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1.
Sci Rep ; 12(1): 13591, 2022 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-35948757

RESUMO

Lymphedema is a progressive disease caused by lymphatic flow blockage in the lymphatic pathway. Primary (hereditary) lymphedema is caused by genetic mutations without secondary causes. We performed clinical profiling on Korean primary lymphedema patients based on their phenotypes using lymphoscintigraphy and made genetic diagnoses using a next-generation sequencing panel consisting of 60 genes known to be related to primary lymphedema and vascular anomalies. Of 27 patients included in this study, 14.8% of the patients had lymphedema of the upper extremities, 77.8% had lymphedema of the lower extremities and 7.4% had 4-limbs lymphedema. Based on the International Society of Lymphology staging, 14, 10, and 3 patients had stage 3, 2, and 1 lymphedema, respectively. Only one family was genetically confirmed to harbor likely pathogenic variants in CELSR1. The proband was carrying two likely pathogenic variants in CELSR1, while her symptomatic mother was confirmed to carry only one of the variants. Furthermore, two other variants of uncertain significance in CELSR1 were detected in other patients, making CELSR1 the most commonly altered gene in our study. The clinical and genetic profile of hereditary lymphedema reported here is the first such data series reported for South Korea.


Assuntos
Vasos Linfáticos , Linfedema , Feminino , Perfil Genético , Humanos , Sistema Linfático/patologia , Vasos Linfáticos/patologia , Linfedema/genética , Linfocintigrafia
2.
Nucl Med Rev Cent East Eur ; 25(2): 101-104, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35929122

RESUMO

BACKGROUND: Sentinel lymph node (SLN) mapping allows minimal invasive assessment of lymph node status in patients with early-stage endometrial cancer (EC). Intraoperative detection of SLNs is based on the results obtained from preoperative nuclear medical images. The purpose of this study was to compare the data obtained from planar lymphoscintigraphy (PL), single-photon emission computed tomography (SPECT), and SPECT with computed tomography (SPECT/CT) for preoperative SLN detection in patients with EC. MATERIAL AND METHODS: A total of 44 images in 22 patients with early-stage EC (22 PL, 9 SPECT and 13 SPECT/CT) were analyzed. The scans were performed in the period 2018-2020 at the Institute of Pathophysiology and Nuclear Medicine in Skopje. Thirteen patients underwent PL and SPECT/CT and nine patients underwent PL and SPECT after cervical injection of 4 mCi 99mTc-SENTI-SCINT on the day of surgery. Descriptive statistics, Wilcoxon Matched Pairs Test, and Spearman rank R coefficient were used for data analyses. RESULTS: Twenty-two patients with mean age of 61.1 ± 7.5 and body mass index (BMI) 34.62 ± 6.4 kg/m2 were included in the study. In four patients (18.2%) SLN was not detected on PL. Detection rate on SPECT and SPECT/CT was 100%. The average number of detected SLN was 1.4 ± 1.05, 2.2 ± 1.1 и 2.15 ± 1.1 on PL, SPECT and SPECT/CT respectively. We found a statistically significant difference in the number of detected SLNs on PL vs SPECT/CT (p = 0.0077). The most common SLN location on SPECT/CT was the right internal iliac followed by the left common iliac region. CONCLUSIONS: The results of the presented study indicate a higher diagnostic value of SPECT/CT in terms of SLN detection and exact anatomic localization as compared to planar lymphoscintigraphy (PL).


Assuntos
Neoplasias do Endométrio , Linfonodo Sentinela , Idoso , Neoplasias do Endométrio/diagnóstico por imagem , Neoplasias do Endométrio/patologia , Neoplasias do Endométrio/cirurgia , Feminino , Humanos , Linfocintigrafia/métodos , Pessoa de Meia-Idade , Linfonodo Sentinela/diagnóstico por imagem , Biópsia de Linfonodo Sentinela/métodos , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Tomografia Computadorizada por Raios X/métodos
3.
J Vasc Surg Venous Lymphat Disord ; 10(5): 1079-1086.e2, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35787386

