Lymphoscintigraphy In Patients Research Articles

The value of the dermal rim sign on nonenhanced magnetic resonance imaging for predicting dermal backflow in patients with primary lower extremity lymphedema

PurposeThe dermal rim sign (DRS) on nonenhanced magnetic resonance imaging has been shown to predict dermal backflow (DBF) in patients with secondary upper limb lymphedema. However, whether the DRS has the same effects on primary lower extremity lymphedema (PLEL) has not been clearly reported. Therefore, this study aimed to explore whether the DRS can be used to diagnose DBF on lymphoscintigraphy in patients with PLEL. MethodsA total of 94 patients who were diagnosed with PLEL were recruited for this retrospective study from January 2022 to December 2023. All the patients were divided into two groups according to the lymphoscintigraphy findings: no DBF and DBF. The magnetic resonance imaging data of the two groups were recorded and statistically compared for the following indicators: range of lymphedema involvement (left, right, whole lower limbs, only thigh, only calf and ankle), signs of lymphedema (notable thickening of skin, parallel line sign, grid sign, honeycomb sign, band sign, lymph lake sign, crescent sign, DRS), and lymphedema measurement (skin thickness, band width). The DRS is characterized by notable thickening of the skin plus the grid sign and/or honeycomb sign, plus the band sign. ResultsThe following statistically significant differences in the following indicators were found between the two groups (P < .05): notable skin thickening, parallel line sign, grid sign, honeycomb sign, band sign, DRS, skin thickness, and band width. The sensitivity, specificity, and accuracy for predicting for DBF with the DRS was 82%, 64%, and 77%, respectively. ConclusionsThis study confirmed good consistency between the DRS and DBF from the perspective of imaging. This tool is suitable for children, adolescents, and patients with contraindications to lymphoscintigraphy. The DRS has important value in assessing the severity of PLEL. The DRS is suggested for the clinical use of combined surgical treatment of PLEL.

Lymphoscintigraphy in patients with breast cancer-related lymphedema after sentinel lymph node dissection and axillary radiation therapy

The purpose of this study was to investigate lymphoscintigraphy pattern according to the presence or absence of axillary site radiation therapy (aRTx) in breast cancer-related lymphedema (BCRL) patients who underwent sentinel lymph node dissection (SLND). The participants were patients who visited our facility from July 2014 to June 2021 due to upper extremity edema. Among them, patients who underwent SLND after the diagnosis of breast cancer were included. The participants were divided into a group without aRTx (group A) and a group with aRTx (group B). In each patient's lymphoscintigraphy, axillary lymph node uptake (ALNU), lymphatic flow delay, dermal back flow, and the presence of any collateral pathway were checked. Thirty-three patients were enrolled. In all, 27 patients were classified in Group A, and 6 patients were classified in Group B. Between the 2 groups, we found a significant difference (P value < .05) between groups at ALNU and lymphatic flow delay. However, there was no significant difference between groups at the dermal backflow and the presence of a collateral pathway (P value > .05). And 24.2% of patients who developed lymphedema after SLND showed normal lymphoscintigraphy. In this study we suggest that SLND and aRTx affects the activity of the axillary lymph node and ultimately adversely affects lymphatic flow, becoming a risk factor for lymphedema. In addition, regardless of SLND or aRTx, lymphedema may eventually occur in the patient with normal lymphoscintigraphy.

Use of non-contrast MR in diagnosing secondary lymphedema of the upper extremities

