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At least 325 records · Page 18Linked to original sources
PubMed1988

Three-dimensional internal mammary lymphoscintigraphy: implications for radiation therapy treatment planning for breast carcinoma.

Conservative surgery combined with radiation therapy for the treatment of early breast carcinoma has been shown to achieve both a high rate of local tumor control and good cosmetic results with a minimum of complications. Whether the internal mammary lymph nodes (IMNs) should be included in the treatment volume is a topic of considerable controversy. Radionuclide internal mammary node lymphoscintigraphy (IMN-LS) can locate these nodes in three dimensions. We have analyzed the results of IMN-LS in 167 patients imaged at the Dana-Farber Cancer Institute and treated at the Joint Center for Radiation Therapy between 1977 and 1980. The location of the IMNs was found variable from patient to patient. At least one IMN was not included within tangential fields arbitrarily arranged to have a medial entrance point 3.0 cm across the midline in 17% of evaluable patients. However, 48% and 66% of patients had IMNs that could be adequately treated with fields positioned only 1.0 cm or 2.0 cm across midline, respectively. We conclude that when treatment of the IMNs is warranted, IMN-LS not only assures their complete coverage in the majority of patients but also may help reduce the amount of heart and lung irradiated.

Breast↗
PubMed1989

The use of lymphoscintigraphy in treatment planning of primary breast cancer.

A technique is described for the use of lymphoscintigraphy in treatment planning of primary breast patients. During simulation of the treatment fields, the positions of the internal mammary nodes are projected back toward the source onto the patient skin surface and are marked by radio-opaque markers for visualization on films. Exact solutions for the coordinates of these surface projection points are derived. Approximate solutions are also given which are independent of the isocenter location and primarily dependent on the treatment field gantry angle. If a typical couch angle and field size are assumed, the projection points can be calculated for various gantry angles prior to simulation. Generally, a decision can then be made beforehand whether it would be better to use deep tangents or a separate field to treat the internal mammary nodes. During simulation, the surface projection points serve as visual and fluoroscopic guides to field design and optimization. A method is also presented for projecting the internal mammary node positions onto a single transverse patient contour for conventional 2-dimensional treatment planning. By accurately showing the projected location of the node with respect to the field edge, adequate treatment margin can be assured.

Breast Neoplasms↗
PubMedDate not supplied

Lymphoscintigraphy does not enhance sentinel node identification or alter management of patients with early breast cancer.

UNLABELLED: Lymphoscintigraphy (LS) is often performed before sentinel lymph node dissection (SLND) for breast cancer. The purpose of this study was to determine whether routine LS enhances rate of identification of sentinel nodes (SN), and if findings on LS alter either the SLND procedure or the subsequent patient management. METHODS: LS using technetium-99m sulfur colloid (99mTc) was performed in 136 consecutive patients undergoing SLND for invasive breast cancer. Three equal aliquots of 99mTc were injected peritumorally, and LS images were obtained at 60 to 120 min after 99mTc injection. Data were collected on the success of LS to visualize SN. Information regarding body mass index (BMI), biopsy type (core vs excisional), tumor location (medial vs lateral), and SN positivity were recorded and comparison was made with success of operative SN identification. In all SLND cases, 1% lymphazurin blue dye was used in addition to the 99mTc. RESULTS: LS failed to identify an SN in 9 of 136 cases (6.6%). Failed mappings did not correlate with biopsy type, tumor location, or SN positivity. There was a positive correlation between increased BMI and failed LS (p = <0.001). Failed LS did not predict operative SLND failure, as an SN was identified in 100% of cases (136/136), including the 9 with a failed LS. In 67% (6/9) of the failed LS, the SN was both hot and blue at operation. Internal mammary (IM) drainage was observed in 4% (6/136) of LS. Positive SN were found in 26% (35/136) of patients. Findings on LS did not affect adjuvant treatment decisions in any patient. CONCLUSIONS: There was a correlation between failed LS and BMI, but no correlation with biopsy type or tumor location. Drainage to extraaxillary sites was rare. LS findings did not enhance success of intraoperative identification of SN or alter the postoperative management of patients with early stage breast cancer.

