Endoscopic fluorescent lymphography for gastric cancer

Lymphography by radioisotope or dye is a well-known technique for visualizing the lymphatic drainage pattern in a neoplastic lesion and it is in use in gastric cancer.Indocyanine green(ICG)more recently has been validated in fluorescent lymphography studies and is under evaluation as a novel tracer agent in gastric cancer.The amount and dilution of ICG injected as well as the site and the time of the injection are not standardized.In our unit,endoscopic submucosal injections of ICG are made as 0.5 mg in 0.5 mL at four peritumoral sites the day before surgery(for a total of 2.0 mg in 2.0 mL).Detection instruments for ICG fluorescence are evolving.Near-infrared systems integrated into laparoscopic or robotic instruments(near-infrared fluorescence imaging)have shown the most promising results.ICG fluorescence recognizes the node that receives lymphatic flow directly from a primary tumor.This is defined as the sentinel lymph node,and it has a high predictive negative value at the cT1 stage,able to reduce the extent of gastrectomy and lymph node dissection.ICG also enhances the number of lymph nodes detected during extended lymphadenectomy for advanced gastric cancer.Nevertheless,the practical effects of ICG use in a single patient are not yet clear.Standardization of the technique and further studies are needed before fluorescent lymphography can be used extensively worldwide.Until then,current guidelines recommend an extensive lymphadenectomy as the standard approach for gastric cancer with suspected metastasis.

Review of Non-Contrast MR-Lymphography Techniques and Findings: Challenges and Opportunities

Lymphedema is a major disorder of lymphatic system that occurs primarily due to lymphatic system disorders or secondary lymphedema which is caused by radiation therapy involving lymph nodes or surgical operation dissection. Magnetic resonance lymphography (MRL) has been used to effectively examine the lymph vessels and identify their morphology. This review study intended to evaluate the role of non MR-lymphographic for the diagnosis assessment of lymphedema and to provide comprehensive review on clinical outcome of non-contrast MRI compared to MRI with contrast medium. In this study, scientific publications published in languages other than English were excluded. A systematic review was done in international databases including PubMed, Scopus, web of sciences, conference proceedings published till 2019. Non contrast MRI lymphography has strong capability to be the main imaging procedure of choice in the diagnosis lymphedema with accuracy up to 90%.

Application progress of lymphography in oncology

Lymphography is often used for the diagnosis of lymphatic metastasis in oncology.Determination of lymphatic metastasis is extremely important for accurate cancer staging,which may directly guide the clinical therapeutic scheme.In recent years,the technology of lymphography has developed rapidly on the basis of traditional lymphography,with the appearance of com-puted tomography(CT)lymphography,nuclear magnetic resonance(MR)lymphography,contrast-enhanced lym-phosonography,and so on;the diagnostic accuracy has also been improved.The imaging principles and methods of these various technologies of lymphography are reviewed in this paper,and their applications and significance in oncology are also discussed in detail.

Comparison of sentinel lymph node detection performances using blue dye in conjunction with indocyanine green or radioisotope in breast cancer patients: a prospective singlecenter randomized study

Objective:This randomized study aimed to compare the clinical efficacy between the novel dual tracer composed of indocyanine green(ICG)and blue dye(BD)and the conventional dual tracer composed of radioisotope and BD for sentinel lymph node(SLN)mapping in patients with breast cancer.Methods:This study enrolled 471 clinically lymph node-negative patients with primary breast cancer.All patients underwent mastectomy,and those undergoing sentinel lymph node biopsy(SLNB)were randomized to receive blue dye plus radioisotope(RB group)or BD plus ICG(IB group).The detection performances on SLN identification rate,positive SLN counts,detection sensitivity,and false-negative rate were compared between the two groups.Results:In the IB group,97%(194/200)of the patients who underwent the ICG and BD dual tracer injection showed fluorescentpositive lymphatic vessels within 2–5 min.The identification rate of SLNs was comparable between the IB group(99.0%,198/200)and the RB group(99.6%,270/271)(P=0.79).No significant differences were observed in the identification rate of metastatic SLNs(22.5%vs.22.9%,P>0.05,RB group vs.IB group,the same below),positive SLN counts(3.72±2.28 vs.3.91±2.13,P>0.05),positive metastatic SLN counts(0.38±0.84 vs.0.34±0.78,P>0.05),SLNB detection sensitivity(94.4%vs.92.5%,P>0.05),or false-negative rate(5.6%vs.7.5%,P>0.05)between the two groups.Conclusions:ICG can be used as a promising alternative tracer for radioisotope in SLN mapping,and when it is combined with BD in lymphangiography,it offers comparable detection sensitivity compared to the conventional lymphatic mapping strategies that are widely used in clinical practice.

间接淋巴造影

淋巴造影在显示正常大小淋巴结的内在结构方面比CT、MRI准确，对颈淋巴结早期转移诊断将有一定的价值，其中间接淋巴造影显影淋巴结有一定的优势。本文就间接淋巴造影原理、造影剂及其应用等方面进行综述。

Practical considerations in starting a peripheral lymphedema magnetic resonance imaging program

The management of chronic peripheral lymphedema benefits from a multidisciplinary approach in which magnetic resonance imaging(MRI)can play a key role.The imaging has been well described in the literature(including this journal),but the process for starting a novel imaging service line is complex.Participants in this process,including radiologists,imaging technical staff,information technologists,and revenue cycle managers,must be engaged and work in harmony to achieve success.The purpose of this article is to detail the building blocks and steps in starting a peripheral lymphedema MRI program,how our process evolved,and lessons learned along the way.