Advantages of the intradermal lymphoscintigraphy

Lymphoscintigraphy is a nuclear medicine procedure that uses a small quantity of radioactive particles for visualizing the lymphatic system.Traditionally,the radiotracer was injected subcutaneously,but the quality of lymphatic path imaging was scarce due to high background.Intradermal radiotracer injection is considered the modern-day intralymphatic injection.We propose rest/stress intradermal lymphoscintigraphy for the diagnosis,staging and surgical planning of lymphedema.Major and minor findings were described in primary and secondary lymphedema.Based on the in-depth information of the lymphatic pathways,physiotherapists and microsurgeons can obtain important functional information in patients’selection to treat with physical treatments and/or undergo microsurgery.

Evaluation of Taping in the Lymphatic System through Lymphoscintigraphy of Upper and Lower Limbs: A Case Study

Introduction: Lymphatic taping has been used extensively in several areas of physical therapy, and has been prominent in the treatment of edema. Its results are considered empirical and no study reports its effect observed by a lymphocyte count study. Purpose: To verify the performance of lymphatic taping in the lymphatic system using lymphoscintigraphy examination. Methods: A 44-year-old male patient with no clinical signs of lymphatic alteration underwent lymphoscintigraphy examination prior to and after application of lymphatic taping in the upper and lower limbs on different days of placement to verify if the use of lymphatic taping may influence the lymph flow. Results: The result was an improvement in the lymphatic flow with application of lymphatic taping only in the lower limbs, where the taping acted only for 24 hours. There was a greater amount of radiopharmaceutical extracted in the feet of the patient, comparing pre- and post-application of taping. At the foot of the left lower limb, the absorption ratio doubled. There was also improvement in the right limb, but on a smaller scale. Conclusion: Through the evaluation of the lymphatic system by lymphoscintigraphy it can be observed that the values analyzed are relatively higher when the patient has lymphatic taping applied with both 10% and 20% of tension in the lower limbs.

Lymphoscintigraphy Using Dynamic Imaging and SPECT/CT in Chylothorax

Lymphoscintigraphy readily provides confirmation of chylothorax but not detailed localization of the leakage site. A 77-year-old woman developed traumatic chylothorax and underwent lymphoscintigraphy with radiolabeled albumin to identify the site of lymph leakage. Dynamic imaging demonstrated appearance of focal activity presumably in the upper mediastinum, followed by spread to the left hemithorax. Subsequently, SPECT/CT showed that the leakage site was located in the left side of the upper mediastinum, and this location was confirmed during video-assisted thoracoscopic surgery. Dynamic imaging demonstrated the site of first appearance of abnormal activity, and SPECT/CT enabled detailed localization of the abnormal activity with anatomic correlation. The combination of dynamic imaging with SPECT/CT appears to be recommendable for lymphoscintigraphic assessment of chylothorax.

Contribution of lymphoscintigraphy by SPECT/CT to preoperative sentinel lymph node localization in oral squamous cell carcinoma

Objective:Sentinel lymph node biopsy(SLNB) is a minimally invasive method that helps to evaluate the status of the lymph node region of a primary tumor.A precise preoperative localization of the sentinel lymph node (SLN) may be helpful for surgical planning.Preoperative lymphoscintigraphy (LS) is important if the cancer is located in regions of anatomical complexity.But it fails to elucidate the specific lymphatic drainage and the anatomical relationship of SLNs.In the present study the benefit of LS by SPECT/CT to the preoperative localization of SLNs was evaluated.Methods:21 clinically nodes-negative patients with T1 or T2-staged oral squamous cell carcinoma were enrolled.LS were performed by submucosa injection of 37-74MB of 99mTc-DX at 4 to 6 points around the tumor followed by immediate dynamic,delay static imaging and skin marking of the SLN.Then the patients underwent SPECT/CT scintigraphy.Planar and fusion images were interpreted separately and compared.Intraoperative dye method was carried out.Results:In all patients,fusion images confirmed the localization obtained by planar images and skin marking.Moreover,in 9 of the 21 patients,the fusion images improved or corrected the preoperative localization of the SLNs in planar imaging:7 nodes that had been identified only on the fused images were located in basins other than or in addition to the basins identified on th planar images,and 1 node that was located closed to the injection sites was hidden by its scattered radiation signals in the planar images,and erroneous diagnosis occurred in 1 node resulted from the scattering.In addition,multiple draining basins were identified on the fusion images in 6 of the 21 patients,however,planar images only in 1 of the 21.Conclusion:Our results showed the additional value of SPECT/CT fusion imaging in revealing SLNs compared to planar imaging and sharpen the localization of the SLN that were of clinical relevance to SLNB in patients with oral squamous cell carcinoma.And by fusion images topographic landmarks could be identified that may further facilitate surgical exploration with a higher diagnostic sensitivity with more SLNs being detectable than by planar LS.

