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PubMed1983

Lymphoscintigraphy for malignant melanoma. Surgical considerations.

Lymphoscintigraphy using technetium-99m atimony sulfur colloid was performed in 22 patients with melanoma referred to Duke University Comprehensive Cancer Center in an attempt to identify patterns of regional lymphatic drainage. Scans from six patients revealed lower extremity lesions with three located below the knee, one in the popliteal space, and two others proximal to the knee joint. Despite the location of the primary, all scans but one showed initial drainage to the inguinal nodes bypassing the popliteal lymph node group. Of the three patients who had primary melanoma of the posterior scalp, the lymphatic drainage was directed to the posterior cervical nodes. No drainage to the parotid nodes or anterior neck nodes was visualized. The knowledge gained from lymphoscintigraphy resulted in posterior neck dissections instead of the standard anterior neck dissection and superficial parotidectomy. In areas of ambiguous lymphatic drainage from the trunk, radiocolloid scanning can identify areas at risk for developing metastatic disease. Six lesions within 5 cm of the midline demonstrated bilateral axillary or groin drainage in 83 per cent of the patients. For two lesions near Sappey's line colloidal uptake to the ipsilateral axilla and groin was the rule. After a 3-year follow-up, during which time 70 to 90 per cent of lymph node metastases are predicted to occur, no nodal metastases were ever documented in areas that did not show colloidal uptake. No correlation was found between amount of radiolabel in positive compared to negative nodes, although those nodes that were completely replaced by tumor contained no 99mTc activity and were negative on scanning.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1983

Predicting nodal metastases in breast cancer by lymphoscintigraphy.

In a prospective trial, 89 women with breast lumps underwent bilateral axillary and internal mammary lymphoscintigraphy preoperatively, using technetium-99m antimony sulfide colloid. All scans were interpreted blindly by three separate observers. Breast biopsy was then performed; if the biopsy specimen showed malignant tumour, definitive therapy was performed with axillary dissection. The interpretation of the axillary and internal mammary lymphoscintigrams was subsequently compared with the histologic assessment of the axillary nodes. Of the 89 women, 54 had benign disease and 35 had cancer. The internal mammary lymphoscintigram was considered to show abnormality in only 1 of the 54 patients with benign disease. One patient with cancer was eliminated from the review. Sixteen of the remaining 34 patients had axillary node metastases. Of these, 8 had an abnormal internal mammary lymphoscintigram. Only 2 of the 18 patients with cancer but no axillary metastases had an abnormal internal mammary lymphoscintigram. One bilateral axillary lymphoscintigram in the 54 patients with benign disease was discarded for technical reasons. The axillary lymphoscintigram was accurate in 52 of the remaining 53 patients. Two such scintigrams in the 35 patients with breast cancer were discarded for technical reasons. The axillary lymphoscintigram indicated abnormalities in 12 of 16 patients with axillary nodal metastases but appeared normal in 13 of 17 patients without axillary metastases. Lymphoscintigraphy may play a valuable role in the staging of breast cancer in the future.

Antimony↗

PubMed1995

Filtered technetium-99m-sulfur colloid evaluated for lymphoscintigraphy.

UNLABELLED: Several 99mTc-labeled radiopharmaceuticals have been developed for lymphoscintigraphy of the extremities. In the United States, however, these agents are not widely used clinically. This study evaluates the use of smaller particle sizes ( < 0.1 micron) of 99mTc-sulfur colloid (99mTc-SC) for lymphoscintigraphy. METHODS: The 99mTc-SC was prepared by kit, and the final preparation was filtered through a sterile 0.1-micron filter. The radiochemical purity (RCP) of the filtered 99mTc-SC was determined before administration. Nineteen patients with suspected lymphedema were injected with 18.5 MBq (500 muCi) filtered 99mTc-SC intradermally in each foot, and whole-body images were obtained immediately and 1, 3, 6 and 24 hr later. Local views over the inguinal or axillary lymph nodes were also obtained every 5 min for the first hour. RESULTS: The average RCP value was 93.4% +/- 4.2% (n = 19), and the RCP difference pre- and postfiltration of the 99mTc-SC preparation was -1.7% +/- 1.4% (n = 40). Evaluation of the particle size with the polycarbonate filter showed that 89.9% +/- 4.5% (n = 28) of particles were less than 50 nm, and the particle size was further determined by electron microscopy to be 38.0 +/- 3.3 nm (n = 202). The mean particle sizes of two peaks measured by laser light scattering techniques were 7.5 and 53.9 nm (major peak). Clinical studies with filtered 99mTc-SC demonstrated similar lymphoscintigrams compared with those obtained with 99mTc antimony sulfide colloid (99mTc-ATC). Filtered 99mTc-SC showed a faster transport rate to the inguinal lymph nodes and lower radiation dosimetry for liver, spleen and whole body compared with 99mTc-ATC. CONCLUSION: Filtered 99mTc-SC can be easily prepared and is readily available for routine clinical use in lymphoscintigraphic studies.

