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1.
Contrast Media Mol Imaging ; 2024: 5453692, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38435483

RESUMO

Purpose: Ovarian cancer in the early stage requires a complete surgical staging, including radical lymphadenectomy, implying subsequent risk of morbidity and complications. Sentinel lymph node (SLN) mapping is a procedure that attempts to reduce radical lymphadenectomy-related complications and morbidities. Our study evaluates the feasibility of SLN mapping in patients with ovarian tumors by the use of intraoperative Technetium-99m-Phytate (Tc-99m-Phytate) and postoperative lymphoscintigraphy using tomographic (single-photon emission computed tomography/computed tomography (SPECT/CT)) acquisition. Materials and Methods: Thirty-two patients with ovarian mass participated in this study. Intraoperative injection of the radiopharmaceutical was performed just after laparotomy and before the removal of tumor in utero-ovarian and suspensory ligaments of the ovary just beneath the peritoneum. Subsequently, pelvic and para-aortic lymphadenectomy was performed for malignant masses, and the presence of tumor in the lymph nodes was assessed through histopathological examination. Conversely, lymphadenectomy was not performed in patients with benign lesions or borderline ovarian tumors. Lymphoscintigraphy was performed within 24 hr using tomographic acquisition (SPECT/CT) of the abdomen and pelvis. Results: Final pathological examination showed 19 patients with benign pathology, 5 with borderline tumors, and 6 with malignant ovarian tumors. SPECT/CT identified SLNs in para-aortic-only areas in 6 (20%), pelvic/para-aortic areas in 14 (47%), and pelvic-only areas in 7 (23%) cases. Notably, additional unusual SLN locations were revealed in perirenal, intergluteal, and posterior to psoas muscle regions in three patients. We were not able to calculate the false negative rate due to the absence of patients with involved lymph nodes. Conclusion: SLN mapping using intraoperative injection of radiotracers is safe and feasible. Larger studies with more malignant cases are needed to better evaluate the sensitivity of this method for lymphatic staging of ovarian malignancies.


Assuntos
Linfocintigrafia , Neoplasias Ovarianas , Feminino , Humanos , Neoplasias Ovarianas/diagnóstico por imagem , Neoplasias Ovarianas/cirurgia , Tomografia Computadorizada de Emissão de Fóton Único , Tomografia Computadorizada por Raios X
2.
Am J Case Rep ; 25: e942424, 2024 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-38268185

RESUMO

BACKGROUND For patients with cN0 breast cancer, sentinel node biopsy (SNB) is performed to confirm metastasis. When cancer recurs after a breast/axillary surgery, performing a second SNB is debatable in terms of its accuracy and significance. However, SNB is often performed because it is less invasive and can provide significant information. This report describes our experience of performing lymphoscintigraphy and single-photon emission computed tomography (SPECT)/CT to determine whether SNB is informative or not in patients who develop ipsilateral breast tumor recurrence (IBTR) following a breast/axillary surgery. CASE REPORT We included 9 patients with breast cancer and a history of ipsilateral breast/axillary surgery who underwent lymphoscintigraphy and SPECT/CT between April 2020 and July 2023. For lymphoscintigraphy, 20-25 MBq of 99mTc-phytate was injected subcutaneously in the areola, and planar images and SPECT/CT were taken at 15 min and 3 h after the injection. In lymphoscintigraphy, radioisotope accumulation was detected in 2 patients at 15 min and 8 patients at 3 h; it was not detected in 1 patient. The accumulation site was only the axilla in 3 patients; other sites including the axilla in 3, and sites outside the axilla in 2. CONCLUSIONS When a patient who previously underwent breast/axillary surgery develops IBTR, the initial surgery may have altered the lymphatic flow. The lymphatic flow varied between the contralateral or ipsilateral internal mammary lymph nodes, contralateral axilla, multidirectional flow, and the axilla alone. Lymphoscintigraphy and SPECT/CT may be useful for early determination of the need for another SNB.


Assuntos
Neoplasias da Mama , Humanos , Feminino , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/cirurgia , Linfocintigrafia , Biópsia de Linfonodo Sentinela , Axila , Recidiva Local de Neoplasia/diagnóstico por imagem , Mamilos , Tomografia Computadorizada de Emissão de Fóton Único , Tomografia Computadorizada por Raios X
3.
Sci Rep ; 14(1): 728, 2024 01 06.
Artigo em Inglês | MEDLINE | ID: mdl-38184673

RESUMO

The purpose of the study is to investigate long-term changes on lymphoscintigraphy and their association with clinical factors in breast cancer-related lymphedema (BCRL) patients. This single-center cohort study included BCRL patients who underwent baseline and follow-up lymphoscintigraphy. The percentage of excessive circumference (PEC) of the affected upper limb compared with the unaffected side was used as an indicator of the clinical severity of BCRL. Each 99mTc-phytate lymphoscintigraphy image was categorized according to the Taiwan lymphoscintigraphy staging system. Clinical parameters and the lymphoscintigraphy stage at baseline and follow-up were compared and analyzed. Eighty-seven patients were included. Baseline and follow-up lymphoscintigraphies were performed at median 7 (interquartile range [IQR]: 2‒14) and 78 (IQR: 49‒116) months after surgery, respectively. Both lymphoscintigraphy stage and PEC showed variable change with overall increases in their severity. Stepwise multivariable analysis revealed follow-up lymphoscintigraphy stage (P = 0.001) to be independent variables for PEC at follow-up, however, baseline lymphoscintigraphy stage was not. The clinical courses of BCRL and patients' lymphoscintigraphy patterns showed diverse changes over long-term follow-up. In addition to initial lymphoscintigraphy for diagnosis, lymphatic remapping by follow-up lymphoscintigraphy can be useful to visualize functional changes in the lymphatic system that may guide the optimal management in BCRL.


