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PubMed1999

Lymphoscintigraphy and gamma probe-guided surgery in papillary thyroid carcinoma: the sentinel lymph node concept in thyroid carcinoma

The authors report the use of lymphoscintigraphy and gamma probe-guided resection of the sentinel lymph node in a 65-year-old woman with clinically and cytologically indicated metastasizing papillary thyroid carcinoma. The results of the preoperative lymphoscintigraphy corresponded well with FDG PET and histologic findings, which gives promise of its validity in thyroid carcinoma. With experience in ultrasound-guided fine-needle aspiration biopsy, this method can be performed without any serious side effects for the patient. The validity of the sentinel lymph node concept in thyroid carcinoma and a possible improvement of nodal staging and local recurrence rate must still be proved.

Journal Article↗
PubMed2005

Lymphatic drainage patterns on early versus delayed breast lymphoscintigraphy performed after injection of filtered Tc-99m sulfur colloid in breast cancer patients undergoing sentinel lymph node biopsy.

The axillary lymph node status is the most important predictor of prognosis and aids in breast cancer treatment planning. Patients with breast cancer now frequently undergo sentinel lymph node (SLN) biopsy rather than axillary lymph node dissection to determine the status of the regional lymph nodes. However, the optimal timing of radionuclide injection relative to the timing of SLN biopsy remains controversial. The objective of this study was to compare the lymphatic drainage patterns on lymphoscintigraphy performed at 15 minutes to 4 hours and at 18 to 24 hours after injection of filtered Tc-99m sulfur colloid, and to determine whether, over time, radiocolloid migrates to second-echelon nodes that are not the SLNs. Fifteen women with breast cancer (mean age, 55 years; range, 38-78 years) were scheduled to undergo SLN biopsy after each received an injection of 18.5 MBq (0.5 mCi) filtered Tc-99m sulfur colloid into the breast parenchyma surrounding the tumor or biopsy cavity. Both early (15 minutes to 4 hours after radionuclide injection) and delayed (18-24 hours after radionuclide injection) lymphoscintigraphy was performed in each patient. SLN biopsy was performed, followed by completion axillary lymph node dissection and planned breast surgery. In each patient the patterns of distribution of the radionuclide in the lymph nodes were the same on early and delayed lymphoscintigrams. These findings, that the distributions of radionuclide in lymph nodes are identical on early and delayed images obtained after injection of filtered Tc-99m sulfur colloid, suggest that performing SLN biopsy on the day after injection does not diminish the accuracy of the technique in predicting the potential site of metastasis in the regional lymph nodes in patients undergoing this procedure for breast cancer.

Adult↗
PubMed1986

Pre-operative axillary lymphoscintigraphy in breast cancer: experience with sub-areolar injection of 99Tcm-nanocolloidal albumin.

Thirty-two patients affected by monolateral breast cancer and five patients with benign mammary pathology were submitted to pre-operative lymphoscintigraphy by sub-areolar injection of nanocolloidal albumin with the aim of evaluating any axillary lymphonodular involvement. The 32 patients, affected by cancer, subsequently underwent a surgical operation so as to permit a pathological-anatomical study of the axillary cavity. A comparison between the clinical and instrumental examinations brought to light the much greater reliability of the latter which gave 87.5% of correct diagnoses. The authors emphasize the absence of false positive results and the excellent sensitivity of the method in bringing to light even limited involvements of the axillary lymphonodes. The authors believe that axillary lymphoscintigraphy deserves to be included in the pre-operative protocols which afford a correct staging of the disease and, consequently, a better assessment of the extent of the surgical action.

Adult↗
PubMed1997

Single-dose isotope injection for both preoperative lymphoscintigraphy and intraoperative sentinel lymph node identification in melanoma patients.

For patients with melanoma the 'sentinel' lymph node biopsy technique, although simple in concept, has the potential to provide misleading information if great care is not taken to ensure accurate sentinel node (SN) identification. The method initially reported involved lymphatic mapping by injection of blue dye around the primary melanoma site. Preoperative lymphoscintigraphy was subsequently shown to improve both the speed and accuracy of SN identification. More recently, intraoperative use of a hand-held gamma probe has been recommended, and it is likely that maximum reliability of SN biopsy will be achieved if all three manoeuvres are undertaken. As originally described, use of a gamma probe intraoperatively followed injection of tracer a short time before the surgical procedure. We report a simpler method of confirming SN identity with a gamma probe, using residual activity in the node following lymphoscintigraphy the previous day. In 21 patients close concordance with preoperative lymphoscintigram results and intraoperative findings after blue dye injection confirmed the reliability of the technique. Avoiding the need for repeat isotope administration on the day of surgery simplifies logistics, reduces costs, minimizes inconvenience and radiation dose for patients, and eliminates potential health and safety problems for operating theatre staff.