Antimony↗

PubMed1994

[Postoperative pelvic lymphocele: demonstration by lymphoscintigraphy].

Eleven patients who had 19 postoperative lymphocele were examined by lymphoscintigraphy using 99mTc human serum albumin (99mTc-HSA). Fourteen postoperative lymphocele were demonstrated, and 5 lymphocele were not. All lesions of 2 cm or greater in short diameter on computed tomography were detected by lymphoscintigraphy, and detectability was not achieved for lesions less than 2 cm in short diameter. The lymphocele can be divided into two groups according to the site of occurrence, the external and internal groups. But we have not detected any characteristic pattern to differentiate the two groups. And delayed scan was more useful in the detection of postoperative lymphocele than early scan.

Adult↗

PubMedDate not supplied

[Diagnostic potential of ultrasound methods of studying the lymph nodes and indirect lymphoscintigraphy in lymphoproliferative diseases].

Ultrasonic and radionuclide investigations of the lymph nodes have been performed in 342 patients with malignant lymphoproliferative diseases. A comparative analysis of the data obtained by sonography and indirect lymphoscintigraphy has specified diagnostic spectrum of these procedures. The accuracy and specificity of sonography and broad-scale visualization secured by it dictate primary usage of the procedure as a screening test in initial examinations and as a control sensitive estimator of the on-going treatment efficacy. Indirect lymphoscintigraphy is recommended as an adjuvant to echography for detailing topics and nature of the lymph node lesion and to assess the process above the diaphragm. Frequency and regimen of the examinations should be based on clinical demands.

Adolescent↗

PubMed1996

Technetium-99m-albumin colloid lymphoscintigraphy in postoperative lymphocele.

An important use of lymphoscintigraphy is to evaluate extremity edema. Lymphoscintigraphy has many advantages over contrast lymphangiography in these patients. We report an unusual case of lymphocele of the left upper chest wall which was discovered incidentally during lymphoscintigraphic evaluation of left upper arm edema. This lymphocele was due to prior surgery, but in some patients the etiology is previous trauma or idiopathology.

Aged↗

PubMed1996

Technetium-99m-sulfur colloid for lymphoscintigraphy: effects of preparation parameters.

UNLABELLED: There has been a resurgence in the use of lymphoscintigraphy for the external detection of lymph nodes for metastatic melanoma and breast tumors. Technetium-99m-antimony trisulfide colloid was the radiopharmaceutical developed for this procedure and was found to have a narrow distribution of small particles, 0.003-0.03 microns, but it was never approved by the FDA. Technetium-99m-sulfur colloid also forms particles and this article reports on the effects different preparation parameters have on its particle size distribution and stability. METHODS: Four groups of kits were evaluated, kits which utilized: (a) a reduced heating protocol with a new 99mTc-elution, (b) a reduced heating protocol with an old 99mTc-elution, (c) a prolonged heating protocol with a new 99mTc-elution and (d) a prolonged heating protocol with an old 99mTc-elution. The particle size distribution and the stability of the different 99mTc-sulfur colloid kit preparations were evaluated over 6 hr utilizing polycarbonate filters ranging from 0.03 to 10 microns. RESULTS: In vitro studies demonstrated no significant change in the particle size distribution over a 6-hr period and all 99mTc-sulfur colloid preparations had a bimodal particle size distribution pattern. Importantly, heating the kit for shorter periods of times utilizing [99mTc]pertechnetate, which had a longer ingrowth of [99mTc]pertechnetate, produced a formulation which had the largest percentage of particles smaller than 0.03 microns. CONCLUSION: In our clinical setting, 99mTc-sulfur colloid prepared with the reduced heating protocol and utilizing [99mTc]pertechnetate, which has the highest ingrowth of [99mTc]pertechnetate has proved to be an excellent agent for lymphoscintigraphy studies. This preparation has demonstrated rapid movement of the particles from the primary site to the lymph nodes in over 97% (106/109) of the patients we have studied.

Humans↗

PubMed1997

Impact of lymphoscintigraphy on sentinel node identification with technetium-99m-colloidal albumin in breast cancer.