Assuntos
Linfedema Relacionado a Câncer de Mama , Neoplasias da Mama , Linfedema , Humanos , Feminino , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/cirurgia , Linfocintigrafia , Estudos de Coortes , Seguimentos , Linfedema/diagnóstico por imagem , Linfedema/etiologia , Linfedema Relacionado a Câncer de Mama/diagnóstico por imagem , Linfedema Relacionado a Câncer de Mama/etiologia , Doença Crônica
4.
PLoS One ; 19(1): e0296466, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38165945

RESUMO

BACKGROUND: Lymphaticovenous anastomosis (LVA) is a promising microsurgical treatment for lower extremity lymphedema (LEL). Lymphoscintigraphy effectively assesses lower limb lymphatic systems before LVA, but its role in predicting the therapeutic outcomes of LVA is indeterminate. In this study we investigate the efficacy of preoperative lymphoscintigraphy using clinical findings to predict outcomes in gynecological cancer-related LEL patients who underwent LVA. METHODS: A retrospective review was conducted on consecutive gynecological cancer patients with LEL who had undergone LVA between June 2018 and June 2021. The therapeutic efficacy was assessed by measuring the change rate of the lower extremity lymphedema index (LELi) six months after surgery. Clinical data and lymphoscintigraphic findings were analyzed to assess therapeutic efficacy of LVA. RESULTS: Out of the 60 evaluated legs, 83.3% of the legs showed improved results after LVA. Univariable linear regression analysis revealed that higher preoperative LELi, and ovarian cancer were associated with superior LELi change rate (LC rate). Absence of dermal backflow (DBF) on lymphoscintigraphy was associated with inferior LC rate. Multivariable linear regression analysis identified ovarian cancer and higher preoperative LELi were independently correlated with favorable outcomes, while the absence of DBF was independently correlated with inferior outcomes. CONCLUSION: The results of this study emphasizes the effectiveness of preoperative lymphoscintigraphy, preoperative LELi, and primary malignancy as predictors of LVA outcomes in gynecological cancer-related LEL patients.


Assuntos
Vasos Linfáticos , Linfedema , Neoplasias Ovarianas , Humanos , Feminino , Linfocintigrafia , Vasos Linfáticos/diagnóstico por imagem , Vasos Linfáticos/cirurgia , Resultado do Tratamento , Linfedema/diagnóstico por imagem , Linfedema/cirurgia , Extremidade Inferior/diagnóstico por imagem , Extremidade Inferior/cirurgia , Anastomose Cirúrgica/métodos , Estudos Retrospectivos
5.
Pediatr Cardiol ; 45(1): 150-155, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37870602

RESUMO

Postoperative chylothorax in patients with congenital heart diseases (CHD) results in poor outcomes if anatomical and functional abnormalities of the lymphatic system are present. While these abnormalities are typically diagnosed by intranodal lymphangiography and dynamic contrast magnetic resonance lymphangiography, the usefulness of lymphoscintigraphy in these patients has not been evaluated. Between January 2019 and December 2021, 28 lymphoscintigraphies were performed in our institution for investigating prolonged pleural effusion after cardiac surgery. The images were assessed by three board-certified pediatric cardiologists retrospectively to determine the likelihood of a central lymphatic flow disorder. The likelihood was scored (range 1-3) based on structural abnormalities and congestive flow in the lymphatic system. Those scores were summed and the likelihood was categorized as low to intermediate (< 8 points) or high (8 or 9 points). Median age at lymphoscintigraphy was 129 days (IQR, 41-412 days), it was performed at a median of 22 days (IQR, 17-43) after surgery, and median score was 6 points (IQR, 4-7.5). Kendall's coefficient of concordance (0.867; p < 0.05) indicated high inter-rater reliability. Overall survival at 6 months after surgery was 92.5% in the low-to-intermediate group but 68.6% in the high group (p < 0.05), and duration of postoperative thoracic drainage was 27 and 58 days, respectively (p < 0.05). Lymphatic abnormalities detected by lymphoscintigraphy were associated with poorer outcomes. Lymphoscintigraphy was thought to be useful in assessing anatomic and functional lymphatic abnormalities, despite its minimal invasiveness.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Quilotórax , Anormalidades Linfáticas , Criança , Humanos , Quilotórax/diagnóstico por imagem , Quilotórax/etiologia , Linfocintigrafia , Estudos Retrospectivos , Reprodutibilidade dos Testes , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Linfografia/métodos
6.
Eur J Nucl Med Mol Imaging ; 51(2): 512-520, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37773437

