Lymphatic Drainage System Research Articles

Lymphatic spreading and lymphadenectomy for esophageal carcinoma.

Esophageal carcinoma (EC) is a highly lethal malignancy with a poor prognosis. One of the most important prognostic factors in EC is lymph node status. Therefore, lymphadenectomy has been recognized as a key that influences the outcome of surgical treatment for EC. However, the lymphatic drainage system of the esophagus, including an abundant lymph-capillary network in the lamina propria and muscularis mucosa, is very complex with cervical, mediastinal and celiac node spreading. The extent of lymphadenectomy for EC has always been controversial because of the very complex pattern of lymph node spreading. In this article, published literature regarding lymphatic spreading was reviewed and the current lymphadenectomy trends for EC are discussed.

Dual-color photoacoustic lymph node imaging using nanoformulated naphthalocyanines

Demarking lymph node networks is important for cancer staging in clinical practice. Here, we demonstrate in vivo dual-color photoacoustic lymphangiography using all-organic nanoformulated naphthalocyanines (referred to as nanonaps). Nanonap frozen micelles were self-assembled from two different naphthalocyanine dyes with near-infrared absorption at 707 nm or 860 nm. These allowed for noninvasive, nonionizing, high resolution photoacoustic identification of separate lymphatic drainage systems in vivo. With both types of nanonaps, rat lymph nodes buried deeply below an exogenously-placed 10 mm thick layer of chicken breast were clearly visualized in vivo. These results show the potential of multispectral photoacoustic imaging with nanonaps for detailed mapping of lymphatic drainage systems.

Structural and functional features of central nervous system lymphatic vessels

One of the characteristics of the CNS is the lack of a classical lymphatic drainage system. Although it is now accepted that the CNS undergoes constant immune surveillance that takes place within the meningeal compartment1–3, the mechanisms governing the entrance and exit of immune cells from the CNS remain poorly understood4–6. In searching for T cell gateways into and out of the meninges, we discovered functional lymphatic vessels lining the dural sinuses. These structures express all of the molecular hallmarks of lymphatic endothelial cells, are able to carry both fluid and immune cells from the CSF, and are connected to the deep cervical lymph nodes. The unique location of these vessels may have impeded their discovery to date, thereby contributing to the long-held concept of the absence of lymphatic vasculature in the CNS. The discovery of the CNS lymphatic system may call for a reassessment of basic assumptions in neuroimmunology and shed new light on the etiology of neuroinflammatory and neurodegenerative diseases associated with immune system dysfunction.

The application of the method of kinesio-taping technique for the combined non-pharmacological rehabilitation of the patients presenting with lymphedema of the lower extremities

Based on the innovative "kinesio-taping" technique proposed by the Japanese researcher Kenzo Kace, we have designed a new physiotherapeutic complex including the well-known physiotherapeutic methods of lymphatic drainage with intermittent pneumatic compression and underwater massage shower. The objective of our study was to evaluate the efficiency of the application of the "kinesio-taping" technique for the non-pharmacological rehabilitative treatment of the patients presenting with stage I-III lymphedema of the lower sextremities. The secondary objective was to evaluate the possibility of correction of endothelial dysfunction in the patients with lymphedema after the application of the "kinesio-taping" technique. The study included 30 patients with stage I-III lymphedema of the lower extremities randomized into two groups. Group 1 was comprised of 15 patients who were consistently treated by a combination of intermittent pneumatic compression, "akinesio-taping", and underwater massage shower. Group 2 contained 15 patients treated with the use of intermittent pneumatic compression and underwater massage shower. The results of study give evidence of positive changes in microcirculation of the patients comprising group 1 that suggest the improvement of endothelial function, vasodilation of precapillaries, enhancement of the blood flow in the microcirculatory system, and reduction of the influence of the ineffective shunting blood flow. The data obtained confirm the effectiveness of the new non-pharmacological rehabilitation complex that includes the innovative lymph-draining method of kinesio-taping, intermittent pneumatic compression and underwater massage shower for the treatment of patients with lymphedema of the lower extremities. The effectiveness of this complex is due to combined stimulation of the lymphatic and venous drainage systems and coupled to the stimulation of blood flow in the microcirculatory bed and the formation of a positive endothelial response.

Recent advances in shell-sheddable nanoparticles for cancer therapy.