Aged↗
PubMed2006

Use of lymphoscintigraphy defines lymphatic drainage patterns before sentinel lymph node biopsy for breast cancer.

BACKGROUND: Lymphoscintigraphy (LSG) can identify lymphatic drainage patterns before sentinel lymph node (SLN) biopsy is performed in patients with early-stage breast cancer, but the importance of extraaxillary SLNs seen on LSG is unknown. We assessed whether drainage patterns seen on LSG were associated with histologic findings in axillary SLNs recovered at SLN biopsy. STUDY DESIGN: From a prospectively maintained database, we identified 1,201 clinically node-negative patients with invasive breast cancer who underwent preoperative LSG and axillary SLN biopsy. Patient and tumor characteristics, LSG results, and final SLN pathology results were examined. RESULTS: LSG showed drainage to internal mammary (IM) nodes in 1.6% of patients, axillary nodes in 68.1%, both IM and axillary nodes in 19.8%, and no drainage in 10.3%. Drainage to IM nodes was observed for tumors in all quadrants of the breast. Patients with IM drainage had a younger median age than patients without IM drainage (51.8 versus 58.3 years, respectively; p < 0.001). The intraoperative axillary SLN identification rate was higher when axillary drainage was observed on LSG than when it was not observed (98.7% versus 93.0%, respectively; p < 0.001), but the LSG drainage pattern was not associated with pathologic status of the SLN or number of metastatic SLNs. At a median followup of 32 months, 4 patients had regional nodal recurrence. CONCLUSIONS: Almost one-fourth of patients had lymphatic drainage to the extraaxillary lymph nodes, particularly the IM nodes, seen on LSG. Extraaxillary drainage seen on LSG did not preclude identification of axillary SLNs at operation. Longterm followup of patients with lymphoscintigraphic evidence of extraaxillary drainage is needed to determine whether regional and systemic recurrence patterns differ in these patients.

Adult↗
PubMed1998

Sentinel lymph node biopsy using lymphoscintigraphy.

Cancer surgery has existed as an elective treatment modality for more than 150 years, yet it is relatively unsophisticated in light of the advances seen in other medical disciplines. Using the nuclear medicine technique of lymphoscintigraphy (i.e., mapping lymph nodes using a radioactive isotope), the surgeon can perform a sentinel lymph node biopsy that targets only the lymph nodes that first drain a primary tumor site. This procedure can provide accurate staging information without risking the potential morbidity associated with lymph node dissection. This type of precise biopsy is made possible by using a gamma-detecting instrument coupled with an ultrasensitive probe designed for intraoperative use.

Biopsy↗
PubMed2000

Melanoma lymphoscintigraphy and lymphatic mapping.

Lymphoscintigraphy in melanoma has proven to be a reliable method to identify regional lymph nodes at risk for metastases. The first lymph node to drain a cutaneous lesion, the sentinel lymph node (SLN), is predictive of the metastatic status of the regional lymph node group. Lymphatic mapping allows for the identification of the SLN and for selective lymph node sampling. Selective lymph node sampling is less invasive and because only a small quantity of high-risk tissue is submitted for pathological examination, it allows for a more complete and comprehensive pathological examination, which identifies melanoma with up to 100 times the sensitivity of conventional examinations.

Humans↗
PubMed1983

Implications of lymphoscintigraphy in oncologic practice: principles and differences vis-a-vis other imaging modalities.

The prompt availability of interstitial lymphoscintigraphy and its utilization offer significant advantages over other techniques. Computed tomography represents a highly sensitive technique that suffers from lack of specificity in detecting small lesions. The expense and accessibility of machine time limit its usefulness as a routine survey procedure. Radiographic lymphangiography represents a tedious and difficult process necessitating identification of lymphatic channels for injection of the contrast material for visualization of the lymph nodes in the region being evaluated. With these demonstrated difficulties, the lymph node scanning technique has emerged as a simple, reliable, and reproducible technique for evaluation of multiple lymph node groups.