RESUMO

OBJECTIVE: The outcomes of lymphaticovenular anastomosis (LVA), especially for the lower extremities, have varied. To determine the optimal patient selection for LVA, we evaluated the smooth muscle function of lymph vessels using preoperative lymphoscintigraphy images and compared the findings with the LVA outcomes. METHODS: We performed a retrospective study of 81 patients with secondary lower extremity lymphedema who had undergone LVA between 2016 and 2018. To reduce the variability in the surgeon-specific variables that can affect the outcomes of LVA, all the cases from 2016 onward were performed by only two surgeons using standardized protocols for preoperative care, surgical technique, number of anastomoses, postoperative ambulation, and compression. The outcomes were evaluated by comparing the circumferences of the pre- and postoperative limbs. The preoperative lymphoscintigraphy findings were categorized into three types according to the range of the cephalad extent of the tracer as follows: type 1, tracer extending to the thigh or groin region; type 2, tracer extending to the lower leg or knee; and type 3, tracer localized at the ankle. The quantitative outcomes were evaluated by measuring the circumferences of the ankle, mid-calf, knee, and thigh. RESULTS: The average percentage in the reduction in the ankle, mid-calf, knee, and thigh circumference was 7.9%, 4.7%, 2.9%, and 3.0%, respectively. The average percentage in the reduction in the circumference for types 1 and 3 at the ankle, mid-calf, knee, and thigh was 11.6% and 8.6%, 7.6% and 1.6%, 5.2% and -0.5%, and 5.4% and -1.2%, respectively, with significant differences between types 1 and 3 in the thigh. The percentage of types 1, 2 and 3 was 60% to 76.4%, 11.7% to 20%, and 0% to 5.5% of the treated limbs that were similar in size to the contralateral healthy limb at the four sites of measurement, respectively. CONCLUSIONS: The use of LVA can effectively reduce the circumference of the lower limb. Our results suggest that the lymphoscintigraphy findings could help to predict the effect of LVA and could facilitate optimal patient selection.


Assuntos
Vasos Linfáticos , Linfedema , Anastomose Cirúrgica/métodos , Humanos , Extremidade Inferior/cirurgia , Vasos Linfáticos/diagnóstico por imagem , Vasos Linfáticos/cirurgia , Linfedema/diagnóstico por imagem , Linfedema/cirurgia , Linfocintigrafia , Estudos Retrospectivos , Resultado do Tratamento
4.
Lymphology ; 55(1): 1-9, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35896110

RESUMO

Lymphoscintigraphy with single-photon emission computed tomography (SPECT-CT) is useful in diagnosing lymphedema. However, there are multiple timings, techniques, and tracers utilized worldwide without any comparison. We examined and compared the image clarity with two different radiotracers, 99mTc human serum albumin (HSA) and 99mTc phytate (phytate), in the same patients. The study retrospectivity examined 46 limbs of 36 patients who underwent lymphoscintigraphy using HSA and phytate from January 2013 to September 2018. Tracer accumulation in the lymph nodes, linear pattern (LP), and dermal backflow (DBF) were qualitatively analyzed; contrast-to-noise ratios (CNR) of DBF and standardized uptake value ratio (SUVR) of LP were also quantitatively analyzed. Neither lymph node accumulation nor DBF identification showed significant difference. However, a significant difference was observed between the LP identification of the unaffected (p<0.001) and affected sides (p<0.001). On quantitative evaluation, CNR and SUVR of LP was significantly higher with HSA than with phytate (p<0.001). SUVR of LP was also significantly higher with HSA than with phytate in both unaffected (p=0.002) and affected (p=0.005) sides. Overall, images acquired with HSA were clearer than that with phytate, and the identification of LP was particularly better with HSA than with phytate. Thus, lymphoscintigraphy using HSA is preferred over phytate for both diagnosis and evaluation of disease severity and surgical site selection.


Assuntos
Linfedema , Linfocintigrafia , Humanos , Extremidade Inferior , Linfedema/diagnóstico por imagem , Ácido Fítico , Agregado de Albumina Marcado com Tecnécio Tc 99m , Tomografia Computadorizada de Emissão de Fóton Único , Tomografia Computadorizada por Raios X
5.
Breast J ; 2022: 6483318, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35711901

RESUMO

Methods: We retrospectively enrolled breast cancer patients who underwent SPECT/CT prior to sentinel lymph node biopsy. Quantification of radiotracer uptake from SPECT/CT data was performed. A radioactivity count threshold (R SPECT) using SPECT/CT was calculated for detecting metastatic sentinel lymph nodes. To localize sentinel lymph nodes exactly, we compared the positions of sentinel lymph nodes localized using SPECT/CT with positions localized surgically using an intraoperative γ-probe. Results: 491 patients were included, with a median of 3 sentinel lymph nodes/patient detected by the γ-probe and 2 sentinel lymph nodes/patient detected by SPECT/CT. As the number of sentinel lymph nodes visualized on SPECT/CT images, the metastasis incidence of lymph nodes in the ≤2 SLNs group was significantly higher than that in the >2 SLNs group (35% vs. 15%, P < 0.001). No metastasis was found in lymph nodes with R SPECT ≤ 30% in the >2 SLNs group, and thus, 30% (157/526) of SPECT/CT-identified nodes would avoid unnecessary removal. The positions of sentinel lymph nodes localized by SPECT/CT and γ-probe were identical in 42% (39/93) of patients. Conclusions: Quantitative Tc-99 m SC SPECT/CT imaging has the potential to preoperatively locate sentinel lymph nodes and intraoperatively avoid unnecessary sentinel lymph node biopsy.


