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Clinical Significance of Lymphoscintigraphy Findings in the Evaluation of Lower Extremity Lymphedema.

Karaçavuş S, Yılmaz YK, Ekim H - Mol Imaging Radionucl Ther (2015)

Bottom Line: The rate of popliteal node visualization was higher in patients with dermal backflow as compared to those without dermal backflow (p<0.001).The duration of lymphedema was also longer in patients with dermal backflow and popliteal nodes (p<0.004).Abstract available from the publisher.

View Article: PubMed Central - PubMed

Affiliation: Bozok University Faculty of Medicine, Department of Nuclear Medicine, Yozgat, Turkey Phone: +90 505 267 82 09 E-mail: seyhan.karacavus@bozok.edu.tr.

ABSTRACT

Objective: The purpose of this study was to investigate the clinical significance of lymphoscintigraphy imaging in the evaluation of lower extremity lymphedema.

Methods: Technetium-99m-labeled nanocolloid was injected subcutaneously in the first web spaces of both feet of 123 patients (M/F: 43/80, mean age 57.5±13.1 years, range 16-78 years) who had clinical evidence of lower extremity swelling with suspicion of lymphedema, and were referred for routine lymphoscintigraphy. Lymphoscintigraphy scan was started as dynamic viewing followed by static whole body imaging at 10 minute, 1 hour and 4 hours after injection.

Results: Eighty-seven patients had lymphedema. Patients who had lymphedema were divided into two groups according to their scintigraphy findings: Group I included 58 patients without uptake in the popliteal nodes, and group II included 29 patients with positive popliteal nodes. The rate of popliteal node visualization was higher in patients with dermal backflow as compared to those without dermal backflow (p<0.001). The duration of lymphedema was also longer in patients with dermal backflow and popliteal nodes (p<0.004).

Conclusion: Lymphoscintigraphy is a reliable, easily applied and well-tolerated objective method to diagnose lower extremity lymphedema. Uptake by popliteal lymph nodes and the presence of dermal backflow on lymphoscintigraphy, which is performed for evaluation of the lower limb lymphedema, were important signs indicating longer disease duration and higher severity of lymphatic dysfunction.

No MeSH data available.


Related in: MedlinePlus

a) Lymphoscintigraphy findings of a patient at L-stage IIa; dermal back-flow and popliteal lymph nodes were seen on the left lower extremity. b) A patient at L-stage IV; without crossing the main lymphatic channels on left lower extremity. Without crossing the main lymphatic channels on left lower extremity
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f3: a) Lymphoscintigraphy findings of a patient at L-stage IIa; dermal back-flow and popliteal lymph nodes were seen on the left lower extremity. b) A patient at L-stage IV; without crossing the main lymphatic channels on left lower extremity. Without crossing the main lymphatic channels on left lower extremity

Mentions: In this study, we identified that the presence of dermal backflow and popliteal lymph nodes demonstrated lymphatic flow impairment, and they were associated with duration of lymphedema, which was longer in patients with dermal backflow and popliteal lymph nodes. Looking at the literature, Burnand et al pointed out in their study that popliteal nodes were observed in patients with abnormalities, and there was a strong relationship between dermal backflow and popliteal lymph node visualization (16). Similarly, Kandeel et al. reported that popliteal lymph node uptake during lymphoscintigraphy indicated lymph flow re-routing from the superficial to the deep system, and it was related to longer duration of lymphatic dysfunction (17). Our results were similar to previous studies. In L-stage II and III, these findings were seen more frequently as compared to L-stage I that represents early stage lymphedema and L-stage IV without crossing the main lymphatic channels and with absence of collateral lymphatic channels. As a matter of fact, lymphoscintigraphic staging is based on lymphoscintigraphic findings such as main lymphatics, dermal backflow and collaterals. Lee and Bergan developed new clinical and laboratory staging systems; the former was based on subjective and objective findings of local and systemic conditions, and the latter on lymphoscintigraphy findings aiming to improve the clinical management of chronic lymphedema (6). They suggested that these two staging systems are not just a new guideline to improve lymphedema management but also to provide a better prediction of treatment outcome, and to guide additional medical and surgical therapy planning. We also believe that standardized documentation of findings is essential for objective assessment, management and follow-up. Figure 3 demonstrates lymphoscintigraphy findings of patients at L-stage IIa and L-stage IV. When referring to a patient at this stage, the presence of a large amount of dermal backflow could be imagined in lymphoscintigraphy of this patient. In addition, abnormal tracer accumulation could be seen on lymphoscintigraphy in other diseases such as extravasation of lymphatic fluid into body cavities (chylothorax or chylous ascites), lymphocele, and lymphangiectasia (1). Figure 4 and 5 show our patients with chylothorax and lymphangitis, respectively.