Antimony↗
PubMed2004

Internal mammary lymph node (IMN) coverage by standard radiation tangent fields in patients showing IMN drainage on lymphoscintigraphy: therapeutic implications.

The purpose of this report is to evaluate the variability in coverage of the internal mammary nodal chain (IMN) by standard radiation tangential fields in those patients with medial drainage on lymphoscintigraphy. Twenty-two patients who showed lymphoscintigraphic IMN drainage underwent radiation simulation planned with computed tomography (CT). Standard tangent fields were placed and CT scans were reviewed to assess IMN inclusion and correlation with presternal fat thickness. Of the 22 patients who showed IMN drainage on lymphoscintigraphy, 10 (45%) had lateral primary lesions, 9 (41%) had medial lesions and 3 (14%) had subareolar lesions. Of these 22 women, 4 (19%) had the IMN completely within the standard tangent fields. Twelve women (55%) had only partial coverage of the IMN and the remaining 6 women (27%) had the IMN region completely outside. Presternal fat thickness greater than 10 mm was less likely associated with complete IMN coverage than fat thickness 10 mm or less, P = 0.001. Lymphoscintigram drainage to the IMN in breast cancer patients may suggest an increased risk of IMN involvement. Our data show that a majority (73%) of these patients had complete or partial incidental inclusion of the IMNs with standard tangents, which may in part explain the historically low IMN failure rate.

Adult↗
PubMed2003

Intratumoral versus intraparenchymal injection technique for lymphoscintigraphy in breast cancer.

A 1.5-cm nonpalpable mass was detected in the upper outer quadrant of the left breast by screening mammography in a 55-year-old woman. The patient was scheduled for a sentinel node procedure, and lymphoscintigraphy was performed the day before surgery. Unintentionally, she received an intraparenchymal tracer injection 3 cm away from the malignant lesion instead of the intended intratumoral injection. Lymphoscintigraphy revealed two sentinel nodes in the axilla. A second dose of Tc-99m nanocolloid was injected the next day into the primary tumor through a catheter that had been inserted under ultrasound guidance the previous day. Once more, a lymphoscintigraphic image was obtained that showed additional sentinel nodes in two different regions outside the axilla. This observation supports the authors' contention that lymphatic watersheds exist in the breast and highlights the importance of tracer administration into or close to the tumor.

Breast Neoplasms↗
PubMed2004

Comparison of subdermal and peritumoral injection techniques of lymphoscintigraphy to determine the sentinel lymph node in breast cancer.

PURPOSE: The purpose of this study was to evaluate 2 different injection techniques for lymphoscintigraphy to determine the axillary sentinel lymph node (SLN) in patients with breast cancer. METHODS: Thirty-six patients with early breast cancer were studied prospectively. Both peritumoral (PT) and subdermal (SD) injections were performed on each patient with Tc-99m rhenium sulfide colloid. PT injections were done 1 to 8 days before surgery and SD injections were done on the day of operation. An intraoperative gamma probe was used to explore the axillary SLNs prior to tumor excision and axillary dissection. All surgical specimens were evaluated histopathologically. RESULTS: In 19 of 36 patients, the same lymphatic drainage sites were observed with both techniques. Of these, 17 patients showed only axillary, 1 showed axillary and internal mammary (IM), and 1 showed axillary and subclavicular drainage sites. With PT injections 26 of 36 patients (72%), and with SD injections 33 of 36 patients (92%), showed axillary drainage and axillary SLNs. With PT injections 9 patients, and with SD injections only 2 patients, did not show any drainage site. During the operation with a gamma probe, axillary SLNs were excised in 35 patients (success rate, 97%). IM drainage was seen in 8 of 36 patients who underwent PT injections and in 3 of 36 with SD injections. CONCLUSION: The success rate was found to be higher with the SD injection technique than with PT injections to visualize the axillary SLN. To increase the visualization of both axillary and IM SLNs, it may be useful to perform lymphoscintigraphy with SD and PT injections together.

Axilla↗
PubMed2004

Incidence of nonlocalization of sentinel lymph nodes using preoperative lymphoscintigraphy in 74 consecutive head and neck melanoma and Merkel cell carcinoma patients.