Assuntos
Neoplasias da Mama , Biópsia de Linfonodo Sentinela , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Feminino , Humanos , Linfonodos/diagnóstico por imagem , Linfonodos/patologia , Linfonodos/cirurgia , Metástase Linfática/diagnóstico por imagem , Metástase Linfática/patologia , Linfocintigrafia/métodos , Estudos Retrospectivos , Biópsia de Linfonodo Sentinela/métodos , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único/métodos , Tomografia Computadorizada de Emissão de Fóton Único/métodos
6.
Pediatr Int ; 64(1): e15156, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35510682

RESUMO

BACKGROUND: To demonstrate the association between pediatric outcomes and tracer hepatic uptake as a marker of systemic circulation in lymphoscintigraphy. METHODS: We included 31 initial lymphoscintigraphic studies. We compared the presence or absence of hepatic uptake between deceased and survived patients in both early and delayed images using Fisher's exact test. Kaplan-Meier survival analysis was performed based on imaging results, and these curves were compared using the log-rank test. The primary endpoint was death and the survival period was defined from the day of examination to the day of the last visit or death. RESULTS: Of 31 patients, six died. Hepatic uptake was significantly different in both early and delayed images (early images, died [with/without visualization] vs. survived [with/without visualization], 0/6 vs. 13/12, P = 0.028; delayed images, died [with/without visualization] vs. survived [with/without visualization], 2/4 vs. 22/3, P = 0.014) between deceased and survived patients. Survival periods were significantly different between the two groups with and without hepatic uptake in early and delayed images (with/without visualization in early imags = 1,177.1 ± 773.8 days/426.7 ± 419.8 days, P = 0.008 and with/without visualization in delayed images = 821.3 ± 738.0 days/467.4 ± 452.4 days, P = 0.003). CONCLUSIONS: Visualization of hepatic uptake in both early and delayed lymphoscintigraphy is associated with patient outcomes. Hepatic uptake could represent tracer inflow into the systemic circulation, indicating preservation of the connection between the lymphatic system and the systemic circulation. Physicians should evaluate these findings carefully on lymphoscintigraphy.


Assuntos
Sistema Linfático , Linfocintigrafia , Criança , Humanos , Linfonodos , Linfocintigrafia/métodos
7.
Nucl Med Commun ; 43(8): 877-880, 2022 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-35582847

RESUMO

OBJECTIVE: Accurate sentinel lymph node (SLN) staging is essential for both prognosis and treatment in patients with breast cancer. However, the preoperative lymphoscintigraphy may fail to visualize the SLN. The aim of this retrospective study was to investigate whether parameters derived from anatomical breast imaging can predict SLN nonvisualization on lymphoscintigraphy. METHODS: For this retrospective study, all data of mammography, breast MRI, and lymphoscintigraphy of SLN procedures from January 2016 to April 2021 were collected and reviewed from the Amsterdam UMC database. RESULTS: A total of 758 breast cancer patients were included in this study. SLN nonvisualization on planar lymphoscintigraphy at 2-h postinjection (pi) was 29.7% and was reduced after a second injection to 7.5% at late lymphoscintigraphy 4-h pi. Multivariable analysis showed that age ≥ 70 years ( P = 0.019; OR, 1.82; 95% CI, 1.10-3.01), BMI ≥ 30 kg/m 2 ( P = 0.031; OR, 1.59; 95% CI, 1.04-2.43), and nonpalpable tumors ( P = 0.034; OR, 1.54; 95% CI, 1.03-2.04) were independent predictors of SLN nonvisualization. Differences in tumor size, Breast Imaging-Reporting and Data System classification, or breast density were not significantly associated with SLN nonvisualization. CONCLUSION: This study shows that, by using a multivariable analysis, risk factors for SLN nonvisualization in breast cancer patients during preoperative lymphoscintigraphy at 2-h pi are age ≥ 70 years, BMI ≥ 30 kg/m 2 , and nonpalpable tumors. Parameters derived from mammography or breast MRI, however, are not useful to predict SLN nonvisualization on lymphoscintigraphy.