PurposeThe purpose of the study is to determine if a combination of dermal thickening and subcutaneous fluid honeycombing on non-contrast MRI, termed the dermal rim sign (DRS), can be diagnostically analogous to dermal backflow seen on lymphoscintigraphy in patients with secondary upper extremity lymphedema. Materials and methodsUpper extremity MRI and lymphoscintigraphy were performed on patients referred to a multidisciplinary lymphedema clinic for suspicion of secondary lymphedema. Sensitivity, specificity, and positive and negative predictive values of DRS on MRI in detecting dermal backflow on lymphoscintigraphy and the correlation between DRS, Indocyanine Green (ICG) lymphography, bioimpedence L-Dex® ratio and MRI Lymphedema Staging were calculated. Weighted interobserver agreements on the presence and location of DRS on MRI were calculated. ResultsOf the 45 patients in the study, 91.1% (41/45) of patients had history of breast cancer. The average age was 58.4 ± 10.5 years, with a mean symptom duration of 4.7 ± 4.4 years. The mean BMI was 30.5 ± 7.0 kg/m2. Interobserver agreement on the presence and the extent of DRS on MRI was 0.93 [95% confidence-interval: 0.80–1]. DRS was present in 97% (32/33) of patients who demonstrated dermal backflow on lymphoscintigraphy. Sensitivity, specificity, PPV, and NPV of DRS were 96.6% [81.7%–99.9%], and 75.0% [47.6%–92.7%], 87.5% [74.9%–94.3%], and 92.3% [63.1%–98.8%]. DRS was associated with severity on ICG lymphography and bioimpedance (both p < 0.001). ConclusionsDRS on non-contrast MRI is highly predictive of dermal backflow and correlates with clinical measures of lymphedema severity. DRS may be used as an independent diagnostic biomarker to identify patients who would benefit from dedicated exams.

Determination of Cervical Metastases by Lymphoscintigraphy in Patients with Oral Cancer: A Single Institute Experience

Background: Oral cancer is the sixth most common cancer in the world. Cervical metastasis is an important adverse prognostic factor and about 40% of the patients with oral cancer develop lymphatic metastasis. Lymphoscintigraphy is the minimally invasive method for the detection of cervical nodal metastasis. The aim of the study was to detect the lymphatic involvement with the aid of lymphoscnitigraphy in patient with oral cancer undergoing surgical procedure and to find out the accuracy of the findings with the post operative histopathological diagnosis.&#x0D; Patients and methods: A total of 30 patients with histologically proven oral cancer underwent lymphoscintigraphic evaluation to detect the lymphatic spread of the tumor. The findings and results of lymphoscintigraphy were compared with the postoperative histopathological diagnosis.&#x0D; Results: Among the 30 patients, lymphatic obstruction was observed in 19 patients of whom 15 patients had perfusion defect and 4 patients had gap defect. No lymphatic obstruction was evident in the rest 11 patients by lymphoscintigraphy. The calculated sensitivity of lymphoscintigraphy in diagnosis of cervical lymph node metastasis was 100%, specificity 78.6%, accuracy 90% and positive predictive value was 84.2% and negative predictive value was 100%.&#x0D; Conclusion: Lymphoscintigraphy was found to be an effective method in detecting lymph node involvement and can be used as an alternative to identify regional lymph nodes metastases pre-operatively in oral cancer patients. Thereby, it will help the surgeon to plan the extent of dissection before surgery which may decrease postoperative complications related to unnecessary extensive lymph node dissection and morbidity.&#x0D; Bangladesh J. Nuclear Med. 21(1): 12-15, January 2018

Procedural Recommendations for Lymphoscintigraphy in the Diagnosis of Peripheral Lymphedema: the Genoa Protocol.

Lymphoscintigraphy is the gold standard for imaging in the diagnosis of peripheral lymphedema. However, there are no clear guidelines to standardize usage across centers, and as such, large variability exists. The aim of this perspectives paper is to draw upon the knowledge and extensive experience of lymphoscintigraphy here in Genoa, Italy, from our center of excellence in the assessment and treatment of lymphatic disorders for over 30years to provide general guidelines for nuclear medicine specialists. The authors describe the technical characteristics of lymphoscintigraphy in patients with limb swelling. Radioactive tracers, dosage, administration sites, and the rationale for a two-compartment protocol with the inclusion of subfascial lymphatic vessels are all given in detail. Examples of lymphoscintigraphic investigations with various subgroups of patients are discussed. The concept of a transport index (TI) for semi-quantitative analysis of normal/pathological lymphatic flow is introduced. Different concepts of injection techniques are outlined. It is past time that lymphoscintigraphy in the diagnosis of lymphatic disorders becomes standardized. This represents our first attempt to outline a clear protocol and delineate the relevant points for lymphoscintigraphy in this patient population.

Predictive value of lymphoscintigraphy in patients with breast cancer-related lymphedema undergoing complex decongestive therapy.