Clinical Significance of Lymphoscintigraphy Findings in the Evaluation of Lower Extremity Lymphedema.

Karaçavuş S, Yılmaz YK, Ekim H - Mol Imaging Radionucl Ther (2015)

a) Lymphoscintigraphy findings of a patient at L-stage IIa; dermal back-flow and popliteal lymph nodes were seen on the left lower extremity. b) A patient at L-stage IV; without crossing the main lymphatic channels on left lower extremity. Without crossing the main lymphatic channels on left lower extremity
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4563174&req=5

f3: a) Lymphoscintigraphy findings of a patient at L-stage IIa; dermal back-flow and popliteal lymph nodes were seen on the left lower extremity. b) A patient at L-stage IV; without crossing the main lymphatic channels on left lower extremity. Without crossing the main lymphatic channels on left lower extremity
Mentions: In this study, we identified that the presence of dermal backflow and popliteal lymph nodes demonstrated lymphatic flow impairment, and they were associated with duration of lymphedema, which was longer in patients with dermal backflow and popliteal lymph nodes. Looking at the literature, Burnand et al pointed out in their study that popliteal nodes were observed in patients with abnormalities, and there was a strong relationship between dermal backflow and popliteal lymph node visualization (16). Similarly, Kandeel et al. reported that popliteal lymph node uptake during lymphoscintigraphy indicated lymph flow re-routing from the superficial to the deep system, and it was related to longer duration of lymphatic dysfunction (17). Our results were similar to previous studies. In L-stage II and III, these findings were seen more frequently as compared to L-stage I that represents early stage lymphedema and L-stage IV without crossing the main lymphatic channels and with absence of collateral lymphatic channels. As a matter of fact, lymphoscintigraphic staging is based on lymphoscintigraphic findings such as main lymphatics, dermal backflow and collaterals. Lee and Bergan developed new clinical and laboratory staging systems; the former was based on subjective and objective findings of local and systemic conditions, and the latter on lymphoscintigraphy findings aiming to improve the clinical management of chronic lymphedema (6). They suggested that these two staging systems are not just a new guideline to improve lymphedema management but also to provide a better prediction of treatment outcome, and to guide additional medical and surgical therapy planning. We also believe that standardized documentation of findings is essential for objective assessment, management and follow-up. Figure 3 demonstrates lymphoscintigraphy findings of patients at L-stage IIa and L-stage IV. When referring to a patient at this stage, the presence of a large amount of dermal backflow could be imagined in lymphoscintigraphy of this patient. In addition, abnormal tracer accumulation could be seen on lymphoscintigraphy in other diseases such as extravasation of lymphatic fluid into body cavities (chylothorax or chylous ascites), lymphocele, and lymphangiectasia (1). Figure 4 and 5 show our patients with chylothorax and lymphangitis, respectively.

Bottom Line: The rate of popliteal node visualization was higher in patients with dermal backflow as compared to those without dermal backflow (p<0.001).The duration of lymphedema was also longer in patients with dermal backflow and popliteal nodes (p<0.004).Abstract available from the publisher.

View Article: PubMed Central - PubMed

Affiliation: Bozok University Faculty of Medicine, Department of Nuclear Medicine, Yozgat, Turkey Phone: +90 505 267 82 09 E-mail: seyhan.karacavus@bozok.edu.tr.

ABSTRACT

Objective: The purpose of this study was to investigate the clinical significance of lymphoscintigraphy imaging in the evaluation of lower extremity lymphedema.

Methods: Technetium-99m-labeled nanocolloid was injected subcutaneously in the first web spaces of both feet of 123 patients (M/F: 43/80, mean age 57.5±13.1 years, range 16-78 years) who had clinical evidence of lower extremity swelling with suspicion of lymphedema, and were referred for routine lymphoscintigraphy. Lymphoscintigraphy scan was started as dynamic viewing followed by static whole body imaging at 10 minute, 1 hour and 4 hours after injection.

Results: Eighty-seven patients had lymphedema. Patients who had lymphedema were divided into two groups according to their scintigraphy findings: Group I included 58 patients without uptake in the popliteal nodes, and group II included 29 patients with positive popliteal nodes. The rate of popliteal node visualization was higher in patients with dermal backflow as compared to those without dermal backflow (p<0.001). The duration of lymphedema was also longer in patients with dermal backflow and popliteal nodes (p<0.004).

Conclusion: Lymphoscintigraphy is a reliable, easily applied and well-tolerated objective method to diagnose lower extremity lymphedema. Uptake by popliteal lymph nodes and the presence of dermal backflow on lymphoscintigraphy, which is performed for evaluation of the lower limb lymphedema, were important signs indicating longer disease duration and higher severity of lymphatic dysfunction.

No MeSH data available.


Related in: MedlinePlus