Assuntos
Neoplasias da Mama , Linfonodo Sentinela , Idoso , Neoplasias da Mama/patologia , Feminino , Humanos , Linfonodos/diagnóstico por imagem , Linfonodos/patologia , Linfocintigrafia/métodos , Estudos Retrospectivos , Linfonodo Sentinela/diagnóstico por imagem , Linfonodo Sentinela/patologia , Biópsia de Linfonodo Sentinela/métodos
8.
Clin Nucl Med ; 47(10): 888-889, 2022 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-35383611

RESUMO

ABSTRACT: As congenital lymphatic malformations, lymphangiomas commonly occur in the neck, tongue, and extremities, whereas scrotum is one of the least frequent sites. For this lymphatic flow disease, lymphoscintigraphy is regarded as a useful imaging method. Herein, in a child with scrotal cysts, scrotal region activity was detected in lymphoscintigraphy, consistent with likely lymphatic disorder. The postsurgical pathology confirmed the diagnosis of lymphangioma.


Assuntos
Linfangioma , Neoplasias Cutâneas , Criança , Humanos , Linfangioma/diagnóstico por imagem , Linfocintigrafia , Masculino , Pescoço/patologia , Escroto/diagnóstico por imagem , Escroto/patologia , Neoplasias Cutâneas/patologia
9.
Plast Reconstr Surg ; 149(6): 1106e-1113e, 2022 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-35383695

RESUMO

BACKGROUND: The changes in the pattern of lymphatic drainage of the superficial abdominal wall after abdominoplasty are still unknown. These changes may increase the risk of numerous complications, including seroma formation. Depending on the alterations, the manual lymphatic drainage technique should be modified in postoperative patients. The aim of this study was to map the pattern of lymphatic drainage of the superficial infraumbilical abdominal wall after abdominoplasty. METHODS: Twenty women with indications for abdominoplasty were selected in the Plastic Surgery Division of the Federal University of São Paulo. Intradermal lymphoscintigraphy with dextran 500-99m-technetium was performed in 20 female patients in the preoperative phase and 1 and 6 months after abdominoplasty to evaluate superficial lymphatic drainage of the abdominal wall. RESULTS: Before surgery, all patients presented with abdominal lymphatic drainage toward the inguinal lymph nodes. One and 6 months after abdominoplasty, only 15 percent exhibited the same drainage pathway. Drainage toward the axillary lymph node chain occurred in 65 percent of the patients, 10 percent displayed a drainage pathway toward both the axillary and inguinal lymph nodes, and lymphatic drainage was indeterminate in 10 percent of the cases. CONCLUSIONS: A significant change in lymphatic drainage pathway occurred in the infraumbilical region after abdominoplasty. The axillary drainage path was predominant after the operation, in contrast to the inguinal path observed in the preoperative period. However, 35 percent of cases exhibited alternative drainage. No significant changes were documented between 1 and 6 months postoperatively. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Parede Abdominal , Abdominoplastia , Parede Abdominal/cirurgia , Abdominoplastia/efeitos adversos , Abdominoplastia/métodos , Axila/cirurgia , Feminino , Humanos , Linfonodos/cirurgia , Linfocintigrafia
10.
Head Neck ; 44(7): 1596-1603, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35429187

RESUMO

BACKGROUND: The purpose of this study is to assess the efficacy of lymphoscintigraphy-guided neck dissection (LSG-ND) in the treatment of N0 oral squamous cell carcinoma. METHODS: A retrospective cohort study of patients with N0 oral squamous cell carcinoma (SCC) who had either LSG-ND or neck dissection (ND) at our institution between 2008 and 2020. RESULTS: Eighty-seven patients met criteria with N0 oral squamous cell carcinoma with no previous treatment or neck surgery (27 LSG-ND, 60 ND). Sentinel lymph nodes were identified on the contralateral side in 14.8% of patients with unilateral tumors in the LSG-ND group, with 22.2% of cases with unexpected lymphatic drainage outside ipsilateral levels I-III. No recurrences to date have occurred in the LSG-ND cohort, while 13.3% of patients with ND had regional recurrence (p = 0.04). CONCLUSIONS: LSG-ND provides a greater ability to identify occult metastatic disease with a significant reduction in regional recurrence in N0 oral SCC.


Assuntos
Carcinoma de Células Escamosas , Neoplasias de Cabeça e Pescoço , Neoplasias Bucais , Segunda Neoplasia Primária , Carcinoma de Células Escamosas/diagnóstico por imagem , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/cirurgia , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Linfonodos/diagnóstico por imagem , Linfonodos/patologia , Linfonodos/cirurgia , Metástase Linfática , Linfocintigrafia , Neoplasias Bucais/diagnóstico por imagem , Neoplasias Bucais/patologia , Neoplasias Bucais/cirurgia , Esvaziamento Cervical , Estadiamento de Neoplasias , Segunda Neoplasia Primária/patologia , Estudos Retrospectivos , Biópsia de Linfonodo Sentinela , Carcinoma de Células Escamosas de Cabeça e Pescoço/diagnóstico por imagem , Carcinoma de Células Escamosas de Cabeça e Pescoço/patologia , Carcinoma de Células Escamosas de Cabeça e Pescoço/cirurgia
11.
Curr Oncol ; 29(3): 1335-1348, 2022 02 23.
Artigo em Inglês | MEDLINE | ID: mdl-35323314

