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PubMedDate not supplied

Current application of sentinel lymph node lymphoscintigraphy to detect various cancer metastases.

In this review article, the application of sentinel lymph node (SLN) lymphoscintigraphy not only in breast cancer and melanoma but also in cancers of the genital organs and the lungs is described. After a brief historical background, including Virchow and Cabanas' views, a description of the basic technique and the sensitivity and specificity of this technique in identifying SLN in breast cancer and melanoma are presented. In cervical and vulvar cancer and also in lung cancer, special techniques are applied before and during surgery and evaluated after surgical operation. The advantages and disadvantages of using SLN lymphoscintigraphy are described. Finally, our experience from using SLN lymphoscintigraphy, especially in cervical cancer, is presented. The technique for SLN mapping may save the patient from extended surgical procedures, indicate the pathways of lymph drainage and identify skip metastases. Nevertheless, the sensitivity of this technique should improve more in order to provide information concerning the extent of surgical treatment.

Breast Neoplasms↗
PubMed2005

Planning of the internal mammary field based on lymphoscintigraphy localization before postoperative radiotherapy of breast cancer.

BACKGROUND: Internal mammary irradiation is still an issue of great debate. Although treatment of internal mammary lymph nodes was routinely given in the majority of randomized trials, data in its value are still limited. The aim of this study is to determine the variability of position of the internal mammary lymph nodes using lymphoscintigraphy and to compare the dose of radiation that reaches these lymph nodes, the heart and lungs if only tangential fields are used. MATERIAL AND METHODS: This is a prospective study that included 30 breast cancer patients treated in the department of radiation oncology of the Egyptian National Cancer Institute, Cairo University, planned for postoperative radiotherapy. Lymphoscintigraphy was done for all patients for detection of the exact site of the internal mammary lymph nodes. Dose volume histogram (DVH) was done to measure the dose to the heart using CT planning. Two plans were done for each patient, the first with internal mammary field (plan I), and the second without but with contralateral crossing of the midline by 1cm (plan II). RESULTS: The mean percentage of the internal mammary lymph nodes included in the internal mammary field (plan I) was 70.03% while in plan II it was 3.05%. The mean dose percentage reaching the heart in plan I was 54.5% of total dose, while in plan II it was 9.16% of total dose with significant p value<0.001. The mean dose to the heart decreased as the heart volume increased, this significant difference between the 2 plans was maintained for the different heart volumes. Also, the radiation dose to the heart in plan I varied significantly (p: 0.001) between the right side vs the left side with a mean dose of 48.02% and 63.5%, respectively. The mean dose percentage reaching the lungs in plan I and plan II was 46.53% and 24.5% respectively, with significant p value<0.001. CONCLUSION: If irradiation of internal mammary chain is intended, then a direct internal mammary field should be used. The planning of internal mammary field should be adjusted according to lymphoscintigraphy so as to include most of the draining internal mammary lymph nodes. The risk of late cardiac and pulmonary complications will increase when using direct internal mammary field, but the risk of cardiac complications will be less in irradiation of right side internal mammary lymph nodes compared to that of irradiation of the left side.

Adult↗
PubMed2006

Lymphoscintigraphy as a diagnostic tool in patients with lymphedema of filarial origin--an Indian study.

Lymphedema is a common clinical problem. Filariasis is the commonest cause of lymphedema in India and is a chronic debilitating disease. The purpose of this study is to highlight the role of lymphoscintigraphy in the evaluation of lymphedema. Our study population consisted of 418 patients diagnosed with filarial lymphedema of different clinical stages referred for lymphoscintigraphy of the limbs by the lymphologist at our institution. An analysis of the various studies was done to determine how lymphoscintigraphy can be useful in documentation of the diagnosis, evaluation, as a screening procedure to prevent progression, and to enhance management of filarial lymphedema.

Adolescent↗
PubMed1990

Lymphoscintigraphy for melanoma: is it always predictive for lymphatic basin mapping?