We evaluated the prognostic value of lymphoscintigraphy after complex decongestive therapy (CDT) in breast cancer-related secondary lymphedema. Prior to CDT, 80 patients with breast cancer-related lymphedema underwent a 99mTc tin-colloid lymphoscintigram. We investigated the uptake patterns of axillary lymph nodes (LNs), main lymphatic vessels, collateral lymphatic vessels, and dermal back flow in the lymphoscintigraphy of the upper extremities. We also compared the above findings with other clinical variables between patients who respond well to CDT (responders) and those who do not (poor responders). We used Pearson's χ2 test and Fisher's exact test to compare the lymphoscintigram findings with the studied variables. There were 50 poor responders and 30 responders 1year after CDT. There were significant differences between the two groups with regard to compliance (P < 0.05) and visualization of axillary LNs (P < 0.05). In combined results, the odds ratio was 21.33 (2.37-192.03) in the compliance and visible axillary LNs group compared to the poor compliance and invisible axillary LNs group. Lymphoscintigraphy of the upper extremities can be a useful tool to predict the prognosis of CDT in breast cancer-related lymphedema patients.

Dual-phase F-18 FDG PET–CT in staging and lymphoscintigraphy for detection of sentinel lymph nodes in oral cavity cancers

AimOur objective was to evaluate the diagnostic role of dual-phase fluor-18 fluorodeoxyglucose (F-18 FDG) positron emission tomography–computed tomography (PET–CT) and planar lymphoscintigraphy in patients with oral cavity cancer (OCC). We also investigated the combined impact of F-18 FDG PET–CT and sentinel lymph node biopsy (SLNB) in decision making for patients with OCC. MethodsSixteen patients (4 female, 12 male; age range, 29–81 years) were included in this prospective study. F-18 FDG PET–CT [1 (early) and 2 h (delayed) after injection] and planar lymphoscintigraphy (2h before the surgery) were performed for all the patients before surgery. The sensitivity, specificity, and negative and positive predictive values in F-18 FDG PET–CT for the early and the delayed scans and tumor/liver uptake (T/L) in the lymph nodes were calculated. Receiver operating characteristic curves were obtained for standardized uptake value (SUV)max and T/L. ResultsHistopathological evaluations revealed that 5 patients had metastatic lymph nodes (pN+) whereas 11 patients had benign lymph nodes (pN−). Out of 43 lymph nodes visualized as cN(+) in F-18 FDG PET–CT, 14 were pathologically positive for malignancy, whereas 29 were pathologically benign. There was no statistical difference between the N(+) and N(−) patients in terms of age, depth of primary tumor, and the number of mitoses. However, there was a significant difference between the N(+) and N(−) patients (P=.011) in terms of early and delayed F-18 FDG uptake of primary tumors. There was a statistically significant difference in the value of SUVmax between the early and the delayed scans for the malignant lymph nodes (P=.00). ConclusionThis study indicates that F-18 FDG PET–CT is a reliable method for the correct evaluation of primary tumor and N staging in OCCs. Delayed phase of F-18 FDG imaging may increase primary lesion detectability due to higher FDG uptake in primary tumors compared to the early phase of imaging. F-18 FDG PET–CT might demonstrate skip metastasis in lymph nodes which can be missed with SLNB. Although SUV values increased in the delayed phase of F-18 PET–CT imaging in detecting lymph node metastases, the specificity and positive predictive value did not increase.

Primary lymphedema of the lower limb: the clinical utility of single photon emission computed tomography/CT.

ObjectiveThe aim of this prospective study was to determine whether the additional use of the single photon emission computed tomography/CT (SPECT/CT) technique improves the diagnostic value of planar lymphoscintigraphy in patients presenting with primary lymph edema of the lower limb.Materials and MethodsFor a defined period of three years (April 2011-April 2014) a total of 34 consecutive patients (28 females; age range, 27-83 years) presenting with swelling of the leg(s) suspicious of (uni- or bilateral, proximal or distal) primary lymphedema were prospectively examined by planar lymphoscintigraphy (lower limbs, n = 67) and the tomographic SPECT/CT technique (anatomical sides, n = 65).ResultsIn comparison to pathological planar scintigraphic findings, the addition of SPECT/CT provided relevant additional information regarding the presence of dermal backflow (86%), the anatomical extent of lymphatic disorders (64%), the presence or absence of lymph nodes (46%), and the visualization of lymph vessels (4%).ConclusionAs an adjunct to planar lymphoscintigraphy, SPECT/CT specifies the anatomical correlation of lymphatic disorders and thus improves assessment of the extent of pathology due to the particular advantages of tomographic separation of overlapping sources. The interpretation of scintigraphic data benefits not only in baseline diagnosis, but also in physiotherapeutical and microsurgical treatments of primary lymphedema.