动物活体淋巴系统99~mTc-DX显像的实验研究

应用自己研制的99~mTc—DX淋巴管显像药盒,对不同处理的动物进行了病理与显像结果分析。选用DX分子量为48,000。注射剂量0.1ml,放射强度0.5mci。大鼠注射尾静脉,小鼠于趾间皮下注射。用单光子发射计算机断层仪(SPECT)分别观察显像情况,并进行病理对比。结果表明:大鼠尾静脉注射后,肝、肾显像清晰。正常小鼠显像淋巴链完整,影像对称;患瘤小鼠局部淋巴通常受阻,淋巴链不完整,影像两侧不对称。显像结果与病理观察相同。研究结果提示:99~mTc—DX药盒除适用于临床推广应用外,还适用于实验动物肿瘤模型的诊断、肿瘤淋巴转移的预测、肿瘤术后的观察及肝癌导向治疗等实验研究。

The Initial Implementation of the Sentinel Lymph Node Biopsy (SLNB) for Breast Cancer Management in Malta

Over the past two decades, the sentinel lymph node biopsy (SLNB) based on sentinel node (SN) being the first lymph node that harbors metastases, revolutionized breast cancer management. SLNB presents much less morbidity when compared to radical axillary lymph node dissection (ALND) where all nodes are dissected irrespective of their metastatic involvement. The purpose of this study was to evaluate the effectiveness of SLNB by investigating whether the histological characteristics of the SNs identified using scintigraphy are predictive of the histological characteristics of the ALN basin. Methods: Fifty-five female breast cancer patients underwent lymphoscintigraphy and SLNB followed by ALND. The histological status of the SN/s was correlated to the histological status of the ALNs to determine whether the SN accurately stages the ALNs in breast cancer. Results: During surgery, SNs were successfully isolated in 52 out of 55 cases (94.5%) (range, 0 to 9). No SNs were identified in 3 cases (5.5%). Results demonstrate a significant association (p = 0.05) between the metastatic status of SNs and the corresponding ALNs in 42 out of 52 patients (80.8%), but with a high false-negative rate (FNR) of 37.5%. Conclusion: The findings of this study show that the sentinel node concept provides the benefits of SLNB in the majority of instances. However, further work is required in reducing the FNR. Once the effectiveness of SLNB as a staging technique is locally established, the need of ALND in SN-negative patients would be limited, thus improving the quality of life of Maltese breast cancer patients.

DETECTION OF SENTINEL LYMPH NODE IN EARLY CERVICAL CANCER

Objective: To assess the value of sentinel lymph node (SLN) localization by lymphoscintigraphy and gamma probe detection in early cervical cancer. Methods: A total of 27 patients with operable invasive early cervical cancer and clinically proved negative pelvic lymph nodes were included in this study. The 99Tcm-dextran of 74 MBq (2 mCi) was injected around the cervix at 2 and 10. Lymphoscintigraphy and gamma probe detection were used to find the SLN. Results: The SLN was identified in 27 patients. The sensitivity and specificity of the SLN detection to predict the metastasis of the pelvic lymph node were 100% and 100% respectively. Conclusion: Identification of the SLN using radionuclide is feasible and possible in women with early cervical cancer.