Cancer remains one of the most incurable diseases associated with high mortality and morbidity. Although extensive studies have been carried out for cancer therapy, there are still no gold standards available for treatment. Spurred by advances in biomaterial sciences, recent efforts have focused on the development of polymeric nanoparticles for site-specific delivery of anticancer drugs. Such nanoparticles have distinct characteristics, including high thermodynamic stability, good biocompatibility, and prolonged circulation in the bloodstream. Owing to these unique features, systemically administered nanoparticles can passively accumulate at tumor tissue with leaky vasculature and poor lymphatic drainage system, which is called the enhanced permeation and retention (EPR) effect. However, the site-specific accumulation of nanoparticles does not guarantee high antitumor efficacy because the conventional nanoparticles release the drugs in a sustained manner via the passive diffusion mechanism, which may not endow tumor tissue with cytotoxic local concentrations of the drugs. To surmount this limitation, nanoparticles that can rapidly release the drug at the tumor site need to be developed. In recent years, it has been demonstrated that shell-sheddable nanoparticles have an ability to rapidly release the drug by recognizing the specific environments of the tumor tissue. After systemic administration, shell-sheddable nanoparticles reach tumor sites via the EPR effect, followed by exposure to tumor microenvironment-specific stimuli which cause a burst release of the drug. Representative stimuli, used to design shell-sheddable nanparticles, include pH, redox, enzymes, temperature, ultraviolet, and ultrasound. In this review, we discuss the recent advances in tumor-specific, shell-sheddable nanoparticles for drug delivery.

Afferent and efferent immunological pathways of the brain: anatomy, function and failure (84.1)

Immunological privilege appears to be the result of two major processes: (a) unique lymphatic drainage systems for the brain; and (b) highly regulated specialised passage of inflammatory cells through the blood‐brain barrier. Most organs of the body have well‐defined lymphatic vessels that carry extracellular fluid to regional lymph nodes. The brain has no such conventional lymphatics. Instead, it has perivascular pathways that drain interstitial fluid (ISF) from the brain parenchyma and cerebrospinal fluid (CSF) from the subarachnoid space to cervical lymph nodes. Solutes and ISF drain along narrow, ~100 nm‐thick basement membranes within the walls of cerebral capillaries and arteries to cervical lymph nodes. This pathway does not allow traffic of cells from the parenchyma to lymph nodes. CSF drains into blood through arachnoid villi and through channels in the cribriform plate of the ethmoid bone into nasal lymphatics, permitting cells to travel from CSF to cervical lymph nodes. Efferent pathways by which lymphocytes enter the brain are regulated by integrins on lymphocytes and selective receptors on endothelial cells. I will review: (a) the functional morphology of lymphatic drainage of the brain; (b) mechanisms involved in the pathways by which lymphocytes enter the brain; and (c) the failure of lymphatic drainage of the brain parenchyma in Alzheimer's disease.

An atypical case of tularemia presented with pseudoptosis

We report an unusual case of tularemia involving pseudoptosis associated with deterioration of the lymphatic drainage system extending from the upper eyelid to the preauricular lymph nodes. A 16-week pregnant patient was admitted with an absess on the neck, preauricular lymphadenopathy, and pseudoptosis on the left side. The micro-agglutination test was positive for Francisella tularensis antibody at a titer of 1/200. The absess was surgically drained and oral cefuroxime was given for 6 weeks. Two weeks after drainage, the pseudoptosis improved due to the recovery of lymphatic drainage system of the eyelid and remission of the absess on the neck. Our case report contributes to the medical literature on tularemia during pregnancy and informs healthcare professionals on the management of the infection in such cases.

Current Studies of Immunotherapy on Glioblastoma

Glioblastoma is a form of brain tumor with a very high morbidity and mortality. Despite decades of research, the best treatments currently in clinical practice only extend survival by a number of months. A promising alternative to conventional treatment for glioblastomas is immunotherapy. Although proposed over a century ago, the field of cancer immunotherapy has historically struggled to translate it into effective clinical treatments. Better understanding is needed of the various regulatory and co-stimulatory factors in the glioblastoma patient for more efficient immunotherapy treatments. The tumor microenvironment is anatomically shielded from normal immune-surveillance by the blood-brain barrier, irregular lymphatic drainage system, and it's in a potently immunosuppressive environment. Immunotherapy can potentially manipulate these forces effectively to enhance anti-tumor immune response and clinical benefit. New treatments utilizing the immune system show promise in terms of targeting and efficacy. This review article attempts to discuss current practices in glioblastoma treatment, the theory behind immunotherapy, and current research into various clinical trials.