Utility of single photon emission computed tomography–computed tomography in selective sentinel lymph node biopsy in patients with melanoma

ObjectiveTo assess the contribution of SPECT–CT lymphoscintigraphy in selective sentinel lymph node biopsy (SLNB) in patients with newly diagnosed malignant melanoma. Material and methodsA prospective study was made between July 2009 and October 2010. It included 63 patients diagnosed with melanoma (32 men and 31 women) with mean age of 55 years (range: 25–88) and inclusion criteria for SLNB. The melanomas were located as follows: 28 in trunk, 5 in head and neck, 16 in upper limbs and 17 in lower limbs. Three patients had two melanomas. Preoperative lymphoscintigraphy was performed after pericicatricial/perilesional injection of 74MBq of 99mTc-labeled nanocolloid human serum albumin, obtaining early planar images, late whole body study and sectorial images and SPECT–CT in the area of interest. Planar scintigraphy findings were compared with SPECT–CT. ResultsThe sentinel node (SN) was localized by planar imaging in 62/63 (98%) patients. SPECT–CT study located the SN in all the patients with a detection rate of 100%. The number of SNs detected with SPECT–CT was higher than that with the planar study in 27 patients. The SPECT–CT provided additional information (change in location and/or in its accuracy in the localization of location uncertain SN) in 14/63 (22.2%) patients, involving changes in the surgical approach and lymph node staging. ConclusionSPECT–CT detects a higher number of SN than planar lymphoscintigraphy in patients with melanoma. Its contribution is more relevant in the melanomas located on the trunk, head and neck. SPECT–CT modified the SN location by 22% compared to planar scan findings, facilitating a correct surgical approach.

Prognostic value of lymphoscintigraphy in patients with gynecological cancer‐related lymphedema

We investigated the prognostic value of qualitative lymphoscintigraphy in gynecological cancer-related lymphedema, which is a common complication after treatment. All 152 patients underwent (99m) Tc tin-colloid lymphoscintigraphy before complex decongestive therapy (CDT). We analyzed the uptake patterns of the inguinal lymph nodes, main lymphatic vessel and collateral lymphatic vessels, as well as dermal back flow. We compared these lymphoscintigraphic findings and other clinical variables between good and poor therapeutic responders using Pearson's Chi-squared test, Fisher's exact test and multiple logistic regression analysis. Eighty-nine patients (58.6%) had a poor therapeutic response to CDT. In univariate analysis, there were significant differences between good and poor responders in clinical stage (P < 0.001), therapy compliance (P < 0.001), main lymphatic vessel uptake pattern (P < 0.01), collateral lymphatic vessel uptake pattern (P < 0.01) and severity of dermal back flow (P < 0.001). After multivariate analysis, only severity of dermal back flow (P < 0.005), clinical stage (P < 0.05) and therapy compliance (P < 0.001) were found to be independent predictors of therapeutic response. Lymphoscintigraphy may be useful to predict the outcome of patients with gynecological cancer-related lymphedema undergoing CDT along with clinical stage and compliance.

Sentinel lymph node biopsy in penile cancer: a comparative study using modified inguinal dissection

In the case of clinically negative inguinal regions in penile cancer, the treatments proposed might vary from careful observation to radical dissection for all patients. We evaluated the effectiveness of the sentinel lymph node biopsy using lymphoscintigraphy in patients with penile cancer and at least one negative inguinal region. In 18 patients, biopsy of the sentinel lymph node from the 32 negative inguinal regions and modified radical lymphadenectomy in these regions regardless of the biopsy results was performed. Clinical staging, pathological results of the sentinel and the other lymph nodes removed during lymphadenectomy, tumor behavior, local and inguinal recurrence and specific disease mortality were accessed. The mean age of the study sample was 57.7 years (44 - 81 years) and the sentinel lymph node presented 0% false negative 66% sensitivity, and 79.3% specificity when compared with the modified inguinal lymphadenectomy as the gold standard treatment. Sentinel lymph node biopsy is a feasible method of assessing the presence of regional metastasis in patients with penile cancer and clinically negative inguinal regions. However, the optimal lymphoscintigraphy technique is still in evolution and requires further optimization at high volume centers.

