are massaged for 2 min immediately after the injection. A high-resolution collimator is always used, the camera speed is set at 8 cm/min, and images of at least 300,000 counts are acquired. A flow study is performed, and the arrival of radionuclide delivery to the knees and groin (or to the elbows and axillary regions for the arms) is timed. Spot and whole-body images are obtained for up to 3-4 hr; the study is also tailored to the need for individual findings.

Findings on Lymphoscintigraphy

In patients with normal lymphatic anatomy and function (Figs. 1A,1B and 2A,2B), a predictable sequence should be seen on lymphoscintigraphy. In the lower extremities, symmetric migration of the radionuclide should be seen through discrete lymph vessels (three to five lymph vessels per calf and one to two per thigh). Then bilateral visualization of ilioinguinal lymph nodes should occur within 1 hr, as should visualization of the liver because of the systemic circulation of the radiocolloid [1]. Typically, approximately one to three popliteal nodes and two to 10 ilioinguinal nodes are visualized [5]. A parallel sequence should be seen in the upper extremities. On lymphoscintigrams with abnormal findings, a variety of findings can be identified including interruption of lymphatic flow, collateral lymph vessels, dermal backflow, delayed flow, delayed visualization or nonvisualization of lymph nodes, a reduced number of lymph nodes, dilated lymphatics, and in severe cases, no visualization of the lymphatic system at all [1, 5]. Purely qualitative analysis has been reported to be very accurate for confirming or excluding the diagnosis of lymphedema, with a sensitivity as high as 92% and a specificity as high as 100% [1].

Despite earlier reports, most authorities believe that primary lymphedema cannot be reliably differentiated from secondary lymphedema on the basis of lymphoscintigraphic findings alone [1, 5]. Some authors have reported that lymphoscintigrams of patients with primary lymphedema tend to show a lack of lymphatic vessels and absent or delayed transport, whereas those of patients with secondary lymphedema tend to show obstruction with visualization of discrete lymphatic trunks and slow transport [3]. In both primary and secondary lymphedema, however, both dermal backflow and a decreased number of lymph nodes can be identified [3].

Therapy for Lymphedema and Role of Scintigraphic Follow-Up

Lymphedema is a chronic condition that is notoriously difficult to treat and that has no known curative therapy. Surgical procedures have been attempted, but none have proven to be particularly successful [2]. At present, the most successful conservative therapy is a 4-6 week regime known as complex lymphedema therapy [6,7,8]. This labor-intensive therapy requires as many as 4 hr per day [4, 6, 7] (Figs. 5D and 5E). In a report by Boris et al. [7], 30 patients whose progress was followed up for as long as 1 year after complex lymphedema therapy had an average 86% decrease in their initial extremity volume. Lymphoscintigraphy can be repeated after therapy to provide an objective measure of the disease status in patients [3, 4, 8].

http://www.ajronline.org/cgi/content/full/178/2/405

Usefulness of lymphoscintigraphy in demonstrating lymphedema in patients with noonan syndrome

Clin Nucl Med. 2008 Mar

Cheng MF, Wu YW, Tzen KY, Yen RF. From the Department of Nuclear Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.

Lymphatic dysplasia/hypoplasia is found in 15% to 20% of patients with Noonan syndrome. We report a 16-year-old boy with a classic phenotype of Noonan syndrome but a normal karyotype in chromosomal study. During the last 5 years, he had progressive bilateral lower limb edema. The microfilaria study, duplex sonography, and MRI of the lower extremities were all unremarkable. But lymphoscintigraphy showed stocking-like dermal backflow in both legs, delayed lymphatic flow to the inguinal nodes, and dilated lymphatic channels in the abdomen and thorax. These findings suggest that lymphoscintigraphy may be useful in providing vital information on the lymphatic drainage for patients with Noonan syndrome.

PubMed

Lymphoscintigraphy of lower limb edema.

Apr 2012

Zimmerman H, Fessa CK, Rossleigh MA, Wegner EA

Source

From the *Department of Nuclear Medicine, The Prince of Wales Hospital, Randwick, NSW Australia; †Department of Nuclear Medicine, Sydney Children's Hospital, Randwick, NSW Australia; and ‡The University of New South Wales Medical School, Kensington, NSW Australia.

Abstract

Lymphedema of the lower limbs is a well-known chronic condition. The cause of lymphedema can be either primary or secondary. Lymphoscintigraphy is a simple and reliable method for evaluation of lymphatic function. We illustrate the different lymph drainage patterns in 4 cases of lower limb edema, with either primary or secondary causes. In all cases, planar images were obtained after bipedal administration of Tc antimony sulfur colloid.

Clinical Nuclear Medicine

Visualization of the sentinel node in early-stage oral cancer: limited value of late static lymphoscintigraphy

July 23, 2012

Heuveling DA, Flach GB, van Schie A, van Weert S, Karagozoglu KH, Bloemena E, Leemans CR, de Bree R.