UNLABELLED: Identification of the sentinel node by using colloidal tracers and a gamma probe or lymphoscintigraphy could be an effective alternative for the complicated original dye-oriented approach. We studied the sentinel node detection rate using early and delayed imaging in breast cancer patients. METHODS: Thirty-seven patients were imaged 2 hr and 18 hr after peritumoral injection of 99mTc-colloidal albumin. Preoperatively, axillary foci were located with a handheld gamma probe that was also used to isolate radiolabeled nodes from the axillary dissection specimens. The predictive value of the sentinel node for the axillary tumorstatus was evaluated with histological examination. RESULTS: Two and 18 hr after injection, lymphoscintigraphy revealed one to three separate axillary lymph nodes in 33 and 34 patients, respectively. In 30 patients the axillary foci were easily localized with the gamma probe preoperatively. In all 34 patients (92%), with visualized axillary foci, at least one radioactive sample could be retrieved using the gamma probe (total 53 samples). Metastases were found in the sentinel nodes of 11 patients, in seven of 11 being the only tumor-positive lymph node in the axilla. There were no false-negative sentinel nodes. CONCLUSION: The selective targeting and prolonged intranodal retention of 99mTc-colloidal albumin allows successful sentinel node identification in most (92%) patients.

Aged↗

PubMed1998

[Diagnosis of sentinel lymph node in malignant melanoma: preoperative lymphoscintigraphy and intraoperative gamma probe guidance].

AIM: The sentinel lymph node (SLN) has shown to reflect the histologic features of the remainder of the lymphatic basin in patients with melanoma and is of considerable prognostic relevance. Aim of the study was to localize the SLN pre and intraoperatively by means of lymphoscintigraphy and gamma probe guidance. METHODS: 38 patients with histologically proven malignant melanoma (tumor thickness > 0.75 mm) were preoperatively examined by injecting 40 MBq 99mTc-Nanocoll intradermally around the lesion. The first lymph node identified was marked on the skin. Immediately after scintigraphy patients were referred to the operation room and intraoperatively mapped using a handheld gamma probe. Activity of the SLN and of the adjacent nodes was measured ex vivo. After excision of the SLN, the lymphatic basin was re-checked for radioactivity and activity of the SLN and of the adjacent nodes was re-measured after removal. RESULTS: The hottest reading was found in all patients in vivo and ex vivo in the preoperatively marked lymph node. Morphologically (macroscopically, ultrasound, CT) all nodes were unsuspicious. Histologically, in 8 patients metastatic involvement of the lymph node was found which led to a wide exploration of the lymphatic basin with consecutive lymph node excision in 7 patients. CONCLUSION: The findings suggest that combined preoperative lymphoscintigraphy and intraoperative mapping with a gamma probe is a powerful approach for exact localization of the SLN. Diagnostic detection of the SLN may have considerable impact for patient management, since extended lymph node dissection may be confined to patients presenting with positive SLN.

Adult↗

PubMed1985

Radionuclide lymphoscintigraphy with technetium 99m antimony sulfide colloid to identify lymphatic drainage of cutaneous melanoma at ambiguous sites in the head and neck and trunk.

Frequently the primary lesion of high-risk cutaneous melanoma (level III, greater than or equal to 1.5mm; greater than or equal to 1.0 mm with ulceration) is in an ambiguous lymphatic drainage site on the trunk, pelvic and shoulder girdles, and head and neck area. Lymphoscintigrams were performed by a circumferential intradermal injection of the biopsy site using technetium 99m (99mTc) antimony sulfide colloid in a total dose of 0.2 to 0.6 mCi in a volume of 0.1 to 0.5 ml. Imaging was done with a large-field gamma camera with high-resolution parallel hole collimator. Technetium 99m antimony sulfide colloid is an ideal agent for lymphoscintigrams because of small particle size (3-30 micron), which permits early migration into the interstitial space and lymphatics and rapid pickup by lymph nodes. Although it is a gamma emmitter with high activity, it has a short half-life and does not induce tissue necrosis. It does not localize the site of lymph node metastases, but indicates only the drainage pattern. Images were obtained at 1, 5, 10, 15, 30, and 60 minutes, respectively, and then three times every hour. Surgery was usually performed 24 hours later. The majority of patients had lesions with ambiguous drainage sites: head and neck (4 of 5 patients) and trunk (9 of 13 patients). The drainage by scan was to unpredictive sites in 72%, and resulted in a change of treatment planning by location and extent of ablation with node dissection in 9 of 18 patients. Ambiguous dissection sites included: (1) question of preauricular dissection with parotidectomy versus posterior auricular and cervical dissection for selected scalp lesions; (2) low-neck with or without axillary dissection for upper chest and shoulder lesions; and (3) axillary versus groin dissections for midflank lesions at zone of ambiguity between axilla and groin. It was concluded that preoperative 99mTc antimony sulfide lymphoscintigraphy is a highly useful planning technique in determining the appropriate lymphatic drainage basin for dissection in selected melanoma patients.