Antimony↗
PubMed1983

Internal mammary lymphoscintigraphy in breast carcinoma--a surgeon's perspective.

Internal mammary lymphoscintigraphy (IML) should now be considered a standard staging procedure in the present state of the art of the management of the patient with breast carcinoma. It provides clues for assessing the extent of disease and helps one to select individualized therapy. The interpretation is reliable enough in expert hands, to rule out the necessity of internal mammary node histopathologic diagnosis. In view of the significance of nodal invasion in relation to distant spread of the disease, one would be entitled to use this test as an indication for complementary systemic therapy when positive. On the other hand, if systemic therapy is to be employed without selection according to the multitude of relevant criteria, there may be no need to carry out this staging procedure prior to a management decision. The authors have reviewed their experience with more than 1000 examinations and have shown some of the practical implications of IML as a staging procedure as well as a guide to therapy.

Breast Neoplasms↗
PubMed1983

Iliopelvic lymphoscintigraphy.

In patients with genitourinary cancers, it is critically important that lymph node metastases be detected prior to surgery. Information regarding the status of these nodes will influence the type and extent of therapy. Radiologic tests currently available for lymph node imaging--contrast lymphangiography, ultrasound, and computed tomography--are sometimes associated with a high false-negative rate. Iliopelvic lymphoscintigraphy, when performed following bilateral perianal injections of 99mTc-antimony trisulfide colloid, offers a physiologic method for visualizing these nodes and allows demonstration of the internal iliac chain, often not visualized on contrast lymphangiographic studies. Additionally, data from initial patient trials suggest that this technique offers a clinically acceptable level of sensitivity and specificity. This article details the methodology of the technique, and addresses reproducibility, sensitivity, specificity, and image interpretation.

Antimony↗
PubMed2001

Usefulness of preoperative lymphoscintigraphy for the identification of sentinel lymph nodes in melanoma.

BACKGROUND: The exact role of lymphoscintigraphy (LS) in the evaluation of sentinel lymph nodes (SLNs) in melanoma is controversial. METHODS: We reviewed our experience with preoperative LS for the determination of the lymph node drainage pattern of clinically node negative primary melanomas, with attention to the rate of ambiguous drainage and the effect of previous wide local excision (WLE). RESULTS: The scans of 87 patients who underwent LS at our institution for evaluation of their primary melanomas from 1995 to the present were reviewed. Fourteen of the primary tumor sites were in the head and neck region, 41 were truncal, and 32 were in the extremities. The average tumor thickness was 2.6 mm. Nine of 14 (64%) head/neck lesions and 12 of 41 (29%) truncal lesions displayed ambiguous drainage, as compared with only 2 of 32 (6%) extremity lesions (P <0.05). Forty-one of the 87 patients (47%) had undergone previous WLE of their primary lesion prior to their LS. The number of draining basins for the WLE and the non-WLE groups were not significantly different, and at least one SLN was found for all WLE cases. CONCLUSIONS: Preoperative LS is important for the treatment planning of SLN biopsy for head/neck and truncal melanomas, but adds little additional information for extremity lesions. Lymph node drainage scans and subsequent SLN biopsies are not contraindicated in the presence of a prior WLE.

Adolescent↗
PubMed1996

Evaluation of lymphatic drainage in free flaps by lymphoscintigraphy: a preliminary study.