RESUMO

PURPOSE: Sentinel lymph node (SLN) biopsy is rarely used for thyroid carcinoma staging. This is due to challenges associated with conventional Tc-99m-labeled tracers, often producing a large hotspot at the injection site, potentially hiding nearby SLNs (shine-through effect). The aim of this study was to demonstrate the feasibility and effectiveness of SLN visualization using the new PET tracer [68Ga]Ga-tilmanocept. METHODS: Patients with thyroid carcinoma underwent ultrasound-guided peritumoral injection of [68Ga]Ga-tilmanocept and ICG-[99mTc]Tc-nanocolloid. [68Ga]Ga-tilmanocept PET/CT scans were conducted at 15 min and 60 min post-injection to visualize the SLNs. SLN biopsy was performed using ICG-[99mTc]TC-nanocolloid for intraoperative identification. The corresponding lymph node level was resected for reference. RESULTS: Seven differentiated thyroid carcinoma (DTC) and 3 medullary thyroid carcinoma (MTC) patients were included, of which 6 were clinically node-negative. The median number of SLNs detected on [68Ga]Ga-tilmanocept PET/CT and resected was 3 (range 1-4) and 3 (range 1-5), respectively. Eight SLNs were found on PET/CT in the central compartment and 19 in the lateral compartment. The SLN procedure detected (micro)metastases in all patients except one. Seventeen of 27 pathologically assessed SLNs were positive, 8 negative, and 2 did not contain lymph node tissue, which led to upstaging in 5 out of 6 clinically node-negative patients. CONCLUSIONS: [68Ga]Ga-tilmanocept PET/CT identified SLNs in all patients, mainly in the lateral neck. The SLNs were successfully surgically detected and resected using ICG-[99mTc]Tc-nanocolloid. This technique has the potential to improve neck staging, enabling more personalized treatment of thyroid cancer according to the lymph node status. TRIAL REGISTRATION: 2021-002470-42 (EudraCT).


Assuntos
Linfonodo Sentinela , Neoplasias da Glândula Tireoide , Humanos , Linfonodo Sentinela/cirurgia , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Radioisótopos de Gálio , Metástase Linfática/diagnóstico por imagem , Metástase Linfática/patologia , Linfocintigrafia/métodos , Biópsia de Linfonodo Sentinela/métodos , Linfonodos/patologia , Neoplasias da Glândula Tireoide/patologia , Compostos Radiofarmacêuticos
7.
J Surg Res ; 293: 613-617, 2024 01.
Artigo em Inglês | MEDLINE | ID: mdl-37837816

RESUMO

INTRODUCTION: Lymphoscintigraphy (LS) helps identify drainage to interval (epitrochlear or popliteal) lymph node basins for extremity melanomas. This study evaluated how often routine LS evaluation identified an interval sentinel lymph node (SLN) and how often that node was found to have metastasis. METHODS: A single institution, retrospective study identified patients with an extremity melanoma who underwent routine LS and SLN biopsy over a 25-y period. Comparisons of factors associated with the identification of interval node drainage and tumor status were made. RESULTS: In 634 patients reviewed, 5.7% of patients drained to an interval SLN. Of those biopsied, 29.2% were positive for micrometastases. Among patients with biopsies of both the traditional and interval nodal basins, nearly 20% had positive interval nodes with negative SLNs in the traditional basin. Sex, age, thickness, ulceration, and the presence of mitotic figures were not predictive of identifying an interval node on LS, nor for having disease in an interval node. Anatomic location of the primary melanoma was the only identifiable risk factor, as no interval nodes were identified in melanomas of the thigh or upper arm (P ≤ 0.001). CONCLUSIONS: Distal extremity melanomas have a moderate risk of mapping to an interval SLN. Routine LS should be considered in these patients, especially as these may be the only tumor-positive nodes. However, primary extremity melanomas proximal to the epitrochlear or popliteal nodal basins do not map to interval nodes, and improved savings and workflow could be realized by selectively omitting routine LS in such patients.


Assuntos
Linfadenopatia , Melanoma , Linfonodo Sentinela , Neoplasias Cutâneas , Humanos , Linfonodo Sentinela/diagnóstico por imagem , Linfonodo Sentinela/patologia , Linfocintigrafia , Estudos Retrospectivos , Metástase Linfática/diagnóstico por imagem , Metástase Linfática/patologia , Cintilografia , Neoplasias Cutâneas/diagnóstico por imagem , Neoplasias Cutâneas/cirurgia , Neoplasias Cutâneas/patologia , Melanoma/diagnóstico por imagem , Melanoma/cirurgia , Melanoma/patologia , Linfonodos/patologia , Biópsia de Linfonodo Sentinela , Extremidade Superior/diagnóstico por imagem , Excisão de Linfonodo
8.
J Vasc Surg Venous Lymphat Disord ; 12(2): 101738, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38103890