RESUMO

INTRODUCTION: Detection of lymph node status in bladder cancer significantly impacts clinical decisions regarding its management. There is a wide range of detection modalities for this task, including lymphoscintigraphy, computed tomography, magnetic resonance imaging, single-photon emission computed tomography, positron emission tomography, and fluoroscopy. We aimed to study the pre- and intraoperative detection modalities of sentinel lymph nodes in urinary bladder cancer. METHOD: This narrative review was performed by searching the PubMed and EMBASE libraries using the following search terms: ("Transitional cell carcinoma of the bladder" OR "urothelial cancer" OR "urinary bladder cancer" OR "bladder cancer") AND (("sentinel lymph node") OR ("lymphatic mapping") OR ("lymphoscintigraphy") OR ("lymphangiography") OR ("lymph node metastases")). Studies analysing the effectiveness and outcomes of sentinel lymph node detection in bladder cancer were included, while non-English language, duplicates, and non-article studies were excluded. After analysing the libraries and a further manual search of bibliographies, 31 studies were included in this paper. We followed the RAMESES publication standard for narrative reviews to produce this paper. RESULTS: Of the 31 studies included, 7 studies included multiple detection methods; 5 studies included lymphoscintigraphy; 5 studies included computed tomography and/or single-photon emission computed tomography; 5 studies included fluoroscopy; 4 studies included magnetic resonance imaging; and 5 studies included positron emission tomography. DISCUSSION: Anatomical, radioactive, and functional detection modalities have been studied independently and in combination. The consensus is that preoperative detection with imaging helps guide surgical management and intraoperative detection methods help capture any lymph nodes that may have been missed. Each of these types of detection represent their own set of benefits and drawbacks, but there is currently limited evidence to support any change in overall practice to replace conventional staging.


Assuntos
Carcinoma de Células de Transição , Linfadenopatia , Linfonodo Sentinela , Neoplasias da Bexiga Urinária , Carcinoma de Células de Transição/patologia , Humanos , Metástase Linfática/patologia , Linfocintigrafia/métodos , Linfonodo Sentinela/diagnóstico por imagem , Linfonodo Sentinela/patologia , Linfonodo Sentinela/cirurgia , Biópsia de Linfonodo Sentinela/métodos , Neoplasias da Bexiga Urinária/diagnóstico por imagem , Neoplasias da Bexiga Urinária/cirurgia
12.
ANZ J Surg ; 92(6): 1434-1439, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35357754

RESUMO

BACKGROUND: The aim of this study is to determine the prevalence of incidental radiological findings detected on SPECT/CT performed as part of pre-operative lymphoscintigraphy for sentinel lymph node biopsy (SLNB) in patients undergoing breast cancer surgery and development of a modified classification to workup these lesions. METHODS: A retrospective audit was performed of all SPECT/CT performed in combination with lymphoscintigrams in breast cancer patients presenting with clinically node negative axillae and operated on by breast surgeons at the Westmead Breast Cancer Institute over a 12-month period. RESULTS: Four hundred and nineteen patients were included in the study. In 149 patients (35.6%), there was a total of 205 incidental findings. The most common findings were, pulmonary abnormalities (38.5%), abdominal findings (27.8%), thyroid nodules (14.6%), cardiac abnormalities (10.7%) and others (8.3%). Using our proposed Westmead SPECT/CT incidental findings (WSIF) classification, 7.8% were known, 17.6% were major findings, 48.3% were minor findings, 15.1% were minimal findings and 11.2% were equivocal findings. 17.6% (n = 36) underwent further workup and investigation and 3.4% of patients (n = 5) required therapeutic intervention, including chemotherapy for primary lung cancer(n = 1) and surgeries (thoracotomy, n = 1; thyroidectomy, n = 2; colonoscopy, n = 1). 93.8% (n = 393) had at least one SLN mapped, most commonly located in Level 1 of the axilla. CONCLUSION: The incidental findings on SPECT/CT in combination with lymphoscintigraphy is within the range of previous studies (27.3-59.5%). A small proportion of patients required significant major interventions (3.4%). We propose that all incidental findings should be assessed according to our WSIF classification to aid in triaging need for further investigation and management.