Therapeutic decision making in treating patients with melanoma is difficult, with very few investigative tools and a lack of treatment options. Surgical extirpation remains the best method for cure and supports discussion in favor of prophylactic regional node dissection for subgroups of patients with stage I disease. In melanoma of the trunk or head and neck, lymphoscintigraphy has reliably provided guidance for resecting the regional lymphatics draining the involved site. This article describes a patient with a melanoma of the posterior neck, with metachronous metastases to the right and left posterior cervical triangles. Lymphoscintigraphy performed in the context of clinically negative nodal regions did not show drainage to either cervical nodal chain. Several explanations are presented, although a false-negative lymphoscintigraphic finding is the only plausible explanation. To our knowledge, this dilemma has not been previously reported, and raises the question of the infallibility of lymphoscintigraphy in predicting lymphatic basin mapping.

Drainage↗
PubMed1987

Utility of lymphoscintigraphy in directing surgical therapy for melanomas of the head, neck, and upper thorax.

Lymphoscintigraphy with technetium99m antimony sulfur colloid or technetium99m human serum albumin helped direct the surgical management of 24 patients who had melanomas of the head, neck, and upper thorax. Eighteen (75%) patients had documented lymphatic flow to other than a single adjacent predictable lymph nodal group. Nineteen patients underwent lymphadenectomy. Availability of the scan altered surgical management in nine patients (47%) who required resection of nodes in addition to resection of adjacent nodes. The discovery of metastatic disease in one patient was clearly attributable to lymphoscintigraphy. This demonstrates the unpredictable lymphatic anatomy of this region and suggests that preoperative lymphoscintigraphy may be useful in directing the surgical management of cutaneous melanomas in which lymph node dissection is planned.

Adult↗
PubMed1983

[Lymphoscintigraphy and internal breast curettage in breast cancer. Comparison of results. 32 cases].

Thirty-two women with breast cancer considered in active phase underwent, successively: internal mammary lymphoscintigraphy with 99m rhenium sulfide, chemotherapy and Pathey-type mastectomy with dissection of the axillary and internal mammary lymph nodes. Lymphoscintigraphy was successful in 97% of the cases, without complications. Its specificity was 0.88 (range: 0.76--0.99) and the sensitivity 0.6 (range: 0.19--0.92). Internal mammary lymph node dissection was technically successful in 87.5% of the cases; one patient developed chondritis. Thus, lymphoscintigraphy is usually successful, without morbidity and specific. However, it cannot pretend to provide a complete answer, as does internal mammary producing invaded lymph nodes.

Adult↗
PubMed1984

[Clinical evaluation of lymphoscintigraphy in urological disease].

Clinical efficacy of lymphoscintigraphy was evaluated in 31 cases of urological disease. To diagnose metastatic change of malignant tumor, 99mTc-rhenium colloid (5mCi) was administrated from bilateral pedal region. Of these patients 12 had true positive finding, 2 had false positive finding, 2 had false negative finding, and 8 had true negative finding defined by lymphoscintigram and pathological finding. Overall accuracy of lymphoscintigraphy revealed 83% in correlation of pathological finding, 78% in lymphangiography. Accuracy between lymphangiography and pathological finding was 80%. The overall clinical efficacy of lymphoscintigraphy was the same as lymphangiography. The merit of this method was that we can examine easily, painlessly, and frequently.

Adult↗
PubMed1981

[Lymph node staging in prostatic carcinoma Lymphography, pedal and intraprostatic lymphoscintigraphy, transcutaneous fine-needle lymph node biopsy and pelvic "guided" lymphadenectomy. Considerations on a series of 20 cases (1 September 1978-31 January 1980)].

Evaluation of lymph node involvement in carcinoma of the prostate is an essential step in staging when radical management is still possible. For this purpose, lymphography, lymphoscintigraphy, thin-needle transcutaneous lymph node biopsy, and pelvic lymphadenectomy have been variously combined since 1978 in 20 new cases (T1-T2-T3/Mo). Pedal lymphography displayed a good correlation with the histological data offered by adenectomy, and proved indispensable for the execution of transcutaneous biopsy under fluoroscopic control. Pedal lymphoscintigraphy is less invasive than lymphography. It provided suggestive morphological pictures of the lymph node chains, including those outside the pelvis; these, however, were difficult to interpret and must be regarded as of great, but complementary utility. Intraprostatic lymphoscintigraphy by injecting the radionuclide into the gland capsule permitted visualisation of the periprostatic nodes and confirmed previous experimental and clinical data. Lymph node metastases were seen in 50% of cases. Their frequency was inversely proportional to the degree of histological differentiation. In all cases, the external iliac and "obturator" (internal chain of external iliac group) notes were involved. Voluminous metastases were observed in two cases of "incidental" (To) carcinoma. The lymphography contrast medium was always found in the "obturators". It is suggested that these findings underscore the need for careful lymph node examination, even in the earliest stages of prostate cancer. They also raise further queries with regard to the treatment of incidental carcinoma.