Afferent and efferent immunological pathways of the brain. Anatomy, Function and Failure

Immunological privilege appears to be a product of unique lymphatic drainage systems for the brain and receptor-mediated entry of inflammatory cells through the blood-brain barrier. Most organs of the body have well-defined lymphatic vessels that carry extracellular fluid, antigen presenting cells, lymphocytes, neoplastic cells and even bacteria to regional lymph nodes. The brain has no such conventional lymphatics, but has perivascular pathways that drain interstitial fluid (ISF) from brain parenchyma and cerebrospinal fluid (CSF) from the subarachnoid space to cervical lymph nodes. ISF and solutes drain along narrow, ∼100 nm-thick basement membranes within the walls of cerebral capillaries and arteries to cervical lymph nodes; this pathway does not allow traffic of lymphocytes or antigen presenting cells from brain to lymph nodes. Although CSF drains into blood through arachnoid villi, CSF also drains from the subarachnoid space through channels in the cribriform plate of the ethmoid bone into nasal lymphatics and thence to cervical lymph nodes. This pathway does allow the traffic of lymphocytes and antigen presenting cells from CSF to cervical lymph nodes. Efferent pathways by which lymphocytes enter the brain are regulated by selected integrins on lymphocytes and selective receptors on vascular endothelial cells. Here we review: (1) the structure and function of afferent lymphatic drainage of ISF and CSF, (2) mechanisms involved in the efferent pathways by which lymphocytes enter the brain and (3) the failure of lymphatic drainage of the brain parenchyma with age and the role of such failure in the pathogenesis of Alzheimer's disease.

Artificial lymphatic drainage systems for vascularized microfluidic scaffolds

The formation of a stably perfused microvasculature continues to be a major challenge in tissue engineering. Previous work has suggested the importance of a sufficiently large transmural pressure in maintaining vascular stability and perfusion. Here we show that a system of empty channels that provides a drainage function analogous to that of lymphatic microvasculature in vivo can stabilize vascular adhesion and maintain perfusion rate in dense, hydraulically resistive fibrin scaffolds in vitro. In the absence of drainage, endothelial delamination increased as scaffold density increased from 6 to 30 mg/mL and scaffold hydraulic conductivity decreased by a factor of 20. Single drainage channels exerted only localized vascular stabilization, the extent of which depended on the distance between vessel and drainage as well as scaffold density. Computational modeling of these experiments yielded an estimate of 0.40-1.36 cm H2O for the minimum transmural pressure required for vascular stability. We further designed and constructed fibrin patches (0.8 × 0.9 cm(2)) that were perfused by a parallel array of vessels and drained by an orthogonal array of drainage channels; only with the drainage did the vessels display long-term stability and perfusion. This work underscores the importance of drainage in vascularization, especially when a dense, hydraulically resistive scaffold is used.

Pathology of the Fetal Neck

ABSTRACT Fetal neck is the site of important pathological changes, related to genetic, cardiovascular, lymphatic, endocrine systems. Among the main neck pathology are fetal hygroma, goiter, teratoma/sarcoma, hemangioma/lymphangioma. Posterior anomalies of the fetal neural tube, such as occipital myelomeningocele or iniencephaly may also be included in this area. Fetal hygroma is the main pathology, probably related to abnormal development of the lymphatic drainage system. There is a large spectrum of the disease, from enlarged nuchal translucency to generalized edema. Enlarged nuchal translucency is often associated with aneuploidy, particularly trisomy 21 and Turner syndrome (monosomy X). However, the pathophysiology is different for the two aneuploidies. On the diagnostic side, cystic hygromas consist of large single or multilocular fluid-filled cavities, which are usually easily identified during first trimester ultrasound examination. About one-third of euploid fetuses with first trimester septated cystic hygromas have major structural anomalies. In contrast, structural anomalies are detected in only 4 to 10% of euploid fetuses with enlarged nuchal translucency. Enlargement of fetal thyroid gland is accompanied by increased or decreased level of thyroid hormones (hyper or hypothyroidism), but the thyroid function may also be normal. The physiopathology of fetal and neonatal goiter is complex. Causes of fetal goiter include inborn errors of thyroid hormone production, transplacental passage of maternal antibodies, maternal ingestion of antithyroid drugs and other goitrogens, thyroid tumors. Detection of the fetal goiter is facilitated by the associated maternal history, present in most of the cases. By definition, goiter means enlargement of the thyroid gland above the 95th centile of the normal range. Reliable and objective data about fetal thyroid function involves an invasive testing. Teratomas are large mixed tumors arising from the neck region. Teratomas are cystic, semicystic or solid tumors. They develop from all three germ cell layers. Cervical teratomas are detected antenatally in most cases, as they are large size tumors. Hemangiomas and lymphangiomas are tumors derived from the endothelial tissue of blood vessels or lymphatic vessels. They may develop anywhere in the body, but in the antenatal life and the first years they show a predisposition for the head, neck and axillar area. Regarding the occipital encephalocele and iniencephaly, even though they represent major anomalies that affect he cervical and cephalic area, from a developmental point of view they are part of the neural tube defects spectrum and should be considered as such especially from a prognosis point of view. How to cite this article Vladareanu R, Zvanca M, Andrei C. Pathology of the Fetal Neck. Donald School J Ultrasound Obstet Gynecol 2012;6(1):55-65.