Assuntos
Neoplasias da Mama , Linfonodo Sentinela , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Feminino , Humanos , Achados Incidentais , Linfocintigrafia , Estudos Retrospectivos , Linfonodo Sentinela/patologia , Biópsia de Linfonodo Sentinela/métodos , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único , Tomografia Computadorizada de Emissão de Fóton Único
13.
Clin Nucl Med ; 47(5): e417-e418, 2022 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-35293355

RESUMO

ABSTRACT: We report a case of a 19-year-old man who presented with severe scrotal swelling. His medical history was notable for severe global edema at birth. Most areas of swelling had resolved by adolescence with exception of the scrotum and the left lower extremity. 99mTc-filtered sulfur colloid lymphoscintigraphy of the lower extremities demonstrated prominent dermal backflow into the superficial scrotum and thighs, which were confirmed on the SPECT/CT images, and correlated with findings on MR lymphangiogram. Lymphoscintigram and MR lymphangiogram may provide complementary information to aid diagnosis and management of primary scrotal lymphedema.


Assuntos
Linfedema , Escroto , Adolescente , Adulto , Coloides , Humanos , Recém-Nascido , Linfedema/diagnóstico por imagem , Linfocintigrafia , Masculino , Escroto/diagnóstico por imagem , Enxofre , Adulto Jovem
14.
Rev Col Bras Cir ; 49: e20222981, 2022.
Artigo em Inglês, Português | MEDLINE | ID: mdl-35239850

RESUMO

INTRODUCTION: secondary forms of lymphedema may occur as consequence of tumors, surgeries, radiotherapy, trauma and infections. Degloving injuries are severe and infrequent forms of trauma, with avulsion at the level of muscular fascia, and consequent injury of the lymphatic system. OBJECTIVE: to evaluate the alterations in lymphatic circulation in patients being victims of circumferential degloving injuries in the lower limbs, using lymphoscintigraphic. PATIENTS AND METHODS: retrospective analysis of the cases treated in the period from 2010 to 2016. Segmental, circumferential and unilateral injuries with involvement of the lower limbs were included. Lymphoscintigraphy was performed after a minimum interval of 12 months after the end of treatment. The non-injured lower limb was used as control. The Kleinhans Semiquantitative Index (KSI) was used for the semiquantitative evaluation of the lymphoscintigraphic findings. RESULTS: eighteen patients were evaluated, six of whom were female and 12 were male. The mean age was 28.11 years. The average vertical extension of the circumferential traumatized segment was 29.33cm. The injured area presented variations of 5 to 15% of the body surface, with an average of 8.95%. Lymphoscintigraphy was performed after an average interval of 22.55 months. Alterations were observed on the traumatized limb (TL) in 13 patients. All control limbs (CL) were normal. The mean KSI observed in TL was 8.32, while in CL, the average value was 0.58 (p<0.001). CONCLUSION: patients with circumferential degloving injuries in the lower limbs present compromised lymphatic circulation and high probability to develop lymphedema.


Assuntos
Desenluvamentos Cutâneos , Linfedema , Adulto , Feminino , Humanos , Extremidade Inferior/diagnóstico por imagem , Linfocintigrafia , Masculino , Estudos Retrospectivos
15.
Clin Imaging ; 84: 43-46, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35134675

RESUMO

PURPOSE: Variation in protocols for axillary sentinel lymph node (SLN) mapping exists. We strive to evaluate the effectiveness of reduction in number of injections on reducing procedural pain, while maintaining nodal detection. METHODS: Over 7 years, the number of periareolar injections performed was reduced stepwise from 4 to 1. This was analyzed for SLN detection and patients' subjective perceived pain. RESULTS: 828 patients with invasive breast cancer who underwent SLN mapping were included. Laterality of breast injection site included 326 (39.4%) in the right breast, 354 (42.8%) in the left breast and 148 (17.9%) in bilateral breasts. In patients who had 4 injection sites in a unilateral breast (n = 143), the reported pain score was 4.3 ± 2.4. Patients with 3 injections (n = 163), 2 injections (n = 163) and 1 injection (n = 211) in a breast reported pain scores of 3.4 ± 2.4, 3.2 ± 2.2, and 2.9 ± 2.6, respectively. In patients who had bilateral sentinel node procedures, those with 4 injections in each breast for a total of 8 injections (n = 37) reported a pain score of 5.7 ± 2.4. Patients with 3 (n = 51), 2 (n = 31) and 1 (n = 39) injection(s) in each breast reported perceived pain of 4.8 ± 2.8, 3.7 ± 2.7 and 3.5 ± 1.9, respectively. Incremental decreased pain scores were achieved with decreasing number of injections (p < 0.001). Nodal detection was maintained. CONCLUSION: A single periareolar subdermal injection site reduces periprocedural pain while maintaining nodal detection.