Lymphatic drainage from free flaps was studied by lymphoscintigraphy in 14 patients in whom free vascularised flaps were used to cover defects caused by trauma or tumour ablation. Lymphoscintigrams were done after intradermal injection of Technetium-99m-Dextran in the flap and in the corresponding contralateral normal area. The retention of radioactivity at the injection sites after 1 h was computed and expressed as percentages of baseline activity at the time of injection. 25 studies were done in 14 patients at intervals varying from 9 days to 6 years postoperatively. In all cases, radioactivity was detected beyond the flaps in the lymphatic channels and draining lymph nodes. There was no significant difference (P = 0.27) between the retention of activity in the flaps (mean 88.68%; s.e.m. 1.25) and that in the corresponding contralateral control area (mean 86.88%; s.e.m. 1.35). This study shows that lymphatic drainage in a free flap is established early after surgery.

Adolescent↗
PubMed1978

Internal mammary lymphoscintigraphy: a rational adjunct to the staging and management of breast carcinoma.

Radionuclide lymphoscintigraphy utilising the bilateral subcostal introduction into the posterior rectus sheath of a small volume of radiocolloid of suitable particle size (99mTc antimony colloid) has provided scintigraphic images of diagnostic quality of the parasternal nodes in 2328 patients with malignant disease. An evaluation of the use of this technique in 1072 patients with breast carcinoma underlines the value of a procedure which, utilised routinely, should alter conventional staging criteria and provide a more rational basis for the management of patients with breast carcinoma and assessment of end results.

Axilla↗
PubMed1985

Determination of depth distribution of internal mammary lymph nodes on lateral lymphoscintigraphy.

A method using a calibrated ruler for measuring lymph node depth on lateral lymphoscintigrams is described. The accuracy of the method was confirmed with a plexiglass phantom. At the time of internal mammary lymphoscintigraphy, lateral images were obtained in 201 patients. A total of 545 lymph nodes were visualised and categorised into 13 depth intervals. The average lymph node depth was 3.0 +/- 1.1 cm with a range of 1.0-7.1 cm. Average lymph node depth was classified according to body weight with an average depth of 2.5, 3.1 and 3.7 cm for patients weighing less than 60, 60-75 and more than 75 kg, respectively. Lateral lymphoscintigrams demonstrated normal anatomical communication between internal mammary and anterior mediastinal lymph nodes in 3.5% of patients.

Breast↗
PubMed2001

Sentinel node staging of early breast cancer using lymphoscintigraphy and the intraoperative gamma detecting probe.

Lymphoscintigraphy combined with intraoperative gamma-probe detection of sentinel lymph nodes in patients with inoperable early primary breast cancers is effective for staging the disease. The clinical alternative is axillary lymph node dissection, which is a far more invasive procedure and is accompanied by significant morbidity. Accuracy of staging is enhanced by immunohistochemical staining of micrometastases, which pathologists can easily perform for one to three sentinel lymph nodes, but not for 20 to 30 nodes, using axillary dissection procedure. Optimum methodology is presented for performing sentinel lymph node imaging and is important for accurate identification of sentinel node(s).

Breast Neoplasms↗
PubMed2000

Principles and controversies in lymphoscintigraphy with emphasis on breast cancer.

The concept of the sentinel node lay fallow until lymph node mapping was developed. This article provides a brief history of the sentinel lymph node concept, discusses reproducibility, radiopharmaceuticals, equipment, techniques, and radiation safety, and addresses metastasis in breast cancer and controversies in breast lymphoscintigraphy.

Breast Neoplasms↗
PubMed2000

Lymphatic mapping and intraoperative lymphoscintigraphy for identifying the sentinel node in penile tumors.

Lymph node mapping has become an integral part of the management of melanoma and breast cancer with regard to both staging and treatment. We report our technique for lymphatic mapping and intraoperative lymphoscintigraphy applied to a patient with penile melanoma. This technique may improve the sensitivity of identifying the sentinel lymph node in patients with malignant penile lesions.

Aged↗
PubMed1999

Subcutaneous and intravenous delivery of diagnostic agents to the lymphatic system: applications in lymphoscintigraphy and indirect lymphography.