RESUMO

OBJECTIVE: Lymphedema (LED) lacks a standard, simple, guiding noninvasive diagnostic test, unlike the two other circulatory disorders-arterial or venous disease. Lymphoscintigraphy (LSG) has been recommended by several guidelines as the diagnostic test of choice for LED. Several recent expert panels, however, have suggested from anecdotal experience that LSG was used infrequently, and that the diagnosis of LED is usually based on clinical examination. METHODS: To determine the use of LSG in a large real-world LED population, the International Business Machines MarketScan Research Database was examined from April 2012 to March 2020 for patients with a new diagnosis of LED (the index date). Use of LSG (LSG+) was ascertained during the period beginning 12 months prior to the initial coding of a LED diagnosis and ending 12 months after the index date based on the corresponding Current Procedural Terminology code; LSG use for sentinel node mapping at the time of oncologic surgery was excluded. Demographic profiles, comorbidities, and causes of LED among patients with and without evidence of LSG were characterized. RESULTS: We identified 57,674 patients, aged ≥18 years, who had a new diagnosis of LED and health care coverage for ≥12 months before and after this index date. Only a small number (1429; 2.5%) of these patients underwent LSG during the study period. The LSG + cohort was younger (53.7 vs 60.7 years), had a higher proportion of women (91.3% vs 73.4%), but a lower percentage of diabetes (12.8% vs 27.5%), heart failure (2.2% vs 8.7%), hypertension (32.4% vs 51.0%), and obesity (15.1% vs 22.2%) compared with the LED population who did not undergo LSG (all P < .001). Most importantly, the use of LSG for diagnosis varied with the etiology of LED (LSG was most frequently utilized among patients with melanoma-LED (9.5%) and patients with breast cancer-LED (6.7%), in contrast to patients with advanced venous disease-related LED (1.1%; P < .05 for both comparisons). CONCLUSIONS: Despite four guidelines recommending LSG, including the Guidelines of the American Venous Forum (Handbook of Venous and Lymphatic Disease-4th edition), which recommended LSG "for the initial evaluation of patients with LED" with a 1B recommendation, LSG plays a minor role in establishing the diagnosis of LED in the United States. This underlines the need for a better, simple diagnostic test for LED to complement clinical examination.


Assuntos
Hipertensão , Doenças Linfáticas , Linfedema , Humanos , Feminino , Adolescente , Adulto , Linfocintigrafia , Biópsia de Linfonodo Sentinela , Linfedema/diagnóstico
9.
Rev. esp. med. nucl. imagen mol. (Ed. impr.) ; 42(6): 374-379, nov.- dec. 2023. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-227101

RESUMO

Objetivo Evaluar mediante linfogammagrafía in vivo y con detección SPECT/TC los patrones de drenaje linfático de los tumores del seno paranasal (SPN). Confirmar o rebatir la creencia de que el ganglio linfático retrofaríngeo (GLRF) se erige en el ganglio de drenaje índice para dichos tumores. Métodos Estudio de cohorte prospectivo realizado en pacientes con tumores del SPN no tratados previamente y sin evidencia clínico-radiológica de metástasis a nivel ganglionar. La linfogammagrafía se realizó mediante la inyección peritumoral de sulfuro coloidal marcado con [99m]TcO4 y asistida por endoscopia nasal. Las inyecciones se clasificaron como anteriores o posteriores en función de una línea vertical que pasaba por el orificio del seno maxilar. Resultados Se incluyeron 17 pacientes. La linfogammagrafía identificó satisfactoriamente 17 ganglios centinelas en 15 pacientes, y no pudo evidenciarlo (fracaso de la linfogammagrafía) en 2 pacientes. Se observó que los lugares predominantes de drenaje del ganglio centinela fueron el GLRF (n=8; 47%) y el nivel I (n=7; 42%). Se identificó drenaje ocasional en el ganglio periparotídeo (n=1) y en el nivel II (n=1). Se observó drenaje linfático contralateral en 2 pacientes (en el nivel I y GLRF, respectivamente). Las inyecciones anteriores drenaron predominantemente hacia el nivel I (6/8) y a GLRF (2/8), mientras que las inyecciones posteriores drenaron predominantemente a GLRF (6/7). El riesgo relativo de que el GLRF fuera identificado como ganglio centinela fue significativamente mayor en las inyecciones administradas posteriormente respecto a las administradas anteriormente (RR: 3,43; IC 95%: 1,0-11,8; p=0,05). Conclusión El GLRF es considerado un ganglio de drenaje frecuente asociado a los tumores del seno nasal, y merece su atención rutinaria en todos los casos de tumor del seno nasal (AU)


Objective To evaluate by in vivo lymphoscintigraphy and SPECT-CT imaging, the lymphatic drainage patterns of para-nasal sinus (PNS) tumours. To confirm or refute the belief of the retropharyngeal lymph node (RPLN) being the significant draining lymph node for such tumours. Methods Prospective cohort study conducted on previously untreated PNS tumours with no clinico-radiological evidence of lymph node metastasis. Lymphoscintigraphy undertaken by nasal endoscopic assisted peritumoral injection of 99mTc sulphur colloid. Injections were classified as anterior or posterior as per a vertical line along the maxillary sinus ostium. Results Seventeen patients were included. Lymphoscintigraphy successfully identified 17 sentinel nodes in 15 patients and was unsuccessful (lymphoscintigraphy failure) in 2 patients. Predominant sites of sentinel lymphatic drainage were noted to be the RPLN (n=8; 47%) and level I (n=7; 42%). Occasional drainage was identified at the peri-parotid node (n=1) and at level II (n=1). Contralateral drainage was noted in 2 patients (level I-1 and RPLN-1). Anterior injections drained predominantly to level I (6/8) and RPLN (2/8), while posterior injections drained predominantly to the RPLN (6/7). The relative risk of RPLN being identified as the sentinel node was significantly higher for posteriorly placed injections than for anteriorly placed injections (RR: 3.43; 95% CI: 1.0-11.8; P=.05). Conclusion The RPLN is noted as a frequent draining node for sino-nasal tumours and merits routine attention in all sino-nasal tumours. The radio-colloid SPECT-CT technique described here offers an excellent in vivo technique to further explore and validate the lymphatic drainage pathways of these tumours (AU)