Injection Techniques For Breast Lymphoscintigraphy: A Review

This review is a retrospective Meta analysis of 3133 patients evaluating injection techniques for breast lymphoscintigraphy in patients with early stage breast cancer. The optimal protocol for breast lymphoscintigraphy in early breast cancer patients was shown to employ areolar injection methods of radiocolloid over both blue dye and combined radiocolloid/blue dye techniques.

The Reproducibility in Routine Clinical Practice of Sentinel Lymph Node Identification by Pre-operative Lymphoscintigraphy in Patients with Cutaneous Melanoma

Pre-operative lymphoscintigraphy (LS) is an important part of successful sentinel lymph node (SLN) biopsy in most melanoma treatment centers. The test accurately maps lymphatic drainage from cutaneous melanoma sites and has been shown to be reproducible in prospective studies. Its reproducibility has not been tested, however, in routine clinical practice. Occasionally, after LS has been performed to map the location of SLNs, the patient is unable to proceed to SLN biopsy surgery within the time limit imposed by the radioactive decay of the 99mTc label attached to the colloid particles. In this situation, the surgery is rescheduled and LS repeated to relabel the SLNs so that they may be accurately biopsied. This has happened on 21 occasions at the Sydney Melanoma Unit and we have performed a retrospective analysis of the reproducibility of the LS results. In 19 patients, the same SLNs were shown in the same locations on the two studies. Two patients had discrepant results. One showed two extra interval nodes on the back as well as concordant flow to SLNs in each axilla. The other with a leg melanoma showed the same groin SLNs but failed to relabel the two popliteal SLNs on the second study. SLN locations were identical during 95%, and SLNs were identical 94% of the time. These results indicate that in routine clinical practice LS is a highly reproducible procedure to locate and radiolabel the SLNs prior to biopsy in patients with melanoma.

Usefulness of preoperative lymphoscintigraphy in patients who undergo radical hysterectomy and pelvic lymphadenectomy for cervical cancer

The purpose of this study was to assess the value of preoperative lymphoscintigraphy before intraoperative lymphatic mapping for sentinel lymph node identification during radical hysterectomy. Fifty patients underwent intraoperative lymphatic mapping on our institutional review board-approved protocol. The location of sentinel lymph nodes that were found on lymphoscintigraphy and intraoperative lymphatic mapping were compared. Fifteen of 21 patients (71%) with solitary sentinel lymph nodes that were found on lymphoscintigraphy had multiple sentinel lymph node basins found during the operation. Thirteen of 25 patients (52%) with unilateral sentinel lymph node basins that were found on lymphoscintigraphy had bilateral sentinel lymph nodes at intraoperative lymphatic mapping. Of 15 patients with 2 sentinel lymph node locations that were identified on lymphoscintigraphy, 12 patients (80%) had > or = 3 found during the operation. Of the sentinel lymph nodes that were located on the external iliac basin (n = 47) on lymphoscintigraphy, only 20 lymph nodes (43%) were found at that location during the operation. Concordance between the 2 methods was poor. Seven of the 9 patients with lymph node metastases had disease that was limited to the sentinel lymph nodes. Preoperative lymphoscintigraphy adds little value over intraoperative lymphatic mapping for sentinel lymph node identification during radical hysterectomy.