Acid Phosphatase↗
PubMed1998

[Cancer of the breast: the return of lymphoscintigraphy?].

Lymphoscintigraphy, after arousing great hope in the past in the field of breast cancer, has now been abandoned. The inability of this examination to predict the metastatic status of the nodes, and progress in therapeutic concepts have led to abandoning this technique. However, certain problems encountered by regional irradiation programmes and the work concerning sentinel node detection may bring this technique back into the spotlight. Lymphoscintigraphy may make it possible to adopt an individual approach, case by case, of the lymphatic drainage basins in breast tumors, thus enabling certain patients to benefit from regional irradiation when it would not have been traditionally recommended for this irradiation. Another aspect concerns the problem of the volumes irradiated. Work carried out with lymphoscintigraphy has enabled internal mammary chain nodes to be precisely located. Theses studies show the necessity of adapting the irradiation field to each individual case, but the clinical impact is limited, in the end, by the low recurrence rate in the internal mammary chain area. However, the new techniques of computer merging of scintigraphic and scanner images could enable the spatial position of the nodes in the upper axillary and supraclavicular regions to be determined. This would have, a priori, much wider clinical impact. Lymphoscintigraphic detection of the sentinel node is another field of major interest, but this technique is in competition with staining techniques. This procedure leads to a large reduction in morbidity of axillary surgery in 70% of patients. The use of techniques for detecting micrometastases in the sentinel node opens prospects in terms of prognosis. The qualities of differents radiotracers and different injection sites possible are also discussed.

Axilla↗
PubMed1985

Evaluation of transport kinetics in lymphoscintigraphy: follow-up study in patients with transplanted lymphatic vessels.

To quantitate visual findings in lymphoscintigraphy with 99mTc-labeled stannous sulfur colloids, a numeric index of transport kinetics was designed by combining visual assessment of five criteria: temporal and spatial distribution of the radionuclide, appearance time of lymph nodes, and graded visualization of lymph nodes and vessels. For assessment, scores were used ranging from 0 to 9. Thus, the resulting transport index (TI) ranged from 0 (normal) to 45 (pathological). TI in healthy extremities was less than 10. Lymphoscintigraphy was performed routinely in healthy lower extremities to ensure normal drainage before transplantation. In 122 investigations of upper and lower extremities, TI was found to be very sensitive (97.4%). Specificity was 90.3%. An interobserver study in 179 investigations revealed a high correlation (r = 0.96). A total of 23 patients underwent autologous lymphatic transplantation. The average decrease of TI was 5.9: 31.1 before and 25.2 after transplantation. This decrease of TI was correlated with a marked decrease of the volumes of the extremities (from 3423 ml to 2580 ml). Changes in TI and volume were significant (p less than 0.05). This method of evaluation has proved to be very sensitive, reproducible, and able to measure the transport capacity of only two or three transplanted lymph collectors.

Adult↗
PubMed1987

Endoscopic lymphoscintigraphy. A new tool for target surgery of rectal cancer.

To define the "in vivo" lymphatic drainage from the rectum and the anal canal, 79 subjects (normal controls and patients with rectal cancer) underwent endoscopic rectal lymphoscintigraphy. This method consists of endoscopically injecting a radiolabelled colloid into the rectal and anal submucosa. The diffusion of the tracer, which is drained preferentially by the lymphatic vessels, was determined by means of a computerized gamma camera. Our results suggest a different pattern of lymphatic drainage from the rectum as compared to traditional anatomical studies. Moreover, analysis of our data yields a new hypothesis about the lymphatic spread of rectal cancer. Therefore, lymphoscintigraphy could be employed in the preoperative assessment of "N" staging of these neoplasms. This should provide better selection of patients for different surgical approaches and for adjuvant therapy. The results of 2 years of experience and possible future applications of this technique are discussed.