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Linfocintigrafia/métodos , Neoplasias Nasais/diagnóstico por imagem , Linfonodo Sentinela/diagnóstico por imagem , Estadiamento de Neoplasias , Estudos Prospectivos , Estudos de Coortes
10.
Sci Rep ; 13(1): 19494, 2023 11 09.
Artigo em Inglês | MEDLINE | ID: mdl-37945581

RESUMO

An added value of SPECT/CT over planar lymphoscintigraphy for initial staging in patients with secondary extremity lymphedema was investigated. Furthermore, we developed a hybrid SPECT/CT classification combining dermal backflow (DBF) of SPECT and honeycomb pattern (HP) of CT, correlated it with lymphoscintigraphic staging and clinical severity. Forty-one patients with secondary extremity lymphedema who underwent lymphoscintigraphy with SPECT/CT were included retrospectively. The severity of extremity lymphedema was assessed using CT volumetry. Lymphoscintigraphic findings were evaluated using the Taiwan Lymphoscintigraphy Staging (TLS), and CT-based and SPECT-based quantitative analysis were performed. TLS was performed by planar scintigraphy only and with SPECT/CT, respectively. The SPECT/CT findings were classified into DBF-/HP-, DBF+/HP-, DBF+/HP+, and DBF-/HP+. Based on these findings, patients were categorized into five classes: Class 1 = DBF-HP- entire limb, Class 2 = DBF+/HP- proximal/distal limb without DBF+/HP+ or DBF-/HP+, Class 3 = DBF+/HP+ proximal/distal limb without DBF-/HP+, Class 4 = Mixed DBF+/HP+ and DBF-/HP+ in proximal/distal limb, Class 5 = DBF-/HP+ entire limb. Adding SPECT/CT to planar scintigraphy showed a 15.4% modification rate in lymphoscintigraphic staging. HP volume ratio significantly increased as clinical severity and lymphoscintigraphic staging increased, while DBF volume ratio increased with severity and followed expected patterns according to lymphoscintigraphic staging. Hybrid SPECT/CT lymphoscintigraphic classification showed strong positive correlation with clinical severity and TLS. Our results demonstrated substantial modification of lymphoscintigraphic staging by adding SPECT/CT to a conventional planar scintigraphy. In addition, a hybrid SPECT/CT is expected to provide new indicators reflecting lymphoscintigraphic staging and clinical severity by providing both of functional DBF and anatomical HP information.


Assuntos
Linfedema , Linfocintigrafia , Humanos , Estudos Retrospectivos , Linfedema/diagnóstico por imagem , Linfedema/etiologia , Tomografia Computadorizada de Emissão de Fóton Único , Extremidades/diagnóstico por imagem , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único , Extremidade Inferior/diagnóstico por imagem
11.
J Pak Med Assoc ; 73(11): 2293-2294, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-38013553

RESUMO

Chronic blockage of the lymphatic system due to functional or anatomical causes results in lymphoedema which results in swelling due to accumulation of lymphatic fluid in the soft tissue. Lymphoedema commonly affects the upper and lower limbs but may be seen in the neck, chest wall, abdomen and genitalia. Lymphoscintigraphy is non-invasive and maps the lymphatic channels thereby indicating location of blockage along the lymphatic pathways. Blockage of lymphatic channels may lead to back pressure resulting in dermal backflow. We present a case of dermal backflow in bilateral lymphoedema.


Assuntos
Linfedema , Linfocintigrafia , Humanos , Linfocintigrafia/efeitos adversos , Linfocintigrafia/métodos , Relevância Clínica , Edema/diagnóstico por imagem , Edema/etiologia , Linfedema/diagnóstico por imagem , Linfedema/etiologia , Extremidade Inferior/diagnóstico por imagem
12.
Nucl Med Commun ; 44(12): 1080-1086, 2023 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-37779454

RESUMO

INTRODUCTION: Phlebolymphoedema is caused by the interaction of the venous and lymphatic systems in a state of chronic venous insufficiency in which increased microvascular filtration causes an increased rate of lymph production. Lymphatic drainage rate increases in response, but this is unsustainable and can cause lymphatic failure and oedema. We hypothesise that in phlebolymphoedema we could measure unusually high lymphatic drainage while the lymph system is still fully functional. METHOD: Patients referred for lymphoscintigraphic investigation of swollen legs between April 2021 and December 2022 were reviewed. Quantitative lymphoscintigraphy was performed following the technique of Keramida et al . (2017) and ilio-inguinal nodal uptake (IIQ%) was calculated. The presence of scintigraphic features of increased lymph production was noted for each limb. RESULTS: A total of 39 patients were reviewed (78 limbs, 29F, 10M). Seven limbs were identified with supranormal lymphatic function (IIQ > 30%) plus three borderline. Of these 10 limbs, all had at least two scintigraphic features of increased lymph production. CONCLUSION: Quantitative lymphoscintigraphy, although developed for diagnosing abnormally low lymphatic function, may also have utility at the upper end of the spectrum for identifying chronic venous insufficiency. An IIQ% upper normal limit of 30% could be used to diagnose venous insufficiency as the cause for limb swelling. This is of note for patients of large body habitus in whom venous ultrasound is difficult.