Assuntos
Neoplasias da Mama , Dor Processual , Linfonodo Sentinela , Axila/patologia , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Feminino , Humanos , Linfonodos/diagnóstico por imagem , Linfonodos/patologia , Linfocintigrafia/métodos , Dor Processual/patologia , Compostos Radiofarmacêuticos , Linfonodo Sentinela/diagnóstico por imagem , Linfonodo Sentinela/patologia , Biópsia de Linfonodo Sentinela/métodos
16.
Biomark Med ; 16(4): 303-316, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-35176878

RESUMO

Lymphedema is defined as a dysfunction of the lymphatic system producing an accumulation of lymphatic fluid in the surrounding tissue, as well as edema and fibrosis. A total of 250 million people worldwide are affected by this condition. Greater than 99% of these cases are related to a secondary cause. As there is a lack of curative therapy, the goal involves early diagnosis, in order to prevent the progression of the disease. Additionally, early diagnosis can aid in decreasing the demand for more complex surgical procedures. Currently, there is an impressive breadth of diagnostic tests available for these patients. We aimed to review the available literature in relation to the utilization of imaging biomarkers for the early diagnosis and treatment response in lymphedema.


Assuntos
Linfedema , Linfocintigrafia , Biomarcadores , Humanos , Linfedema/diagnóstico por imagem , Linfedema/terapia , Linfocintigrafia/efeitos adversos , Linfocintigrafia/métodos
17.
Eur J Surg Oncol ; 48(2): 326-332, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35000820

RESUMO

BACKGROUND: In patients with melanoma, sentinel lymph node (SLN) status is pivotal for treatment decisions. Current routine for SLN detection combines Technetium99m (Tc99) lymphoscintigraphy and blue dye (BD). The primary aim of this study was to examine the feasibility of using a low dose of superparamagnetic iron oxide (SPIO) injected intracutaneously to detect and identify the SLN, and the secondary aim was to investigate if a low dose of SPIO would enable a preoperative MRI-evaluation of SLN status. METHODS: Patients with melanoma of the extremities were eligible. Before surgery, a baseline MRI of the nodal basin was followed by an injection of a low dose (0.02-0.5 mL) of SPIO and then a second MRI (SPIO-MRI). Tc99 and BD was used in parallel and all nodes with a superparamagnetic and/or radioactive signal were harvested and analyzed. RESULTS: Fifteen patients were included and the SLNB procedure was successful in all patients (27 SLNs removed). All superparamagnetic SLNs were visualized by MRI corresponding to the same nodes on scintigraphy. Micrometastatic deposits were identified in four SLNs taken from three patients, and SPIO-MRI correctly predicted two of the metastases. There was an association between MRI artefacts in the lymph node and the dose SPIO given. DISCUSSION: It is feasible to detect SLN in patients with melanoma using a low dose of SPIO injected intracutaneously compared with the standard dual technique. A low dose of SPIO reduces the lymph node MRI artefacts, opening up for a non-invasive assessment of SLN status in patients with cancer.


Assuntos
Extremidades/diagnóstico por imagem , Nanopartículas Magnéticas de Óxido de Ferro , Melanoma/diagnóstico por imagem , Biópsia de Linfonodo Sentinela/métodos , Linfonodo Sentinela/diagnóstico por imagem , Neoplasias Cutâneas/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Extremidades/patologia , Estudos de Viabilidade , Feminino , Humanos , Linfocintigrafia/métodos , Imageamento por Ressonância Magnética , Magnetometria , Masculino , Melanoma/patologia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Linfonodo Sentinela/patologia , Neoplasias Cutâneas/patologia
18.
Lymphat Res Biol ; 20(2): 144-152, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-34415778

RESUMO

Background: In patients with secondary upper limb lymphedema, positive correlations have been observed between the dermal back flow (DBF) type and visualization of lymph nodes around the clavicle, between the former and the lymph flow pathway type, and between the latter and the visualization of lymph nodes around the clavicle when using single photon-emission computed tomography/computed tomography/lymphoscintigraphy (SPECT-CT LSG). Methods and Results: We analyzed the associations between the visualization of inguinal lymph nodes, the lymph flow pathway type, and the DBF type using SPECT-CT LSG in 81 patients with unilateral secondary lower limb lymphedema by statistical analysis using Fisher's exact test. We revealed that the lymph flow pathways in the lower limb can be classified into nine types because the type in the lower leg is not always equal to the type in the thigh. Associations were observed between the visualization of inguinal lymph nodes and types of DBF (p < 0.01), between the types of lymph flow pathway in the thighs and visualization of the inguinal lymph nodes (p = 0.02), and between the lymph flow pathway types in the thighs and lower legs (p < 0.01). Conclusion: Detriment to the superficial lymph flow pathways in the lower limb appears to usually start from the proximal side, and deep pathways are considered to become dominant from a compensatory perspective as lymphedema severity increases.