Anal Canal↗
PubMed1997

[Involvement of the lymphatic system in primary non-lymphogenic edema of the leg. Studies with 2-compartment lymphoscintigraphy].

Two-compartment lymphoscintigraphy was developed to examine the sub- and epifascial lymphatics of the leg. Digital images were evaluated visually and semiquantitatively by calculating the uptake of activity within the lymph nodes. The data from patient groups with four different types of leg edema were compared with those of the control group to prove the involvement of the lymphatics in the non-lymphatic edema. The cyclic idiopathic edema demonstrated an accelerated transport of the lymph consistent with a high volume insufficiency. In phlebedema the high volume insufficiency was epifascially so distinct, that it could be detected scintigraphically. In post thrombotic syndrome the transport of the lymph was reduced dramatically corresponding to a safety valve insufficiency. Epifascially however, an accelerated lymph flow was observed due to compensatory mechanisms. The lipedema did not show any scintigraphic abnormalities. These results show that two-compartment lymphoscintigraphy can detect alterations in lymphatic function secondary to non-lymphogenic leg edema. The lymphatic function is changed according to the underlying pathophysiology which may be facilitate the differential diagnosis of such a leg edema.

Adult↗
PubMed1993

Development of a dextran kit for labelling with 99mTc and its evaluation for lymphoscintigraphy.

A cold dextran (molecular weight 60,000-90,000) kit has been developed by a modified procedure to produce instant preparation of 99mTc-dextran suitable for lymphoscintigraphy. The preparation was subjected to various quality control measures. Effect of pH and amount of stannous chloride as a reducing agent on the labelling efficiency using ITLC were studied. The labelled complex was separated from both the reduced pertechnetate and pertechnetate and quantified. In a series of experiments hydrolysed/reduced 99mTc was found to be less than 3.0%, whereas pertechnetate was approx. 1.0%. Biokinetics of the agent in mice and blood clearance and rate of disappearance from the site of intradermal injection of the agent in rabbits were studied. The tagged agent for imaging of the lymphatic system activated by administering Freund's complete adjuvant (FCA)/E. coli in rabbits exhibited its suitability for lymphoscintigraphy.

Animals↗
PubMed2006

The role of lymphoscintigraphy in the detection of lymph node drainage in melanoma.

Lymphatic drainage of the skin cannot be predicted based on clinical guidelines developed more than 100 years ago. Approximately 30% of patients experience drainage from the skin to unexpected lymph node sites rather than those specified by these guidelines, and therefore these outdated assumptions should no longer be used to plan surgery. A possible survival benefit has been shown for the early detection and surgical removal of metastatic disease in the draining lymph nodes, and therefore, clinicians must obtain accurate lymphatic mapping for each patient who has intermediate thickness melanoma to plan appropriate surgical therapy. Lymphoscintigraphy can be used to accurately define the precise position of each true sentinel node in every patient, whether these nodes lie in a standard node field or in an unusual location. In this way, lymphoscintigraphy has a direct beneficial impact on the surgical management of patients who have melanoma.

Humans↗
PubMed2003

[Planning and monitoring of autologous lymph vessel transplantation by means of nuclear medicine lymphoscintigraphy].

Autologous lymph vessel transplantation significantly improves the lymph drainage in patients with primary and secondary lymphedema. The aim of the present study was to prove whether scintigraphic long-term follow-up could demonstrate the function of autologous lymph vessels and the persisting success of this microsurgical technique respectively. In this study, visual and semiquantitative lymphoscintigraphy was used to prove the function of lymphatic vessel grafts in 20 patients comparing a preoperative baseline study with postoperative follow-up investigations once a year for a period of seven years. The reason for microsurgical lymph vessel transplantation was a primary (n = 4) or a secondary (n = 16) lymphedema. In 12 cases the transplantation site was at the upper extremity, in eight cases at the lower limb. In 17/20 patients lymphatic function significantly improved after autologous lymph vessel transplantation compared to the preoperative findings, as verified by visual improvement of lymph drainage and decrease of a numeric transport index. In 5/20 cases the vessel graft could be visualized directly. In these patients with scintigraphic visualization of the vessel graft, the transport index decreased to a significantly greater extent compared to the preoperative baseline study. 3/20 patients did not benefit from microsurgical treatment. Lymphoscintigraphy has shown to be an easy, reliable and readily available technique to assess lymphatic function on the long run. Scintigraphic visualization of the vessel graft showed a significantly better postoperative outcome than those without. The scintigraphic visualization of the vessel graft therefore seems to indicate a favourable prognosis regarding lymph drainage.