Adult↗

PubMed1986

Radionuclide lymphoscintigraphy performed on the mastectomized chest wall.

Lymphatic flow in the anterior chest wall of 64 patients who underwent surgery for breast carcinoma was studies on images of lymphoscintigraphy using 99mTc-rhenium colloid. Scintigraphic images taken 4 hours after the intradermal injection of radionuclides along both sides of the surgical wound frequently made it possible to visualize the contralateral axillary lymph nodes. In particular, among 20 patients with local chest wall recurrence after the mastectomy, the contralateral axillary nodes were demonstrated in 13. Stimulated lymphatic flow seems to be manifested around the site of local recurrence over the chest wall. On the precise analysis of lymphographic images, faint lymphatic drainages were occasionally identified up to the contralateral axillary lymph nodes at various levels of the anterior chest wall. It is essential that the radiation field be made large towards the area including the downstream of the lymphatic flow. Additionally, accumulation of radionuclides in the lymph nodes appeared to be slowly impaired by the postoperative irradiation after the completion of radiotherapy.

Adult↗

PubMed1988

Quantitative lymphoscintigraphy.

A radioisotopic method was used to evaluate the state and dynamics of the lymphatic system in 92 patients affected by chronic oedema of the limbs and in 12 control subjects. After interstitial injections of 99mTc-sulphur microcolloid, scans were obtained using a LFOV camera linked to a data processor. The quantitative indices of clearance and lymph node uptake obtained showed good correlation with lymphoedema etiology, controls and ostensibly healthy limbs of patients affected by monolateral disease. In conclusion, quantitative lymphoscintigraphy appears to be a feasible indicator of early changes in the lymph pathophysiology and supports the hypothesis that lymphoedema generally arises from a predisposing congenital pathology.

Adolescent↗

PubMed2000

Protein-loss into retroperitoneal lymphangioma: demonstration by lymphoscintigraphy and blood-pool scintigraphy with Tc-99m-human serum albumin.

A rare, benign congenital lymphangioma has been reported to occur frequently in the neck and axilla, but rarely in the retroperitoneal space. We report a case of a retroperitoneal lymphangioma associated with hypoproteinemia caused by protein-loss into the tumor. In this case, lymphoscintigraphy with subcutaneously injected Tc-99m-human serum albumin (HSA) disclosed the communication between the tumor and the lymphatic system, and sequential abdominal scintigraphy with intravenously injected Tc-99m-HSA revealed the protein loss into the tumor. Abdominal scintigraphy with Tc-99m-HSA injected intravenously or subcutaneously is occasionally useful for determining the etiology of hypoproteinemia.

Adolescent↗

PubMed1996

Inguinoscrotal lymphatic reflux detected by lymphoscintigraphy.

We performed lymphoscintigraphy with 99mTc-human serum albumin in a case of suspected lymphedema of the right leg after inguinal lymph node dissection. Dermal backflow of the leg and lymphocele at the inguinal chain were observed, and lymphatic reflux into the scrotum was also delineated. The scintigraphy could demonstrate a persistent lymphatic problem under conservative treatment, and could lead the physician to conduct surgical treatment. Scintigraphic demonstration of the inguinoscrotal lymphatic reflux has not been previously reported.

Bone Neoplasms↗

PubMed2001

Assessment of leg oedema by dynamic lymphoscintigraphy with intradermal injection of technetium-99m human serum albumin and load produced by standing.