INTRODUCTION: Lymphatic drainage pathways in the head and neck region are more variable than in any other location of the body. Occasionally, head and neck lymphoscintograms fail to identify a definitive lymphatic drainage pattern, making preoperative and intraoperative identification of sentinel nodes very difficult. The purpose of this study was to determine the incidence of nonlocalization on lymphoscintigraphy of sentinel nodes in patients with head and neck cutaneous malignancies. METHODS: A retrospective chart review was conducted of a single surgeon's (WKS) 135 consecutive head and neck melanoma and Merkel cell cancer patients from August 1997 to August 2002. In all cases. technetium-99m sulfur colloid was the radioactive tracer used by the nuclear medicine department to perform the lymphoscintograms. RESULTS: Of the 135 patients, 74 underwent preoperative lymphoscintigraphy in preparation for performing a sentinel lymph node biopsy. Of these 74 patients, 5 (6.8%) were found to have nonlocalization of a sentinel node(s). Of the 5 patients who failed to localize, 3 had primary lesions near the midline scalp, while 2 had primary lesions located on the cheek. Two of the 5 patients underwent reinjection of the radioisotope by the treating surgeon (WKS) but failed to further localize the radiotracer. All 5 patients went on to have wide local excision of the primary cancer on the day of the lymphoscintogram, as well as undergoing intraoperative examination of all head and neck nodal basins with a handheld gamma detector. No focal areas of radiation were identified and no lymph nodes were biopsied. To date, 1 patient has developed distant metastases and has succumbed to her disease. The remaining 4 patients are free of disease. CONCLUSION: In a series of 135 consecutive patients with head and neck cutaneous malignancies, 74 of whom were treated with preoperative lymphoscintograms, a nonlocalization rate of 6.8% was found. This is a significant rate of nonlocalization and reflects either the inherent difficulty in imaging the head and neck region and/or the possible rapid rate of dye washout via multiple lymphatic drainage pathways that exist in this location.

Aged↗
PubMed1996

Lymphoscintigraphy pre- and post-surgical lymphatic leak repair.

This case report demonstrates the use of lymphoscintigraphy for the localization of a pelvic lymphatic leak. The study was made before and after the operative repair of a lymphatic leak and a marked reduction in the leakage was evident postoperatively. The patient, a 38 year old woman, had a history of adenocarcinoma of the cervix, that was treated by abdominal hysterectomy and pelvic node dissection, and she subsequently developed chylous ascites that required ongoing drainage via a Tenckhoff catheter. This case study illustrates how lymphoscintigraphy aided in the localization of a lymphatic leak and the follow up of surgical repair.

Adenocarcinoma↗
PubMed1983

Iliopelvic radionuclide lymphoscintigraphy in patients with testicular cancer.

The utility of iliopelvic lymphoscintigraphy was assessed in 21 patients with testicular cancer (six seminoma patients, 15 nonseminoma patients). Normal lymphoscintiscans demonstrated symmetric uptake of technetium-99m-labeled radiocolloid throughout the lymphatic chain, from the internal iliac nodes to the level of the renal hilum. Signs of abnormality included decreased or no uptake of radionuclide in consecutive nodes of a lymphatic chain or in an entire lymphatic chain, and diminished uptake at the level of the renal hilum. In the 15 patients with nonseminomatous germ cell cancer, correlation of the results of scanning with pathologic specimens obtained upon dissection of retroperitoneal lymph nodes revealed a sensitivity of 0.89 and a specificity of 0.83. In the six patients with seminoma, there was good correlation between scan findings and results of other radiologic tests. This study suggests that iliopelvic lymphoscintigraphy is a sensitive means of determining whether lymph node metastases are present in patients with testicular cancer.

Abdomen↗
PubMedDate not supplied

Lymphoscintigraphy in the sentinel lymph node technique for breast tumor: value of early and late images for the learning curve.