Assuntos
Linfedema , Insuficiência Venosa , Humanos , Linfocintigrafia/métodos , Linfedema/diagnóstico por imagem , Extremidade Inferior/diagnóstico por imagem , Sistema Linfático
13.
J Cancer Res Clin Oncol ; 149(19): 17223-17229, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37801136

RESUMO

PURPOSE: Near-infrared fluorescence imaging using indocyanine green (ICG) combined with radioactive markers has the potential to improve sentinel lymph-node (SLN) mapping in oral squamous cell carcinoma (OSCC). This study aimed to evaluate the ability of 99mTc and ICG in identifying the sentinel lymph nodes in patients with early stage OSCC. METHODS: Data were collected prospectively, and a retrospective analysis of 15 patients with early stage OSCC and a cN0 neck was performed. All patients received peritumoral injection of 99mTc the day before surgery and ICG was administered intraoperatively. Intentionally, the application of the two different tracers were done by two different physicians with varying degrees of experience. The number of identified lymph nodes positive for 99mTc and ICG, the overlap or possible discrepancies of both methods, and the time until fluorescence signals of ICG were detected were noted. RESULTS: In all patients, a 100% agreement in sentinel lymph-node identification was achieved, regardless of both the exact location of the peritumoral injection and the experience of the injecting surgeon. Time until ICG accumulation in the sentinel lymph node was consistently found to be between 1 and 3 min. CONCLUSION: ICG constitutes a viable and useful addition to 99mTc for intraoperative sentinel lymph-node detection in this study.


Assuntos
Carcinoma de Células Escamosas , Neoplasias de Cabeça e Pescoço , Neoplasias Bucais , Linfonodo Sentinela , Humanos , Verde de Indocianina , Linfonodo Sentinela/diagnóstico por imagem , Linfonodo Sentinela/cirurgia , Linfonodo Sentinela/patologia , Biópsia de Linfonodo Sentinela/métodos , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas de Cabeça e Pescoço/patologia , Estudos Retrospectivos , Agregado de Albumina Marcado com Tecnécio Tc 99m , Linfocintigrafia/métodos , Neoplasias Bucais/patologia , Neoplasias de Cabeça e Pescoço/patologia , Linfonodos/diagnóstico por imagem , Linfonodos/patologia , Compostos Radiofarmacêuticos
14.
Clin Nucl Med ; 48(10): 879-880, 2023 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-37682603

RESUMO

ABSTRACT: Lymphoscintigraphy is a safe, minimally invasive, and well-established imaging modality for evaluating lymphatic drainage in patients with suspected lymphedema. We report a case of an 8-year-old girl with lymphangioma circumscriptum of the labium majora. She was referred to lymphoscintigraphy for swelling of the lower extremities. Scintigraphy showed widespread dermal backflow at bilateral lower limbs, aberrant uptake in the abdominal lymph nodes, and unexpected uptake in the right axillary lymph nodes.


Assuntos
Linfangioma , Linfocintigrafia , Feminino , Humanos , Criança , Transporte Biológico , Extremidade Inferior/diagnóstico por imagem , Linfonodos/diagnóstico por imagem , Linfangioma/diagnóstico por imagem
15.
Eur J Surg Oncol ; 49(10): 107006, 2023 10.
Artigo em Inglês | MEDLINE | ID: mdl-37572588

RESUMO

INTRODUCTION: In early-stage vulvar squamous cell carcinoma (VSCC) a sentinel lymph node (SLN) procedure is regarded successful if at least one SLN is removed with minimal residual radioactivity. An inguinofemoral lymphadenectomy is considered if not all SLNs visualized on lymphoscintigraphy can be found, with subsequent increased morbidity. We correlated lymphoscintigraphy findings with surgical outcome and groin recurrence with focus on number of SLNs found. METHODS: This study concerns a retrospective cohort of 171 women treated for early-stage VSCC who underwent a SLN procedure between 2000 and 2020. The risk of groin recurrence was compared after either a successful or complete SLN procedure, i.e. removal of all SLNs that were visualized on lymphoscintigraphy. RESULTS: In 13 (7.6%) groins of 171 patients SLN visualization on lymphoscintigraphy failed. In 230 of the 246 (93.5%) groins in which a SLN was visualized, at least one SLN was found during surgery. In 224 of the 246 (91.1%) groins the SLN procedure was regarded either successful (n = 14) or complete (n = 210). An isolated groin recurrence was documented in 5 out of 192 (2.6%, 95%-CI; 0.34 to 4.9) SLN-negative groins after a median follow-up of 47.0 months. All recurrences were noted in the complete SLN group (5/180 groins). The difference with the successful SLN group (0/12 groins) was not significant. CONCLUSION: Risk of groin recurrence was 2.6% after SLN negative biopsy in early-stage VSCC. The risk appeared not increased if at least one SLN was found with minimal residual radioactivity, in case more SLNs were visualized on lymphoscintigraphy.