Sentinel lymphoscintigraphy in patients with breast cancer undergoing excisional biopsy

Some small tumors of the breast cannot be diagnosed by needle biopsy, and an excisional biopsy is occasionally needed for the diagnosis. Sentinel node navigation surgery is frequently suitable for patients with such small breast cancers. The purpose of this study was to compare sentinel lymphoscintigrams in breast cancer patients who had previously undergone excisional biopsy with sentinel lymphoscintigrams in patients undergoing no excisional biopsy. We also investigated the possibility of clinical application of the sentinel node navigation procedure in the former group of patients. Sentinel lymphoscintigrams of 43 patients with breast cancer undergoing excisional biopsy were compared to those of 116 patients without excisional biopsy. Lymphoscintigrams were obtained by using intradermal and/or subdermal injections of technetium-99m labeled phytate at 2 points on each side of the dermal incision in patients after excisional biopsy. Injections were performed at 2 points of the skin over the tumor in the patients who had not undergone excisional biopsy. Axillary lymph nodes were visualized in 42 of 43 patients undergoing excisional biopsy (98%) and in 115 of 116 patients without excisional biopsy (99%). The number of visualized axillary nodes was 1 to 5 (mean +/- SD = 2.1 +/- 1.0) and 1 to 5 (mean +/- SD = 1.9 +/- 1.0) in the two groups, respectively. No significant difference was determined between the two groups. Parasternal lymph nodes were depicted in 3 patients after excisional biopsy who had the tumor in the outer half of the breast, in contrast to 4 without excisional biopsy who had the tumor in the inner half. Intramammary hot spots were observed in 5 patients after excisional biopsy and in 2 without excisional biopsy. Lymphatic vessels were observed in 23 patients (53%) who had the excisional biopsy, and in 37 (32%) who did not have the biopsy. The former figure was significantly higher than the latter (p < 0.02). Sentinel node navigation surgery for axillary nodes was shown to be possible in patients undergoing excisional biopsy. However, the visualization of parasternal nodes, intramammary hot spots and lymphatic vessels tended to increase in number, and care must be exercised in the management of these patients.

REPRODUCIBILITY OF LYMPHOSCINTIGRAPHY FOR LYMPHATIC MAPPING IN PATIENTS WITH PENILE CARCINOMA

We evaluated the reproducibility of lymphoscintigraphy in the assessment of the location and number of sentinel nodes in patients with penile carcinoma. A total of 20 patients were prospectively included in analysis. Lymphoscintigraphy was performed after intradermal injection of technetium nanocolloid around the tumor or excision scar. We performed 10-minute anterior dynamic imaging, and static anterior and lateral images were obtained at 30 minutes and 2 hours. The following day scintigraphy was repeated after a second injection of the radiolabeled colloid given in an identical fashion, preceded by acquisition of a starting image. An observer evaluated the paired images and count rates were calculated from the images. At least 1 sentinel node was visualized in all patients on the first lymphoscintigram. A total of 56 sentinel nodes were seen in 38 basins. Drainage to both groins was seen in 18 patients. In 1 of these patients drainage to the prepubic area was also observed. There were 2 patients with drainage to 1 groin. The second lymphoscintigram revealed the same drainage pattern in all patients- the same number of nodal basins and number of sentinel nodes were visualized at identical locations. All hotspots that were visualized during the first lymphoscintigram showed an unequivocal increase in radioactivity after repeat injection. Thus, the reproducibility of penile lymphoscintigraphy was 100% (95% CI 85%-100%). The Pearson correlation coefficient of the paired count rates was 0.69 (p <0.0001). Results of lymphoscintigraphy in patients with penile carcinoma are highly reproducible for assessment of the number and location of sentinel nodes.

Laparoscopic sentinel node mapping in early-stage cervical cancer

Objective We aimed to determine the feasibility and accuracy of sentinel node (SN) mapping and its ability to predict the status of the regional nodal basin. Methods From October 2000 to September 2002, 70 patients undergoing radical surgery for early-stage cervical cancer (stage IA, IB, and IIA) were offered lymph node mapping for identification of the sentinel node. All patients underwent SN identification laparoscopically followed by a complete laparoscopic pelvic node and parametrial dissection. The SN mapping was done after intracervical blue dye injection in all cases and was combined with preoperative lymphoscintigraphy following intracervical Tc-99 injection and intraoperative SN detection with a miniaturized laparoscopic gamma probe in 29 cases (42%). Results The blue dye technique alone ( n = 70) identified at least 1 SN in 61 (87%) of the patients. The rate of SN detection by side of dissection was 74%, 70% on the left side and 77% on the right side. Bilateral SN were identified in 60% of cases. In the subgroup of patients who had the combined technique ( n = 29), the rate of SN detection increased from 79 to 93% ( P = 0.04). The bilateral SN detection rate increased from 55 to 72% when adding lymphoscintigraphy ( P = 0.03). In the last 15 cases of the series, the SN detection rate reached 93% (14/15) and this was statistically significant compared to the detection rate of the first 55 cases ( P < 0.01). A total of 135 SN were identified, with the majority (88%) being located at three main sites: the external iliac, obturator, and bifurcation. Thirty-six patients (51%) had 2 SN identified, and 16 (24%) had 3 SN or more. Twelve (17%) patients had positive lymph nodes. In those cases, the rate of SN detection per side of dissection in patients with normal appearing nodes at laparoscopy was 75%, whereas it was only 56% in patients with macroscopically involved lymph nodes ( P = NS). The false negative rate was 0. The negative predictive value of SN mapping was 100% and the sensitivity was 93% with the combined technique. Two patients had allergic reactions to the blue dye (3%). Conclusion Sentinel node mapping with the combined blue dye technique and lymphoscintigraphy in patients with cervical cancer is laparoscopically feasible and is highly accurate. The detection rate improves significantly with experience and with the use of lymphoscintigraphy.