Detecting of breast cancer metastasis by means of regional lymph node sampling during autologous breast reconstruction – a screening of 519 consecutive patients

SummaryBackgroundThe internal mammary artery and vein is often used as a site of anastomoses in microvascular breast reconstruction. This area supports lymphatic drainage of the breast and its role in breast cancer metastasis remains unclear. We hypothesize that sampling of internal mammary lymph nodes at the time of microvascular anastomoses preparation may identify persistent or recurrent local disease and mandate the need for additional treatment in this area.Material/MethodsA retrospective chart review from 519 patients in the time between January 2006 and September 2009 was performed on all patients who underwent internal mammary lymph node sampling at the time of microvascular breast reconstruction.ResultsMicrovascular breast reconstruction was performed in 519 patients. Enlarged internal mammary lymph nodes were found and harvested in 195 patients for histological review. Six of 195 (3.08%) were found positive for metastatic disease requiring additional oncologic treatment.ConclusionsThe internal mammary lymphatic drainage system is an important and often underappreciated pathway for breast metastasis. Routine sampling of these lymph nodes at the time of microvascular breast reconstruction is easy to perform and is a useful tool to identify women, who might require additional treatment and increase cancer-free survival.

P3-07-41: Sentinel Lymph Node Biopsy Is a Reliable Method for Lymph Node Evaluation in Neoadjuvant Chemotherapy Treated Breast Cancer Patients.

Abstract Background: Successful sentinel lymph node mapping in breast cancer patients treated with neoadjuvant chemotherapy has been debated by practicing surgeons due to the potential compromise of the lymphatic drainage system after treatment. Furthermore, whether clinicopathologic variables associated with sentinel lymph node positivity in breast cancer patients differ from similar patients who have been treated with neoadjuvant chemotherapy has not been well-studied. Materials and Methods: Breast cancer patients who received neoadjuvant chemotherapy were identified in our files. A similar number of breast cancer patients who did not receive such therapy was also selected as a comparison group. Clinicopathologic parameters such as age, type of surgical procedure, number of sentinel lymph nodes removed and/or positive, number of non-sentinel lymph nodes removed and/or positive, tumor size, histologic type/grade, presence of lymphovascular invasion, biomarker expression (ER,PR, HER-2/neu) and multifocality were recorded for each patient in both cohorts. Statistical analysis was performed for each cohort to identify variable(s) that correlated with sentinel lymph node positivity. Additional analysis was performed by computing the odds ratio of sentinel lymph node positivity after adjusting for selected variables. Results: Ninety-seven and ninety-three patients who were and were not treated with neoadjuvant chemotherapy, respectively, were identified. In all patients, successful sentinel lymph node mapping was achieved. When these cohorts were separately analyzed, tumor size, lymphovascular invasion, and non-sentinel lymph node positivity were associated with sentinel lymph node positivity in the cohort that did not receive neoadjuvant chemotherapy. In the cohort that received therapy, lymphovascular invasion and non-sentinel lymph node positivity were associated with sentinel lymph node positivity. In addition, after adjusting for tumor size, lymphovascular invasion and histologic grade, patients treated with neoadjuvant chemotherapy were more likely to have sentinel lymph node positivity than those who did not have this treatment (odds ratio: 5.4, 95% CI 2.4, 12.1). Conclusions: Successful sentinel lymph node mapping was achieved in all ninety-seven breast cancer patients studied. Regardless of whether neoadjuvant chemotherapy was administered, the presence of lymphovascular invasion and non-sentinel lymph node positivity were found to predict sentinel lymph node positivity. By comparing two cohorts of breast cancer patients differing only in the use of neoadjuvant chemotherapy and adjusting for select variables, those in the treated cohort still remained more likely to have a positive sentinel lymph node. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-07-41.