Assuntos
Carcinoma de Células Escamosas , Linfadenopatia , Linfonodo Sentinela , Neoplasias Vulvares , Humanos , Feminino , Linfonodo Sentinela/diagnóstico por imagem , Linfonodo Sentinela/cirurgia , Linfonodo Sentinela/patologia , Virilha/cirurgia , Virilha/patologia , Neoplasias Vulvares/diagnóstico por imagem , Neoplasias Vulvares/cirurgia , Neoplasias Vulvares/patologia , Estudos Retrospectivos , Linfocintigrafia/métodos , Biópsia de Linfonodo Sentinela/métodos , Excisão de Linfonodo/métodos , Linfonodos/diagnóstico por imagem , Linfonodos/cirurgia , Linfonodos/patologia , Linfadenopatia/patologia , Carcinoma de Células Escamosas/diagnóstico por imagem , Carcinoma de Células Escamosas/cirurgia , Carcinoma de Células Escamosas/patologia , Resultado do Tratamento
16.
Artigo em Inglês | MEDLINE | ID: mdl-37399973

RESUMO

OBJECTIVE: To evaluate by in- vivo lymphoscintigraphy and SPECT-CT imaging, the lymphatic drainage patterns of para-nasal sinus(PNS) tumors. To confirm or refute the belief of the retropharyngeal lymph node (RPLN) being the significant draining lymph node for such tumors. METHODS: Prospective cohort study conducted on previously untreated PNS tumors with no clinico-radiological evidence of lymph node metastasis. Lymphoscintigraphy undertaken by nasal endoscopic assisted peritumoral injection of 99mTc Sulfur colloid. Injections were classified as anterior or posterior as per a vertical line along the maxillary sinus ostium. RESULTS: 17 patients were included. Lymphoscintigraphy successfully identified 17 sentinel nodes in 15 patients and was unsuccessful (lymphoscintigraphy failure) in 2 patients. Predominant sites of sentinel lymphatic drainage were noted to be the RPLN (n = 8; 47%), and Level I (n = 7; 42%). Occasional drainage was identified at the peri-parotid node(n = 1) and at Level II (n = 1). Contralateral drainage was noted in 2 patients (level I-1 and RPLN-1). Anterior injections drained predominantly to Level I (6/8) and RPLN (2/8), while posterior injections drained predominantly to the RPLN ( 6/7). The relative risk of RPLN being identified as the sentinel node was significantly higher for posteriorly placed injections than for anteriorly placed injections (RR- 3.43; 95% CI-1.0-11.8, p = 0.05). CONCLUSION: The RPLN is noted as a frequent draining node for sino-nasal tumours and merits routine attention in all sino-nasal tumors. The radio-colloid SPECT-CT technique described here offers an excellent in-vivo technique to further explore and validate the lymphatic drainage pathways of these tumours.


Assuntos
Linfocintigrafia , Biópsia de Linfonodo Sentinela , Humanos , Linfocintigrafia/métodos , Biópsia de Linfonodo Sentinela/métodos , Estudos Prospectivos , Compostos Radiofarmacêuticos , Linfonodos/diagnóstico por imagem , Linfonodos/patologia , Metástase Linfática/diagnóstico por imagem , Coloides
17.
J Pharmacol Toxicol Methods ; 122: 107280, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37295617

RESUMO

Snakebite envenomation is one of the major public health concerns across many countries; with the WHO designating it as a 'priority neglected tropical disease' and stressing for a need to develop novel therapeutic strategies to reduce death and disability rate by end of 2030. Since a major component of venom; the high molecular weight (HMw) toxins enter the bloodstream through lymphatic system, research is focusing on modulating the lymphatic flow rate after topical application of suitable drug candidates. Present study compared the suitability of three radiopharmaceutical agents, namely 99mTc-Sulfur colloid (SC), 99mTc-Phytate (Phy) and 99mTc-Human serum albumin (HSA), to be used as mock-venom agent in studying modulation in lymphatic flow rate in preclinical models of peripheral snakebite envenomation using lymphoscintigraphy studies. The study was performed in 72 Sprague Dawley rats; divided into six groups of 12 rats each. Control groups were given intradermal injection (1.29-1.48 MBq in 100 µl normal saline) of either 99mTc-Phy/ 99mTc-SC/ 99mTc-HSA into the tail as 'mock-venom'. In respective test groups, commercially available topical formulation (Anobliss® Cream) containing Nifedipine (Nif; 0.3% w/w) and Lidocaine (Lid; 1.5% w/w) was applied topically over the animals' lower body (tail and hind limbs) immediately within 20s of administering intradermal injection of the radiopharmaceutical. Any modulation in lymph transit time from periphery to systemic circulation was assessed using lymphoscintigraphy by taking dynamic gamma-scintigraphy images of 60s each till 1 h post-injection of the test radiopharmaceuticals. Significant difference in movement of the three radiopharmaceuticals was noted in terms of their lymphatic movement. 99mTc-Phy did not show significant travel through the lymphatics and the liver was faintly visualized in control as well as test intervention groups. In case of 99mTc-SC, significant changes in movement of the radiotracer after topical application of Nif/Lid in the test intervention groups were clearly noted in comparison to control (P < 0.05). Multiple numbers of lymph nodes (LNs) could be clearly visualized in control (5 ± 1 LNs) and test intervention groups (3 ± 1 LNs). Liver uptake was more prominent in control animals and it reduced significantly in test intervention groups. On the other hand, 99mTc-HSA showed lesser number of lymph nodes and higher accumulation in liver as compared to 99mTc-SC, suggesting very fast movement of this radiopharmaceutical. Results indicates that 99mTc-SC could be used as a suitable agent to mimic lymphatic transit behavior of HMw toxin components of snake venom and could therefore be used as a model in studying the effect of any test pharmacological intervention in modulating lymphatic transit rate. Additional advantage could be a significant reduction in the need for sacrificing large number of animals, particularly during initial screening phase of drug development cycle.