Lymphoscintigraphy in patients with primary rectal cancer, by Peter Sterk et al.

Lymphoscintigraphy in patients with primary rectal cancer, by Peter Sterk et al.

Lymphoscintigraphy in patients with primary rectal cancer: the role of total mesorectal excision for primary rectal cancer--a lymphoscintigraphic study.

Total mesorectal excision based operations is the gold standard of care in patients with middle and lower rectal cancer, but the extent of resection varies widely. In our view, extended lymphadenectomy is unnecessary with precise total mesorectal excision, i.e., anatomically correct and sharp surgery. Sixteen patients with primary rectal cancer underwent rectal lymphoscintigraphy 1 day prior continence-preserving anterior resection with total mesorectal excision. The specimens were examined for integrity by postoperative angiography of the superior rectal artery in anteroposterior and lateral views. Twelve patients had only mesorectal lymph nodes, and four had additional extramesorectal iliac lymph nodes. The labeled lymph nodes were identified and removed perioperatively using a gamma probe. Activity was measured again in the preparations outside the situs. Histological examination showed tumor-free lymph nodes only. Lymph vessels can be divided anatomically into visceral and somatic, and detection of extramesorectal lymph nodes does not call for lateral lymphadenectomy. Primary rectal cancer confined to the organ metastasizes within the mesorectum and does not invade extraregional lymph nodes. The mesorectum is the major visceral route for caudocranial metastatic spread.

Accuracy of the intra-operative radioauided localization of the sentinel lymph node (SLN) 24 hours after lymphoscintigraphy in patients with malignant melanoma

For optimized logistics for the sentinel lymphadenectomy (SL) it might be helpful for the clinics involved if a longer time period between the lymphoscintigraphy (LS) and surgery is possible. Therefore, we investigated if a precise localization of the sentinel lymph node is possible 24 hours after LS. 78 patients with primary malignant melanoma (MM; n = 44) or with MM pre-operated by excisional biopsy (n = 34) were investigated. In 40 cases the tumor was localized on the trunk and in 38 cases on the extremities. Mean MM thickness was 2.68 mm (range: 0.29 to 12 mm). In all patients a lymphoscintigraphy (LS) with an average of 85 MBq of Tc-99m nanocolloid was performed one day prior to surgery. Immediately after tracer application dynamic data acquisition was started at a LFOV gamma camera followed by a whole body scan. With a hand-held gamma detector (C-Trak) 2, 4, 6, 8, and 24 hours after tracer administration the SLN was identified and the counts registered. 94 SLNs were identified in 87 lymphatic basins from which 86 could be resected. Nine MM showed two draining channels. After 24 hours 15.5% (as an average) of the initial counts could be measured in the SLN. The uptake in the SLN in pre-operated versus patients with primary tumor was statistically not significant (p = 0.4). In 16 cases (20.5%) the SLN was tumor positive. Four of those patients developed distant metastases and two died within the first year. None of the patients with negative SLN developed distant metastases or died. The remaining activity in the SLN up to 24 hours after administration is sufficient for their intra operative localization. The method of lymphoscintigraphy and localization of the SLN by a hand-held gamma detector optimizes the intra operative identification of the SLN in patients with malignant melanoma.