Assuntos
Linfedema , Linfocintigrafia , Humanos , Extremidade Inferior/diagnóstico por imagem , Extremidade Inferior/patologia , Sistema Linfático/diagnóstico por imagem , Sistema Linfático/patologia , Linfedema/diagnóstico por imagem , Linfedema/etiologia , Linfedema/patologia , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único/efeitos adversos
19.
J Surg Oncol ; 125(4): 712-718, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34786720

RESUMO

BACKGROUND: In 2014, technetium-99m tilmanocept (TcTM) replaced technetium-99m sulfur colloid (TcSC) as the standard lymphoscintigraphy (LS) mapping agent in melanoma patients undergoing sentinel lymph node biopsy (SLNB). The aim of this study was to examine differences in mapping time, intra-operative identification of sentinel lymph node (SLN), and false negative rate (FNR) between patients who underwent SLNB with TcTM compared to TcSC. METHODS: Patients who underwent SLNB between 2010 and 2018 were retrospectively identified. Patient demographic, tumor, and imaging data was stratified by receipt of TcSC (n = 258) or TcTM (n = 133). Student's t test and χ2 test were used to compare characteristics and outcomes. RESULTS: Both cohorts were similar in demographic, primary tumor characteristics, and total number of SLN identified (TcTM 3.56 vs. TcSC 3.28, p = 0.244). TcTM was associated with significantly shorter LS mapping times (51.8 vs. 195.1 min, p < 0.01). There was no significant difference in the number of patients with positive SLN (TcTM 11.3 vs. TcSC 17.4%, p = 0.109) and the FNR was similar between both groups (TcTM 25% vs. TcSC 22%). CONCLUSION: TcTM was associated with significantly shorter LS mapping time while identifying similar numbers of SLN. Our results support further study to ensure similar FNR and oncologic outcomes between agents.


Assuntos
Linfocintigrafia/métodos , Melanoma/patologia , Recidiva Local de Neoplasia/patologia , Compostos Radiofarmacêuticos/metabolismo , Linfonodo Sentinela/patologia , Pentetato de Tecnécio Tc 99m/metabolismo , Coloide de Enxofre Marcado com Tecnécio Tc 99m/metabolismo , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Seguimentos , Humanos , Masculino , Melanoma/diagnóstico por imagem , Melanoma/metabolismo , Melanoma/cirurgia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/metabolismo , Recidiva Local de Neoplasia/cirurgia , Prognóstico , Estudos Retrospectivos , Linfonodo Sentinela/diagnóstico por imagem , Linfonodo Sentinela/metabolismo , Linfonodo Sentinela/cirurgia , Biópsia de Linfonodo Sentinela , Adulto Jovem
20.
Future Oncol ; 18(2): 193-204, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34882010

RESUMO

Aims: The clinical significance of nonvisualized sentinel lymph nodes (non-vSLNs) is unknown. The authors sought to determine the incidence of non-vSLNs on lymphoscintigraphy, the identification rate during surgery, factors associated with non-vSLNs and related axillary management. Patients & methods: A total of 30,508 consecutive SLN procedures performed at a single institution from 2000 to 2017 were retrospectively studied. Associations between clinicopathological factors and the identification of SLNs during surgery were assessed. Results: Non-vSLN occurred in 525 of the procedures (1.7%). In 73.3%, at least one SLN was identified intraoperatively. Nodal involvement was only significantly associated with SLN nonidentification (p < 0.001). Conclusion: Patients with non-vSLN had an increased risk for SLN metastasis. The detection rate during surgery was consistent, reducing the amount of unnecessary axillary dissection.


Lay abstract To study the clinical significance of nonvisualized sentinel lymph nodes (non-vSLNs) in axillary surgery for breast cancer, 30,508 consecutive SLN procedures performed at a single institution from 2000 to 2017 were retrospectively reviewed with the aim to analyze the incidence of non-vSLNs on lymphoscintigraphy, the identification rate during surgery, factors associated with non-vSLNs and related axillary management. Associations between clinicopathological factors and the identification of SLNs during surgery were assessed. Non-vSLN occurred in 525 of the procedures (1.7%). In 73.3%, at least one SLN was identified intraoperatively. Nodal involvement was only significantly associated with SLN nonidentification (p < 0.001). Patients with non-vSLN had an increased risk for SLN metastasis. The detection rate during surgery was consistent, reducing the amount of unnecessary axillary dissection.


Assuntos
Neoplasias da Mama/patologia , Metástase Linfática/diagnóstico , Linfocintigrafia/estatística & dados numéricos , Mastectomia/estatística & dados numéricos , Idoso , Axila , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/cirurgia , Feminino , Humanos , Incidência , Período Intraoperatório , Metástase Linfática/patologia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos , Linfonodo Sentinela/diagnóstico por imagem , Linfonodo Sentinela/patologia , Biópsia de Linfonodo Sentinela/estatística & dados numéricos
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