Assuntos
Linfocintigrafia , Mordeduras de Serpentes , Humanos , Animais , Ratos , Compostos Radiofarmacêuticos/farmacologia , Coloide de Enxofre Marcado com Tecnécio Tc 99m , Peçonhas , Mordeduras de Serpentes/diagnóstico por imagem , Ratos Sprague-Dawley , Linfonodos , Compostos de Enxofre
18.
Clin Nucl Med ; 48(8): 679-684, 2023 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-37276486

RESUMO

OBJECTIVES: Acquired lymphedema of upper extremity is a chronic pathologic status that frequently occurs after breast cancer treatment. Reliable and quantitative evaluation of lymphedema is crucial for successful management of patients. Although lymphoscintigraphy is the primary investigation for the confirmation and evaluation of lymphedema, the specific protocol of stress intervention is not well established. This study aims to introduce intermittent pneumatic compression (IPC) as a part of stress lymphoscintigraphy and compare the effectiveness of conventional stress lymphoscintigraphy (CSL) and pneumatic compression-assisted lymphoscintigraphy (PCAL). METHODS: Our study was designed as a retrospective analysis of 85 breast cancer patients with lymphedema who underwent lymphoscintigraphy utilizing either IPC device or conventional stress maneuver and received complex decongestive therapy. The flow extent of the lymphatic fluid (FE) was evaluated using a 0- to 4-point scale based on lymphoscintigraphic images. The visualization of lymph nodes was also assessed. The clinical outcomes were evaluated by changes in side-to-side circumferential and volume differences of upper extremities and compared between groups. RESULTS: Of 85 patients, 47 underwent CSL, and 38 underwent PCAL. Participants with relatively preserved flow extent of the lymphatic fluid (FE 3) showed a significant difference in percentage reduction of volume (PRV) between CSL and PCAL groups ( P = 0.036). In the other groups, CSL and PCAL demonstrated comparable differences in PRV without statistical significance. CONCLUSION: Our study suggests that participants in the PCAL group with relatively preserved lymphatic flow extent (FE 3) had better PRV compared with those in the CSL group. The use of IPC devices in lymphoscintigraphy with the novel stress maneuver can help in the quantitative description of lymphedema status and the selection of an appropriate treatment method.


Assuntos
Neoplasias da Mama , Linfedema , Humanos , Feminino , Linfocintigrafia/métodos , Neoplasias da Mama/complicações , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/terapia , Estudos Retrospectivos , Linfedema/diagnóstico por imagem , Linfedema/terapia , Linfonodos
19.
Int J Gynaecol Obstet ; 163(3): 813-817, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37332155

RESUMO

OBJECTIVE: To compare single-photon emission computed tomography with computed tomography (SPECT/CT) and lymphoscintigraphy (LSG) for the detection of sentinel lymph nodes (SLNs) in patients with early-stage cervical cancer. METHODS: This hospital-based, single-center, retrospective study included 128 patients with cervical cancer (aged >18 years) treated between 2014 and 2022. Injection of 99 m Technetium-labeled phytate into the uterine cervix was used to detect pelvic SLNs. SNL identification rates and locations were analyzed for preoperative LSG and SPECT/CT. RESULTS: Median age and body mass index of patients were 40 years (range, 20-78 years) and 21.7 kg/m2 (range, 16-40 kg/m2 ), respectively. There was no significant difference in overall identification rates (identification of at least one SLN) of SLNs between SPECT/CT (91%) and LSG (88%). There was no significant difference in bilateral SLN identification rates between SPECT/CT (66%) and LSG (65%). A total of 219 pelvic SLNs (110 right and 109 left hemipelvis) were identified by SPECT/CT; the most frequent locations were the obturator (122 SLNs, 56%) and external iliac (67 SLNs, 30%). CONCLUSION: SPECT/CT and LSG showed high SLN identification rates in patients with cervical cancer, and there was no significant difference in overall or bilateral SLN identification rates between the two techniques.


Assuntos
Linfonodo Sentinela , Neoplasias do Colo do Útero , Feminino , Humanos , Linfonodo Sentinela/diagnóstico por imagem , Linfonodo Sentinela/patologia , Neoplasias do Colo do Útero/patologia , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Tomografia Computadorizada por Raios X , Estudos Retrospectivos , Linfocintigrafia/métodos , Linfonodos/diagnóstico por imagem , Linfonodos/patologia
20.
Clin Nucl Med ; 48(8): e377-e379, 2023 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-37314702

RESUMO

ABSTRACT: We describe a 57-year-old man with prostate cancer. A radical prostatectomy with a pelvic lymphadenectomy was performed. After 2 years, a mild swelling of the lower extremities appeared, and the patient was referred for lower-limb lymphoscintigraphy. A lymphoscintigraphy of the superficial lymphatic system in the limbs showed prominent, dermal backflow in the area of the right hypogastrium. Lymphoscintigraphy of the deep lymphatic system showed reflux in the left hypogastrium. This discrepancy between the findings in the superficial and deep lower-limb lymphatic systems was explained by asymmetric sampling of the lymph nodes during the lymphadenectomy.


Assuntos
Extremidade Inferior , Sistema Linfático , Linfocintigrafia , Humanos , Masculino , Pessoa de Meia-Idade , Sistema Linfático/diagnóstico por imagem , Sistema Linfático/fisiopatologia , Extremidade Inferior/diagnóstico por imagem , Prostatectomia , Neoplasias da Próstata , Linfonodos , Pelve/diagnóstico por imagem
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