Adult↗
PubMed1982

[The place of lymphoscintigraphy in the treatment of malignant melanoma of the skin (author's transl)].

Lymphoscintigraphy was performed pre- or postoperatively in 42 patients with malignant melanoma of the skin. The test consisted of the injection of 1.5-2.0 mCi 99mTc-labelled antimony sulphide colloid, both intracutaneously and subcutaneously, either around the primary tumour or along its edges or into the centre of the excision scar or contralaterally. The draining lymph-node groups were scanned with a gamma-camera 4-6 hours after the injection. Except for one patient, the radioactive tracer had always disappeared from the injection site and had accumulated in th regional lymph-nodes. In 11 of 28 patients with melanoma on the trunk, lymphatic drainage was to more than one regional lymph-node group. In most cases with cutaneous melanoma on the trunk, lymphatic drainage could not be anatomically predicted, but easily and unequivocally identified by lymphoscintigraphy. On the other hand, lymphatic drainage of a melanoma of the head or neck, as well as of distal segments of the limbs, almost always followed anatomical expectations. Using lymphoscintigraphic findings, prophylactic lymphadenectomy could be performed selectively in "high risk" melanomas.

Adult↗
PubMedDate not supplied

Lymphoscintigraphy in cutaneous melanoma: a total body atlas of sentinel node mapping.

Lymphoscintigraphy of malignant melanoma has been a reliable method of identifying regional lymph nodes at risk for metastases and is now considered part of the standard of care in patients with melanoma. The status of the sentinel lymph node (SLN) is predictive of the metastatic status of the corresponding regional lymph node group. Lymphatic channel mapping allows identification of the SLN, thereby making selective lymph node sampling possible. Consequently, SLN identification with lymphoscintigraphy results in both less extensive surgery and more efficient pathologic examination of the lymph node specimens. Therefore, it is imperative that radiologists and nuclear medicine physicians know which radiopharmaceuticals to use, recognize different lymphatic drainage patterns from various primary tumor sites throughout the body, use proper imaging techniques, and recognize potential pitfalls in image interpretation.

Humans↗
PubMed1999

[Lymphoscintigraphy in the study of lymphatic drainage patterns in patients with melanoma].

BACKGROUND: In order to plan the pertinent surgical technique for each patient with melanoma or other skin malignancies, it is mandatory to identify those lymphatic basins at risk for metastases. The advent of radiotracers for functional studies of the cutaneous lymphatic system during the last decade has resulted in the disclosure of an unexpected interindividual variability of the lymphatic drainage in both head and neck and trunk. OBJECTIVE: To ascertain the usefulness of lymphoscintigraphy for depicting the cutaneous lymphatic draining basins in patients with primary melanoma of the head, trunk and limbs, and to compare the observed lymphatic drain with the expected pattern of lymph flow according to the classical anatomical studies. MATERIAL AND METHODS: Prospective study in a university hospital (Barcelones Nord area). Consecutive patients with the diagnosis of cutaneous melanoma were recruited after excisional biopsy of the primary tumor. Every patient was intradermally injected with rhenium-sulfide colloids or colloidal technetium labelled with Tc-99m in four quadrant doses of 0.3 ml around the lesions or its excisional scar. Scintigraphic imaging of the migrating radiotracer resulted in a flow pattern that was compared with its "classical" expected counterpart. RESULTS: Altogether, 55 lesions were studied, including 9 in the head, 21 in the trunk and 25 in the limbs (7 upper and 18 lower). The scintigraphic drain pattern did not match the expected classical pattern in 37.0% of the lesions overall (14% upper limbs, 42% truncal lesions out from an area 2.5 cm at both sides of Sapey's line or the midline, 16.6% lower limbs and 89% head and neck). CONCLUSIONS: Lymphatic drain of the skin shows a very high intrapersonal variability leading to the need for an individual work-up in order to know the lymphatic basins at risk for metastases. The high rate of unexpected or non-matching patterns casts some doubts over those previous studies that did not include lymphoscintigraphy on a patient-basis.

Adult↗