As the performance of early (H+1 to H+4) and late (D1) lymphoscintigraphic images raises organizational problems in outpatient surgery for breast cancer, only early images are generally obtained. The present study evaluated whether two series of images are better than one and defined the advantages of both methodologies. One hundred and eighteen patients with infiltrating breast carcinoma (T(0), T(1) and T(2)) were included in the study: 87 in group A (early and late images) and 31 in group B (only early images). All patients received two peritumoral injections of (99m)Tc-sulfur colloid, 15-18 MBq (group A) and <15 MBq (group B). During the operation, the patent blue bye technique was associated with radioactivity detection. The two groups were comparable for histological type and tumor size and localization. Successful localization of sentinel nodes on early lymphoscintigraphic images was significantly greater for group B. The identification of a sentinel node focus on early lymphoscintigraphy increased by 10% during the study. Sentinel node detection by the isotopic method alone, or the two methods combined, was comparable for both groups. In radioactivity detection, the count rate for sentinel nodes versus background (contralateral breast) was similar for the two groups. During the learning phase, two series of images gave a definite advantage. Subsequently, lymphoscintigraphy performed at +2 h was sufficient (the results for the two groups became indistinguishable).

Adult↗
PubMed1992

Lymphoscintigraphy of head-and-neck cancer.

To achieve the visualization of regional lymph nodes by lymphoscintigraphy, 21 patients with head-and-neck cancer were studied with the aid of 99mTc-labeled rhenium sulfur colloid (99mTc Re). Four injection sites were selected; the injections were given into the subcutaneous tissue of the parietal area of 11 patients, into the submucosa of the retromolar area of 6 patients, into the subcutaneous tissue of the postauricular area of 2 patients, and into the thyroid glands of 2 patients. Lymphoscintigraphy was done three hours after the injection. The cervical regions were visible in 85.7% of the patients on the affected side and in 90.5% on the healthy side. The visualization comprised the following regions: submental, submandibular, deep cervical, accessory, and supraclavicular regions. In total, 102 nodes were visualized on the affected side (average 4.8 per patient) and 110 nodes in the healthy side (average 5.5). Histologically, 15 of 21 patients had lymph nodes metastases and 6 did not. Of these 21 patients, 66.7% (14/21) had confirmed lymph node metastases in the visualized regions. This technique appears to be a relatively easy and efficient method of imaging the regional lymph nodes in head-and-neck cancer both before treatment and after neck surgery.

Aged↗
PubMed1985

Lymphoscintigraphy of the neck.

Lymph node imaging has been helpful in managing patients with lymphoma, melanoma, and breast cancer. To evaluate 38 patients with head and neck cancers, 99mTc minicolloid was injected adjacent to the tumor and into a similar area on the uninvolved side. Lymphoscintigraphy of the neck was performed at 3- and 5-hour intervals after injection and bilateral cervical lymphatic drainage was observed. Each patient then underwent a neck dissection. The pathologic node findings were then correlated with the neck scans. Results confirmed that cervical lymphatic drainage is unpredictable in 50% of the patients once the channels are involved with metastatic disease. Lymphoscintigraphy is not a reliable method of detecting early metastatic cervical carcinoma.

Carcinoma, Squamous Cell↗
PubMedDate not supplied

Lymphoscintigraphy and gamma probe tracing in detecting breast cancer lymph node involvement: can they replace axillary lymph node dissection?

BACKGROUND: Axillary lymph node status is the most important pathological determinant of prognosis in early breast cancer. However, axillary lymph node dissection (ALND) performed for pathological assessment is not without costs and morbidity. Recently, radioisotope-guided sentinel node biopsy (SNB) has been proposed as a promising technique for staging breast cancer patients. AIM OF THE STUDY: In this study we report our experience (76 patients) in radioguided sentinel node (SN) biopsy in breast cancer. The study was divided into two phases: the first represents our learning curve, necessary to establish our guidelines for its use in clinical practice, while the second phase was aimed at assessing the feasibility of SN localization using preoperative lymphoscintigraphy and intraoperative gamma probe (GP) detection. METHODS: All patients underwent lymphoscintigraphy (LS) up to two hours after tracer delivery (99mTc-micro-nanocolloid, four i.d. injections of 200 microCi/200 miccroL around the primary lesion) 24 hours before surgery and GP tracing during surgery. Subsequently ALND was performed for pathological assessment. RESULTS: SNs were identified in 73/76 patients using LS and in 72/76 using GP. In one case the SN was detected by GP alone while in two cases GP was not able to locate the SN although it had been identified by means of LS. Thirty-three of these 73 patients had axillary node involvement. In 31/33 cases the SN was the only positive node. No positive nodes were found in the remaining 40 ALNDs where SNs were identified. Thus, according to our experience 40/73 ALNDs could have been avoided. SNB seems to be a very interesting technique but further experience in lymph node radioisotope tracing is needed.

Axilla↗
PubMed1979

Lymphoscintigraphy: a comparison of 99Tc(m) antimony sulphide colloid and 99Tc(m) stannous phytate.