Lymph node status is important in the staging of many malignancies. Although tissue characterization by histologic analysis of biopsy samples may improve staging, noninvasive staging is more acceptable to both patients and clinicians. Several imaging techniques may serve this goal. Modern noninvasive techniques such as computed tomography and magnetic resonance detect lymph node abnormality by nodal enlargement, but that does not always imply malignant involvement. On the other hand, many nodes are infiltrated or replaced by tumour without change in size. This becomes a serious diagnostic defect by these modalities. Consequently, attention has been focused to develop contrast agents and radiolabelled complexes for better cancer detection as well as characterization of individual tumours in lymph nodes. For delivery of such materials to regional lymph nodes one can take advantage from the distinct physiological function of the lymphatic capillaries. The thin-walled and fenestrated lymphatic microvessel is easily penetrated by particulate and macromolecular agents after injection into the extracellular space. Once inside the vessel, materials that are transported with the lymph either specifically target certain nodal elements (e.g. neoplastic cells) or become cleared by macrophages located in the lymph nodes. Indeed, interstitial delivery of diagnostic agents have been of benefit in determining regional spread of cancer and assessing lymphatic function either by lymphoscintigraphy or indirect lymphography. On the other hand, development of contrast materials that can reach lymph nodes after a single intravenous injection is highly desirable because of the large number of lymph nodes in the body and access being difficult to most of them. Today, a number of contrast agents exist that can reach a vast array of lymph nodes in the body, particularly those that are not readily accessible for histologic evaluation, after a single intravascular injection to help distinguish between normal and tumour-bearing nodes or reactive and metastatic nodes with magnetic resonance. In this article we critically examine advantages and limitations of both subcutaneous and intravenous routes of injection for the delivery of diagnostic agents to the lymphatic system.

Journal Article↗
PubMed2002

How iliopelvic lymphoscintigraphy can affect the definition of planning target volume in radiation therapy of pelvic and testicular tumors.

PURPOSE: External beam radiation therapy (EBRT) of most intrapelvic and testicular tumors has been generally performed with large fields encompassing both the primary disease and lymphatic drainage. This study was carried out to map the pelvic and periaortic lymphatics by means of iliopelvic lymphoscintigraphy (IPL) in preparation for radiotherapy planning. METHODS AND MATERIALS: Between January 2000 and October 2001, 70 patients scheduled for EBRT (61 operated on, 52 females, 18 males, mean age 61, range, 24-80), affected with uterine (43), rectal (11), testicular (8), anal (4), penile (2), and vulvar (2) cancers were enrolled in the study. IPL was performed by injection of 99mtechnetium-nanocolloids in the bipedal (70 cases) or bipedal plus perianal (20 cases) sites. The sensitivity of IPL in mapping the lymphatic anatomy was evaluated first. Then three radiation oncologists scored the modifications induced by IPL on the planning target volume (PTV) which had been previously delineated only on the basis of bony landmarks. The original fields were classified "inadequate" if they failed to match the new PTV by more than 1 cm. RESULTS: IPL sensitivity in showing the inguinal, external iliac, common, and periaortic lymphatics was 100%, 90%, 80%, and 70% in anterior-posterior (A-P) projections, and 100%, 80%, 70%, and 60% in lateral projections respectively. For the presacral and hypogastric ones the sensitivity was 40%. When compared with bony landmarks, IPL changed the delineation of PTV in 24 of 70 A-P P-A fields (34%) and 22 of 58 (38%) lateral fields. Furthermore, 8/12 (67%) lymphadenectomies resulted in being incomplete. No IPL-related toxicity was observed. CONCLUSION: IPL is a safe, inexpensive (cost: 100 Euros), and effective method to map the lymphatic chains. In the A-P scintigrams these structures were detected in 85% (70-100%) of the patients referred for total pelvis irradiation, and this figure could be higher in subjects not operated on. IPL can also give a reliable evaluation of the lymphadenectomies in order to schedule the proper treatments after surgery. Finally, IPL may change the conventional PTV for pelvic irradiation in about 36% (34-38%) of the cases; therefore, the fields should be tailored more around the lymphatic landmarks than the bony landmarks.

Adult↗