Technical Aspects of Performing Lymphoscintigraphy

Krynyckyi, Borys R.; Miner, Michele; Ragonese, Jennifer M.; Firestone, Michael I.; Kim, Chun Ki; Macháč, Josef

doi:10.1097/00003072-200012000-00003

Cited by 33 publications

(6 citation statements)

References 10 publications

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“…However, plain lymphoscintigraphy images do not show any anatomical detail or exact location of the sentinel nodes in axilla which are very important factors for surgery planning 4. Skin pen marking1, stereoscopic lymphoscintigraphy5 and body outlining6 are three solutions to deal with this problem. Several methods are in use for outlining the body contour during lymphoscintigrpahy imaging with their own advantages and drawbacks 7.…”

Section: Introductionmentioning

confidence: 99%

Scatterogram: a method for outlining the body during lymphoscintigraphy without using external flood source

Momennezhad¹,

Kakhki²,

Jangjoo³

et al. 2011

Radiology and Oncology

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BackgroundWe evaluated the feasibility of outlining the body with scattered photons using a low dose intradermal injection of the radiotracer.Patients and methods.Sixty breast cancer patients were included into the study. 30 minutes post radiotracer injection static lymphoscintigraphy images were acquired using low energy high resolution collimator in anterior and lateral views. For patients with 2-day protocol another set of images was taken 20 hours post-injection. Two photopeaks were used during imaging: 1-Tc-99m (130-150 keV) and 2- Scatter photons (60-120). The fusion image of these two images was constructed by NM-NM fusion workflow of the workstation. The usual body outline of the patients was also acquired in 20 cases using the external flood source without moving the patients from their positions.ResultsThe early (30 minute image) scatterograms of the patients clearly showed the contour of the body. The 20 hour scatterograms were not as high quality as the corresponding early images. The constructed overlaid images showed the location of the axillary sentinel nodes and the body contours clearly for early scatterograms but not the delayed (20 hour) ones. The processing of the images for the reconstruction of overlaid scatterograms took the mean time of 10±5 seconds.ConclusionsImaging the scattered photons is feasible for the intradermal low dose injection of the radiotracers in order to outline the body contour. This imaging method does not increase the radiation exposure of the patients or operators and does not extend the time of imaging either.

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Section: Introductionmentioning

confidence: 99%

Scatterogram: a method for outlining the body during lymphoscintigraphy without using external flood source

Momennezhad¹,

Kakhki²,

Jangjoo³

et al. 2011

Radiology and Oncology

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“…Image acquisition when the patient's arm is 90 from the long axis of the patient to simulate the surgical position has been discussed. Because of the impracticality of obtaining lateral views, arm angles of between 135 and 180 have been suggested as a compromise (8). However, this is also not the native position of the surgery.…”

Section: Discussionmentioning

confidence: 99%

“…However, this positioning is not practical for image acquisitions in 2 different views using a dual-head camera. Also, oblique images may be more difficult to interpret (8). Image acquisitions in a prone position with the breast hanging using a special pad with cutouts to move the injection site away from the axilla has been described.…”

Section: Discussionmentioning

confidence: 99%

A Practical Technique to Improve Visualization of Sentinel Nodes in the Axillary Region on Breast Lymphoscintigraphy: Medial Breast Traction by Patient

Özdemir

Corner

Searcy

et al. 2021

J. Nucl. Med. Technol.

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Methods: A standard method of performing breast lymphoscintigraphy is to obtain anterior and lateral views after periareolar intradermal injection of a radiotracer. However, a sentinel lymph node may be obscured by the activity at the injection site, especially on anterior views. Also, breast tissue may cause attenuation to prevent sentinel node visualization. In cases in which a sentinel lymph node is visualized on one view but not the other view or a sentinel lymph node is either not visualized or inadequately visualized, we repeat anterior and lateral views during medial traction of the breast performed by the patient. Results: We have found the medial breast traction technique performed by the patient to be especially useful for identification of axillary sentinel nodes. Conclusion: Repeat images during medial traction of the breast by the patient is an effective technique to improve visualization of sentinel lymph nodes in the axillary region.

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“…However, radioisotope shows some inherent limitations. It has been reported to cause moderate and severe pain at the site of injection in many patients 23 . Moreover, the suboptimal spatial resolution of the detecting system and the lack of anatomic landmarks showing on the monitor hinder the accuracy of lymph node localization and numbers assessed even by experienced surgeons.…”

Section: Discussionmentioning

confidence: 99%

Comparison of sentinel lymph node detection performances using blue dye in conjunction with indocyanine green or radioisotope in breast cancer patients: a prospective single-center randomized study

Yuan

Zhang

et al. 2018

Cancer Biology & Medicine

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Objective:This randomized study aimed to compare the clinical efficacy between the novel dual tracer composed of indocyanine green (ICG) and blue dye (BD) and the conventional dual tracer composed of radioisotope and BD for sentinel lymph node (SLN) mapping in patients with breast cancer.Methods:This study enrolled 471 clinically lymph node-negative patients with primary breast cancer. All patients underwent mastectomy, and those undergoing sentinel lymph node biopsy (SLNB) were randomized to receive blue dye plus radioisotope (RB group) or BD plus ICG (IB group). The detection performances on SLN identification rate, positive SLN counts, detection sensitivity, and false-negative rate were compared between the two groups.Results:In the IB group, 97% (194/200) of the patients who underwent the ICG and BD dual tracer injection showed fluorescent-positive lymphatic vessels within 2–5 min. The identification rate of SLNs was comparable between the IB group (99.0%, 198/200) and the RB group (99.6%, 270/271) (P = 0.79). No significant differences were observed in the identification rate of metastatic SLNs (22.5% vs. 22.9%, P > 0.05, RB group vs. IB group, the same below), positive SLN counts (3.72 ± 2.28 vs. 3.91 ± 2.13, P > 0.05), positive metastatic SLN counts (0.38 ± 0.84 vs. 0.34 ± 0.78, P > 0.05), SLNB detection sensitivity (94.4% vs. 92.5%, P > 0.05), or false-negative rate (5.6% vs. 7.5%, P > 0.05) between the two groups. Conclusions:ICG can be used as a promising alternative tracer for radioisotope in SLN mapping, and when it is combined with BD in lymphangiography, it offers comparable detection sensitivity compared to the conventional lymphatic mapping strategies that are widely used in clinical practice.

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Technical Aspects of Performing Lymphoscintigraphy

Cited by 33 publications

References 10 publications

Scatterogram: a method for outlining the body during lymphoscintigraphy without using external flood source

Scatterogram: a method for outlining the body during lymphoscintigraphy without using external flood source

A Practical Technique to Improve Visualization of Sentinel Nodes in the Axillary Region on Breast Lymphoscintigraphy: Medial Breast Traction by Patient

Comparison of sentinel lymph node detection performances using blue dye in conjunction with indocyanine green or radioisotope in breast cancer patients: a prospective single-center randomized study

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