In vitro comparison of 99Tc(m) antimony sulphide colloid and 99Tc(m) stannous phytate as well as in vivo studies in six rabbits and seven patients indicate disparity in the colloidal properties and localization of these two agents. The variability in lymphatic uptake and the relatively poor quality of scintigraphic images following interstitial injection of 99Tc(m) stannous phytate, when compared with 99Tc(m) antimony sulphide colloid, provide evidence of the unsuitability of this agent for lymphoscintigraphy. Maintenance of the diagnostic quality of the lymphoscintigraphic image and adherence to interpretive criteria already established therefore preclude the routine use of 99Tc(m) stannous phytate for interstitial lymphoscintigraphy.

Animals↗
PubMed2000

Pedal (99m)Tc-sulfur colloid lymphoscintigraphy in primary isolated chylopericardium.

Primary isolated chylopericardium is a rare disorder in which chylous fluid accumulates in the pericardial space. In this case report of a 61-year-old man with chylopericardium, pedal (99m)Tc-sulfur colloid (SC) lymphoscintigraphy was performed after emergent pericardiocentesis, and when there was a recurrent massive pericardial effusion. The results showed that (99m)Tc-SC lymphoscintigraphy can clearly reveal the lymphodynamics in patients with primary isolated chylopericardium. This noninvasive investigation is valuable and can be easily performed either before or after pericardiocentesis.

Humans↗
PubMed1999

Lymphoscintigraphy and intraoperative lymphatic mapping of sentinel lymph nodes in melanoma patients.

Identification of sentinel lymph nodes (SLNs) using lymphoscintigraphy, the blue dye technique and intraoperative lymphatic mapping with a gamma-detecting probe has become the standard of care in diagnosing and treating melanoma. Numerous clinical studies have proven the reliability of predicting the histology of remaining lymph nodes in the lymphatic basin from the histologic evaluation of the SLNs. Technical and clinical factors presented in this paper have been shown to increase the accuracy of localization of SLNs. The nuclear medicine technologist shares a vital role in the radiopharmaceutical preparation and administration for preoperative lymphoscintigraphy and intraoperative lymphatic mapping in patients with melanoma.

Humans↗
PubMed2000

Evaluation of mammary lymphoscintigraphy by a single intratumoral injection for sentinel node identification.

UNLABELLED: The aim of this study was to evaluate the findings of mammary lymphoscintigraphy by a single intratumoral injection in 150 patients with breast carcinoma: 100 patients (group A) investigated in the validation phase of the study and 50 (group B) studied after the tracer dose was optimized. METHODS: Immediately after injection of 99mTc-nanocolloid using a 25-gauge needle and a 0.2-mL volume, simultaneous anterior and lateral images were acquired with a dual-head gamma camera during 20 min followed by sequential static anterior and prone lateral breast images after 30 min and after 2 and 4 h. 57Co-assisted skin marking defined the sentinel node location for subsequent gamma probe, blue dye-guided sentinel node biopsy. RESULTS: In group A (mean dose, 61.6 MBq; range, 42-88 MBq) scintigraphy revealed lymph nodes in 83 patients (83%), with an increase in the rate of visualization from 72% for the first 40 patients to 90% for the last 60; patient age (P = 0.01) and administered tracer dose (P = 0.04) were found to be significant factors for visualization, with optimal results obtained from doses higher than 65 MBq. Lymph nodes were visible in 34 patients (41%) during the first 30 min after injection, whereas in 49 patients appearance occurred at 2-4 h. A total of 97 lymphatic basins were visualized (80 axillary, 3 clavicular, 14 internal mammary). In group B (mean dose, 90.8 MBq; range, 68-124 MBq), the visualization rate was 94%, with early lymph node appearance in 27 patients (57%) and a total of 53 basins (45 axillary, 8 internal mammary). In combination with intraoperative blue dye mapping and y probing, the identification rate increased to 90% in group A and 98% in group B. Prone lateral images contributed to identification of intramammary lymph nodes in a total of 14 patients and axillary nodes close to the injection site in 8 other patients. CONCLUSION: Mammary lymphoscintigraphy by single intratumoral injection is a valid method for lymphatic mapping and identification of both axillary and nonaxillary sentinel nodes. Lymph node visualization appears to be improved with higher tracer doses. The compactness of the injection site enables high-quality additional lateral images that can depict intramammary or axillary lymph nodes adjacent to the injection site.

Adult↗