Safety study of axillary reverse mapping in the surgical treatment for breast cancer patients

With the purpose of minimizing arm lymphedema after axillary staging surgeries in breast cancer patients, the axillary reverse mapping (ARM) technique has been developed to identify and preserve arm drainage system during axillary surgery. This study aimed to clarify risk factors for metastasis in arm lymphatic drainage system in breast cancer patients with clinically negative axillary nodes. Sixty-nine patients who underwent successful both sentinel lymph node (SLN) biopsy (SLNB) and ARM from October 2009 to August 2010 were enrolled in this study. Radioactive tracer was used for SLN localization and blue dye was used for ARM. All of the identified SLNs and ARM nodes were sent for pathological assessment. ARM nodes metastasis occured in 6 of 69 patients. Age, pathological tumor size (pT) and pathological lymph node status (pN) were not associated with ARM nodes metastasis (P>0.01). Interestingly, in these 6 patients, all metastatic ARM nodes coincided with SLN-ARM nodes (hot SLN and blue ARM node were the same lymph node). In 50 of 69 patients whose ARM nodes did not coincided with SLNs, all ARM nodes were negative, even in 12 patients with metastatic SLNs. Crossover between breast and ipsilateral arm lymphatic drainage system contributes for ipsilateral arm lymph node metastasis. When ARM and SLNB are simultaneously performed in a patient, selectively preservation of the ARM nodes that do not coincided with SLNs would be safe, even if the SLNs are positive. Pathological lymph node status does not account for the occurrence of metastasis in ARM nodes. ARM nodes could be preserved safely, independent of the pathological lymph node status.

Manifestation of lymphoma expansion following lymphatic drainage on 18F-FDG PET/CT

18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) imaging is strongly recommended in patients with diffuse large B-cell lymphomas (DLBCL), which are routinely highly FDG avid, for adequate disease staging [1]. The mean standardized uptake value (SUV) can be used to distinguish aggressive from indolent lymphoma variants [2]. PET scanning is a reliable method for the diagnosis of DLBCL compared with the reference method immunohistology [3]. We present a case of a 70-year-old female patient who presented to the hospital with progressive swelling, pain and loss of sensibility in her right lower limb. Nine months earlier she had been diagnosed with DLBLC, localized in the lungs, mediastinum and mesenterium for which she was treated with rituximab plus cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP) chemotherapy. 18F-FDG PET/CT scanning was performed for restaging of lymphoma disease in this patient. 18F-FDG PET/CT showed an extensive lesion in the right lower limb, with extremely high avidity for FDG, corresponding with tumour mass in muscular tissue on the low-dose CT (figure). It was spreading upwards, following the lymphatic drainage system and surrounding vessels, up to the right groin region. The SUVmean of this large lesion was 16.4 (calculation conforming to the EANM procedure guidelines for tumour PET imaging [4]). Further on, a lesion was detected dorsally in the right lung. Biopsy of the swelling in the right lower limb revealed aggressive DLBCL recurrence. This aggressive form was already expected due to the high SUVmean value. This scan shows how aggressive DLBCL can appear as a fast growing lymphoma with an atypical configuration by following the lymphatic drainage.

