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Modalities of detection of sentinel nodes in lymphatic mapping
Published in Charles F. Levenback, Ate G.J. van der Zee, Robert L. Coleman, Clinical Lymphatic Mapping in Gynecologic Cancers, 2022
Blanca Segarra, Nuria Agusti, Pedro T. Ramirez
The first stage of SLN identification is preoperative lymphoscintigraphy. It is performed in a 1- or 2-day protocol with the injection of99mTc-labeled radiocolloid on the day of the surgery, 4–6 hours before the planned surgery, or a day before, 16–20 hours before the scheduled surgery, respectively. The preparations are based on the protocol used, 15–20 MBq (1-day protocol) or 37–74 MBq (2-day protocol). The protocol choice depends on the logistics and experience of the team.6 Intraoperative lymphoscintigraphy is usually performed 120 minutes after administration of the radiocolloid (the static phase of examination). In some instances, to establish the direction of lymphatic drainage and to facilitate identifying the SLN, a dynamic exam is performed immediately after the administration of the radioactive tracer.7 It is recommended to perform a quantitative measure of the radioactivity in the sentinel node with the gamma probe in order to detect an increase in the radiation count compared with the basal count (at least five to ten times greater than background radioactivity).
Lymphoscintigraphy
Published in Michael Ljungberg, Handbook of Nuclear Medicine and Molecular Imaging for Physicists, 2022
Rimma Axelsson, Maria Holstensson, Ulrika Estenberg
Today MRI, CT, ultrasonography, and lymphoscintigraphy are imaging modalities used for patients with swollen limbs. Radiological methods can demonstrate signs of lymphedema such as edema, skin thickening, fluid accumulation, and honeycomb pattern of the subcutaneous tissue, which are characteristic for the disease [5–7]. While all these are signs of consequences of lymphatic diseases, lymphoscintigraphic imaging provides direct visualization of the lymphatic vessels and physiological information of the lymph flow [8]. Lymphoscintigraphy is simple and is an easily reproducible imaging technique allowing assessment and visualization of the lymph distribution through the lymph vessels and nodes. Apart from the low radiation exposure associated with lymphoscintigraphy (further discussed in section 1.10), there are no known risks or side effects [9].
Miscellaneous procedures
Published in A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha, Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha
Lymphoscintigraphy also plays a role in diagnostic imaging. This nuclear medicine imaging procedure involves the administration of 99mTc-nanocolloid into the interstitial tissues allowing demonstration of the lymphatic vessels in the limbs and is mainly used in cases where the lymphatic system has been compromised and more specifically cases of lymphoedema.
Modelling uptake and transport of therapeutic agents through the lymphatic system
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2022
T. D. Jayathungage Don, V. Suresh, J. E. Cater, R. J. Clarke
Studies that model the extended peripheral lymphatic vessel network are rarer. The optimal organisational structure of the lymphatic capillary network has been investigated through the use of homogenization theory (Roose and Swartz 2012), which leads to a volume-averaged representation of the initial lymphatics as an anisotropic porous medium. There has also been some modelling work undertaken in the context of lymphatic imaging, which is often used to facilitate disease staging for a variety of cancers and for lymphoedema (Thompson and Uren 2005; Suami et al. 2019). For example, lymphoscintigraphy (LS) is used to identify which lymph nodes directly drain a cancerous tumour. This is done by injecting a radiocolloid at the primary tumour site, so that lymphatic drainage can be mapped and the draining sentinel lymph nodes (SLNs) identified for biopsy. Prior modelling work analysing LS imaging has shown collective patterns of lymphatic drainage from primary tumours to SLNs (Reynolds et al. 2007; Blumgart et al. 2011), however, these models did not explicitly include the lymphatic vessels.
Primary ectopic lobular breast cancer of the vulva: case report and review of literature
Published in Journal of Obstetrics and Gynaecology, 2020
Luka Matak, Branko Dukić, Tvrtko Tupek, Nataša Lisica-Šikić, Mislav Mikuš
On exam, she was noted to have a red ulceration of approximately 0.5 cm in diameter with a palpable subcutaneous tumour of 1 cm in diameter on the mons pubis at the median line, 1 cm above the clitoris and under the skin. The immunohistochemical stain of the tumour cells was cytokeratin 7 (CK7), epithelial membrane antigen (EMA), AE1/AE3, oestrogen, progesterone all-positive; while HMB 45, melan A, calretinin, alpha-inhibin were all negative. The patient was further evaluated with positron emission tomography, mammography, ultrasound of the breast, multislice computer tomography of the thorax and abdomen, magnetic radiography of the breast and tumour markers CEA, Ca 15-3, Ca 19-9, Ca 125. These analyses, however, did not confirm the breast as the origin of the tumour. Five hours before the second surgery, each quadrant around the scar was superficially injected at 3, 6, 9 and 12 hours with deposits of technetium 99-m HAS colloid in a total of 37 MBq. A dynamic lymphoscintigraphy was performed with a handheld gamma camera. Both the left and right groin were checked for localisation, and positive lymph node was identified in the right groin.
The application of indocyanine green (ICG) and near-infrared (NIR) fluorescence imaging for assessment of the lymphatic system in reconstructive lymphaticovenular anastomosis surgery
Published in Expert Review of Medical Devices, 2021
Albert H. Chao, Steven A. Schulz, Stephen P. Povoski
Compared to other types of lymphatic imaging, ICG lymphangiography is better suited for the purposes of lymphatic surgery. Lymphoscintigraphy involves radiation exposure, provides insufficient resolution, and lacks the capacity to provide real-time information about the lymphatic system[56]. Magnetic resonance lymphangiography (MRL) depicts the lymphatic system with high resolution and without radiation exposure, but cannot be performed intraoperatively nor provide real-time information. However, it is worth noting that MRL images both superficial and deep lymphatic channels, and thus can provide additional information beyond ICG lymphangiography [57,58]. This has led some investigators to utilize both ICG lymphangiography and MRL for planning lymphatic surgery[59].