Methodological Aspects of Lymphoscintigraphy: Bicompartmental Versus Monocompartmental Radiocolloid Administration

Sollini, Martina; Bartoli, Francesco; Marciano, Andrea; Zanca, Roberta; D’Errico, Giovanni; Mariani, Giuliano; Erba, Paola Anna

doi:10.1007/978-3-030-45296-4_4

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“…Lymphoscintigraphy using the conventional self-conducted stress maneuver may underestimate the lymphatic drainage capacity of the proximal upper extremities of some patients with a trace amount of functioning lymphatic vessels. This finding is consistent with previous studies demonstrating insufficient visualization of lymphatic vessels in the proximal upper extremities using the self-conducted stress maneuver 22,45,46 . Previous studies have recommended additional administration of radiotracers as a compensatory procedure to evaluate proximal lymphatic drainage.…”

Section: Discussionsupporting

confidence: 92%

“…This finding is consistent with previous studies demonstrating insufficient visualization of lymphatic vessels in the proximal upper extremities using the self-conducted stress maneuver. 22,45,46 Previous studies have recommended additional administration of radiotracers as a compensatory procedure to evaluate proximal lymphatic drainage. Our study shows that the pneumatic compression of the upper extremity before lymphoscintigraphy sensitively visualizes remaining lymphatic vessels in the upper arm compared with the conventional stress maneuver.…”

Section: Discussionmentioning

confidence: 99%

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Pneumatic Compression–Assisted Lymphoscintigraphy for Quantitative Evaluation of Breast Cancer–Related Lymphedema

et al. 2023

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ObjectivesAcquired 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).MethodsOur 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.ResultsOf 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.ConclusionOur 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.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%