Pattern of lymph node metastases of esophageal squamous cell carcinoma based on the anatomical lymphatic drainage system

The recent anatomical studies of the esophagus showed that submucosal longitudinal lymphatic vessels connect to the superior mediastinal and the paracardial lymphatics and lymphatic routes to periesophageal nodes originate from the muscle layer. Using clinical data for lymph node metastasis, we verify these anatomical bases to clarify the rational areas of lymph node dissection in esophageal cancer surgery. Analysis was performed on 356 consecutive patients who underwent esophagectomy with three-field dissection. Patients were divided into those with tumor limited within the submucosal layer and those with tumor invading or penetrating the muscle layer. Frequency of node metastasis was compared according to supraclavicular, upper mediastinum, mid-mediastinum, lower mediastinum, perigastric and celiac areas. In patients with tumor limited to the submucosal layer, node metastasis was more frequent in the upper mediastinum and perigastric area than the mid- or lower mediastinum. Even in patients with tumor located in the lower esophagus, node metastasis was more frequent in the upper mediastinum than the mid-mediastinum or lower mediastinum. In patients with tumor located in the mid-esophagus, node metastasis was more frequent in the supraclavicular area than the mid-mediastinum or lower mediastinum. In patients with tumor invading or penetrating the muscle layer, node metastasis in the mid- and lower mediastinum increased dramatically, but was still less frequent than those in the upper mediastinum or the perigastric area. Postoperative survival curves did not differ among the involved areas. The most predictive factor associated with lymph node metastasis for postoperative survival was not the area of involved nodes, but the number of involved nodes by multivariate analyses. These clinical results verify recent anatomical observations. The lack of difference in survival rates among the involved areas suggests that these areas should be staged equivalently. For adequate nodal staging, the upper mediastinum should be dissected for the lower esophageal tumor and supraclavicular areas should be dissected for the mid-esophageal tumor even in patients with tumor limited to within the submucosal layer.

Absence of lymphatic vessels in human dental pulp: a morphological study

Few and controversial data are available in the literature regarding the presence of lymphatic vessels in the human dental pulp. The present study was designed to examine morphologically the existence of a lymph drainage system in human dental pulp. Human dental pulp and skin sections were immunohistochemically stained with specific antibodies for lymphatic endothelium (D2-40, LYVE-1, VEGFR-3 [vascular endothelial growth factor receptor-3], and Prox-1), with the pan-endothelial markers CD31 and von Willebrand factor (vWF), and with the blood-specific marker CD34. Several blood vessels were identified in human pulps and skin. Lymphatic vessels were found in all human skin samples but in none of the pulps examined. Western blotting performed on human dermis and on pulps treated with collagenase (to remove odontoblasts) confirmed these results. Transmission electron microscopy indicated that vessels which, by light microscopy, appeared to be initial lymphatic vessels had no anchoring filaments or discontinuous basement membrane, both of which are typical ultrastructural characteristics of lymphatic vessels. These results suggest that under normal conditions human dental pulp does not contain true lymphatic vessels. The various theories about dental pulp interstitial fluid circulation should be revised accordingly.

Drainage developers

Researchers identify interacting engineers of the body's lymphatic drainage system.

Protein-losing enteropathy during highly active antiretroviral therapy in a patient with AIDS-related disseminated Mycobacterial avium complex infection

Protein-losing enteropathy (PLE) is defined as a condition in which excess protein loss into the gastrointestinal lumen, due to various causes, is severe enough to produce hypoproteinemia and hypoalbuminemia. We report a 28-year-old Japanese woman with PLE. She had been diagnosed with AIDS and disseminated Mycobacterium avium complex (MAC) infection at age 26. Although highly active antiretroviral and antimycobacterial treatments helped her overcome this critical situation, 2 years after initiation of the treatments, she was readmitted to our hospital because of hypoalbuminemia and edema of the lower extremities, and she was diagnosed, by the use of double-balloon enteroscopy, with PLE due to intestinal lymphangiectasia (IL). The etiology was thought to be obstruction of the mesenteric and retroperitoneal lymphatic drainage systems by MAC lymphadenitis. Even with intensive antimycobacterial treatment, octreotide treatment as a long-acting somatostatin analogue, and a low-fat diet enriched with medium-chain triglyceride, IL was not cured during the follow-up period. In patients with AIDS, complete clinical remission of MAC (especially disseminated MAC) infection is very difficult.

Bedeutung der nuklearmedizinischen Bildgebung für die Lymphknotenchirurgie

Nuclear medicine imaging techniques allow the noninvasive in vivo visualization of cellular and subcellular molecular processes. In the context of lymph node surgery and patient management in uro-oncology, two molecular nuclear imaging techniques deserve special interest: positron emission tomography (PET) for staging, restaging, and follow-up, and preoperative identification and subsequent biopsy of the sentinel lymph node (the first lymph node in the lymphatic drainage system of the tumor). Both methods and their clinical potential are described in this review. Future trends in molecular imaging in uro-oncology are also discussed.