Source

Departments of aOtolaryngology/Head and Neck Surgery bNuclear Medicine and PET Research, VU University Medical Center Departments of cOral and Maxillofacial Surgery/Pathology dPathology, VU University Medical Center/Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands.

Abstract

OBJECTIVE: Various lymphoscintigraphic imaging protocols exist for sentinel node (SN) identification in early-stage oral cancer. This study aimed to evaluate the clinical value of performing additional late lymphoscintigraphic imaging.

METHODS: We retrospectively analysed early (directly following injection of Tc-Nanocoll) and late (2-4 h after injection) imaging results of 60 early-stage (T1-T2, cN0) oral cancer patients scheduled for SN procedure. Lymphoscintigraphic results of late imaging were categorized into: (a) no visualization of additional hotspots considered to be SNs; (b) additional hotspots visualized that are considered to be SNs and © hotspots visualized only during late imaging. Histopathological results of the harvested SNs were related to the corresponding hotspot.

RESULTS: In all patients (n=60) lymphoscintigraphy was able to visualize a hotspot that was identified as an SN. In 51/60 (85%) patients, early imaging was able to visualize at least one hotspot, whereas in 9/60 (15%) patients, mostly with oral cavity tumours other than mobile tongue and floor-of-mouth tumours, only late imaging was able to visualize hotspots. In 14/51 (27%) patients, late imaging resulted in additionally visualized hotspots marked as SNs, resulting in a more extensive surgical procedure. These additionally removed SNs appeared to be of no clinical relevance, as all SNs identified during early imaging correctly predicted whether the neck was positive or negative for cancer.

CONCLUSION: Results of this study indicate that additional late lymphoscintigraphic imaging should be performed only in selected cases.

Muclear Medicine Communications

External Links

The Third Circulation: Radionuclide Lymphoscintigraphy in the Evaluation of Lymphedema*

Andrzej Szuba, MD, PhD1, William S. Shin1, H. William Strauss, MD2 and Stanley Rockson, MD1 1 Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California 2 Division of Nuclear Medicine, Stanford University School of Medicine, Stanford, California

http://jnm.snmjournals.org/cgi/content/full/44/1/43

Tc-99m Human Serum Albumin Lymphoscintigraphy With SPECT/CT in Chylothorax.

Lymphedema: Evaluation of qualitative and quantitative lymphoscintigraphy in 238 patients

Abstract

H Weissleder and R Weissleder Department of Radiology, Kreiskrankenhaus Emmendingen, Federal Republic of Germany

http://radiology.rsnajnls.org/cgi/content/abstract/167/3/729

Quantitative lymphoscintigraphy for diagnostics and therapy of upper limb lymphedema

Contribution to Quantitative Evaluation of Lymphoscintigraphy of Upper Limbs

Contribution to Quantitative Evaluation of Lymphoscintigraphy of Upper Limbs

by Petr Gebousky, Miroslav Kárny and Hana Krizová

http://www.ercim.org/publication/Ercim_News/enw43/gebousky.html

Whole Body Lymphoscintigraphy Using Transmission Scans

Practical Aspects of Indirect Lymphography and Lymphoscintigraphy

Lymphoscintigraphy in Cancer Diagnosis

Sentinel Node Lymphoscintigraphy in Cutaneous Malignant Melanoma

Rachel A Powsner, MD Department of Radiology Boston Medical Center Boston Massachusetts USA Lara M Patriquin, MD Department of Radiology Boston Medical Center Boston Massachusetts USA Robert M Beazley, MD Department of Surgery Boston Medical Center Boston Massachusetts USA

http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijd/vol1n2/lymph.xml

Lymphoscintigraphy and sentinel lymph node biopsy for melanoma

L.O. AJEKIGBE and P.E. BAGULEY Department of Plastic Surgery, Middlesborough General Hospital, Middlesborough U.K.

http://www.rcsed.ac.uk/journal/vol45_6/4560009.htm

Procedure guideline for lymphoscintigraphy and the use of intraoperative gamma probe for sentinel lymph node localization in melanoma of intermediate thickness.

Preoperative lymphoscintigraphy and triangulated patient body marking are important parts of the sentinel node process in breast cancer

Clinical Breast Lymphoscintigraphy: Optimal Techniques for Performing Studies, Image Atlas, and Analysis of Images1

Borys R. Krynyckyi, MD, Chun K. Kim, MD, Martin R. Goyenechea, MD, Peggy T. Chan, MD, Zhuang-Yu Zhang, PhD and Josef Machac, MD

http://radiographics.rsnajnls.org/cgi/content/abstract/24/1/121

The Impact of Nonvisualization of Sentinel Nodes on Lymphoscintigraphy in Breast Cancer

C. Rousseau, MD1, J. M. Classe, MD2, L. Campion, MD3, C. Curtet, PhD1, F. Dravet, MD2, R. Pioud, MD2, C. Sagan, MD4, B. Bridji, MD1 and I. Resche, MD1

http://www.annalssurgicaloncology.org/cgi/content/abstract/12/7/533

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