This study was a preliminary evaluation of the utility of dynamic lymphoscintigraphy with technetium-99m human serum albumin (HSA) and a load produced by standing in the assessment of lymphatic dysfunction in patients with leg oedema. The 71 subjects investigated included 53 patients with lymphoedema, six with venous occlusion alone and five with lymphovenous occlusion, as well as seven normal subjects. After intradermal injection of 99mTc-HSA into an interdigital space in each foot, dynamic scintigrams were recorded with the patient supine for 15 min. The subjects then stood in place and images were recorded for an additional 15 min. Relative changes in lymphatic tracer transport before and after standing were analysed on time-activity curves (TACs). This test was compared with a conventional test in a supine position in six patients with lymphoedema, and was repeated in five other patients with lymphoedema. It was found that in the normal limbs, a standing load activated tracer transport to the draining lymphatic vessels, resulting in a rapid stepwise increase in tracer activity, large spiking waves and a decreasing phase following a peak in tracer activity on TACs. In 59 lymphoedematous limbs, including some with a mild form of oedema without morphological abnormalities on scintigrams, this load failed to induce a sufficient activation of tracer transport, and the frequencies of each of the three normally appearing changes described above significantly decreased compared with those in the 14 normal limbs (P < 0.0001, P < 0.01 and P < 0.0001, respectively). In addition, there were significant reductions in the relative increases in maximum activity and clearance times after standing (both P < 0.0001). These abnormalities significantly correlated with the grade of severity of oedema. Six limbs with lymphovenous occlusion showed significant reductions in tracer transport compared to six limbs with venous occlusion. Lymphatic dysfunction was accentuated more by this test than by the conventional test, and repeated tests showed consistent results in the same individuals. It is concluded that under a standardized load, this quick test seems of value in providing a sensitive and objective assessment of lymphatic dysfunction in the lower limbs, and is also advantageous for image interpretation since accelerated tracer transport clearly visualizes compromised lymphatics. This test may also be helpful in distinguishing purely venous oedema from mixed lymphovenous disease.

Adult↗

PubMed1986

Indirect cervical lymphoscintigraphy in healthy subjects via submucosal cheek injections.

A new method of cervical lymphoscintigraphy is presented. It was performed on 16 healthy individuals via bilateral submucosal cheek injections with 99mTc-rhenium-sulfide-colloid. The ipsilateral uptake by the lymphatics on each side of the neck was consistently demonstrated in 15 subjects and allowed a comparative evaluation of the cervical lymphatic chains, including the submental, submandibular, jugulo-digastric and jugulo-omohyoid. The transverse cervical chain was demonstrated in 10 of 16 subjects. The method is simple, reliable and capable of clearly visualizing the lymphatic drainage of the oral cavity.

Adult↗

PubMedDate not supplied

Extremely indirect dermal lymphatic channels: value of areolar-cutaneous junction injection technique for breast lymphoscintigraphy.

This case describes a patient who initially had peri-excisional injections of radiocolloid around a lumpectomy site that failed to visualize sentinel nodes during lymphoscintigraphy. After additional areolar-cutaneous junction injections, extremely indirect dermal lymphatic pathways were evident with resultant drainage to two sentinel nodes, both of which contained disease. Hybrid combination injections of radiotracer during sentinel lymph node biopsy is gaining in popularity. This case illustrates the validity of the hybrid injection techniques and the demonstrated accuracy despite seemingly disconnected and extremely tortuous pathways as demonstrated in the figure.

Aged↗

PubMed2005

Noncontrast three-dimensional magnetic resonance imaging vs lymphoscintigraphy in the evaluation of lymph circulation disorders: A comparative study.

BACKGROUND: Visualization of the lymphatic vessels is a challenge in patients with disorders of the lymphatic circulation. In an effort to improve the diagnostic scope of lymphatic imaging, we compared traditional lymphoscintigraphy (LSG) with three-dimensional magnetic resonance imaging (3D MRI). METHODS: From October 1, 2002, to May 30, 2004, 39 patients (27 males and 12 females) with lower extremity lymphedema and/or skin lymphorrhea in the abdominal wall or the external genitalia underwent LSG and 3D MRI. Patients' ages ranged from 3 to 71 years. Assessment of the imaging studies included the degree and quality of visualization of the malformations of the lymphatic collectors, lymphatic trunks, lymph nodes, and tissue edema. RESULTS: In patients with lymphedema, chylous reflux syndrome, or both, LSG depicted the enlarged lymphatics and nodes as a fused band or mass. In 3D MRI, the dilated superficial lymphatic collectors and deep lymphatic trunks, as well as the accumulation of chyle and node enlargements, were clearly visualized. In patients with hypoplasia or aplasia of the lymphatics, LSG usually displayed the pattern of dermal backflow in the form of radiotracer filling of the dermal lymphatics or stagnation of the isotope at the injection point. The images obtained by 3D MRI were able to demonstrate the extent of tissue fluid accumulation and distinguish edema fluid from subcutaneous fat. CONCLUSIONS: In patients with peripheral and central lymphatic malformations, LSG provided images representative of the function of the lymphatic vessels but failed to give detailed information regarding its anatomy. 3D MRI provided extensive information on the anatomy of the lymph stagnated vasculature as well as on the effects of lymphatic dysfunction on local structures and tissue composition.

Adolescent↗