Feasibility of Performing Sentinel Lymph Node Biopsy (SLNB) after Mastectomy: A Case Report

Introduction: Previous mastectomy remains a contraindication to SLNB as normal drainage patterns of the breast can be disturbed. Patients diagnosed with DCIS on core biopsy and later found to have microinvasive or invasive carci-noma at the time of mastectomy are deprived of the opportunity for SLNB and need to undergo axillary dissection. We explored the option and feasibility of performing SLNB in a 39-year-old female who underwent a simple mastectomy without axillary sampling for extensive DCIS and later found to have microinvasive ductal carcinoma on permanent pathology. Results: Lymphatic mapping using subdermal injection of 99mTc-labeled sulfur colloid and blue dye led to the identification of five SLNs. Histopathologic examination showed no metastasis. Conclusion: SNLB is feasible in this setting. However, before its use is routinely adopted, its feasibility and accuracy has to be demonstrated in larger num-bers of patients in whom a negative SLNB is followed by a completion axillary dissection.

Sentinel lymph node biopsy in renal malignancy: The past, present and future

Sentinel lymph node biopsy （SLNB） is now an establishedtechnique in penile and pelvic cancers, resulting in alower mortality and morbidity when compared withthe traditional lymph node dissection. In renal cancer however, despite some early successes for the SLNB technique, paucity of data remains a problem, thus lymph node dissection and extended lymph node dissection remain the management of choice in clinically node positive patients, with surveillance of lymph nodes in those who are clinically node negative. SLNB is a rapidly evolving technique and the introduction of new techniques such as near infra-red fuorescence optical imaging agents and positron emission tomography/computed tomography scans, may improve sensitivity. Evidence in support of this has already been recorded in bladder and prostate cancer.Although the lack of large multi-centre studies and issues around false negativity currently prevent its widespread use, with evolving techniques improving accuracy and the support of large-scale studies, SLNB does have the potential to become an integral part of staging in renal malignancy.

Chylorrhea complicating D2＋a gastrectomy： review of the literature and clarification of terminology apropos one case

Lymphatic complications leading to retention,accumulation or drainage of peritoneal fluid are frequently encountered following extended or superextended lymphadenectomy for gastric cancer.1 The vast majority of these drainages usually subsides spontaneously, but in some instances they can persist for long period of time causing significant morbidity.However, the classification,

Diagnostic workup of lymphedema

Lymphedema is a chronic and progressive pathological state of tissue swelling caused by congenital or acquired lymphatic abnormality.History,physical and laboratory examinations could help to diagnosis>90%lymphedema patients.Early stage lymphedema could be challenging to diagnose.The aim of this review is to provide an objective appraisal of current diagnostic methods,such as lymphoscintigraphy,lympho-fluoroscopies,lymphangiography and etc.focusing on their respective advantages and weaknesses,and hopefully shed some lights on developing a practical diagnosis modality beneficial to early detection and clinical decision making of lymphedema.

Contemporary use of sentinel lymph node biopsy in the head and neck

Sentinel lymph node biopsy has become a well-established and commonplace prac-tice in many oncologic disease sites as a means to stage the regional lymphatics, avoid unnec-essary surgery and decrease patient morbidity. In the head and neck, its role is well established for cutaneous melanoma with proven fidelity and survival benefit. Its role in use for other sites such as oral cavity carcinoma continues to develop with promising results from several recent trials. Although not widely adopted, the potential benefits of sentinel lymph node biopsy in the management of oral cavity carcinoma are apparent. Refinements in tech-nology and protocols including development of novel radiopharmaceutical tracers, routine incorporation of detailed anatomic imaging, increasing surgeon experience and development of new intraoperative identification aids will likely lead to improvements in the use and accu-racy of this technique. Copyright a 2016 Chinese Medical Association. Production and hosting by Elsevier B.V. on behalf of KeAi Communications Co., Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).