LENFÖDEM VE PERİFERİK LENFOSİNTİGRAFİ

Abstract

Periferik ekstremite lenfödemi lenfatik sistemin mekanik veya fonksiyonel obstrüksiyonu sonucunda oluşur. Lenfödemli has taların uygun şekilde yönetilebilmesi için doğru tanı konulması önemlidir. Lenödemin saptanması için ilk tercih edilecek yön temler arasında lenfosintigrafi önemli bir yer tutar. Testin sonucu nu etkileyen faktörler, farklı test protokollerinin yorumlanmasını zorlaştırabilir. Bu derlemenin amacı, alt ekstremite lenfödeminin etiyolojisi ve tanı yöntemleri hakkında literatüre dayalı bir bakış sağlamak ve lenfosintigrafi protokolleri ve yorumlaması hakkın daki güncel bilgileri özetlemektir.

Keywords

• Periferik lenfödem
• lenfosintigrafi
• sintigrafi protokolleri

LYMPHEDEMA AND PERIPHERAL LYMPHOSCINTIGRAPHY

Abstract

Peripheral lymphedema occurs because of mechanical or func tional obstruction of the lymphatic system. Accurate diagnosis is important for the appropriate management of patients with lymphedema. Lymphoscintigraphy is a useful technique among the first-choice methods to detect lymphedema. Factors affect ing the outcome of the test and different test protocols can make it difficult to interpret. The aim of this review is to provide a literature-based overview of the aetiology and diagnostic meth ods of extremity lymphedema and to summarise the current knowledge on lymphoscintigraphy protocols and interpretation.

Keywords

• Peripheral lymphedema
• lymphoscintigraphy
• scin tigraphy protocols

References

1. 1. Walker LA. Localization of radioactive colloids in lymph nodes. The J Lab Clin Med 1950;36(3):440-9. google scholar
2. 2. Sherman AI, Ter - Pogossian M. Lymph-node concentration of radioactive colloidal gold following interstitial injection. Cancer 1953;6(6):1238-40. [CrossRef] google scholar
3. 3. Threefoot S, Kent W, Hatchett B. Lymphaticovenous and lymphaticolymphatic communications demonstrated by plastic corrosion models of rats and by postmortem lymphangiography in man. The J Lab Clin Med 1963;61:9-22. google scholar
4. 4. Szuba A, Shin WS, Strauss HW, Rockson S. The third circulation: radionuclide lymphoscintigraphy in the evaluation of lymphedema. J Nucl Med 2003;44(1):43-57. google scholar
5. 5. Jensen MR, Simonsen L, Karlsmark T, Bülow J. Lymphoedema of the lower extremities-background, pathophysiology and diagnostic considerations. Clin Phisiol Funct I 2010;30(6):389-98. [CrossRef] google scholar
6. 6. O’Donnell Jr TF, Rasmussen JC, Sevick-Muraca EM. New diagnostic modalities in the evaluation of lymphedema. J Vasc Surg-Venous L 2017;5(2):261-73. [CrossRef] google scholar
7. 7. Barrett T, Choyke PL, Kobayashi H. Imaging of the lymphatic system: new horizons. Contrast Media Mol I 2006;1(6):230-45. [CrossRef] google scholar
8. 8. Maclellan RA, Greene AK. Lymphedema. Semin Pediatr Surg 2014;23(4):191-7. [CrossRef] google scholar

9. 9. Tiwari A, Cheng KS, Button M, Myint F, Hamilton G. Differential diagnosis, investigation, and current treatment of lower limb lymphedema. Arch Surg 2003;138(2):152-61. [CrossRef] google scholar
10. 10. Erickson VS, Pearson ML, Ganz PA, Adams J, Kahn KL. Arm edema in breast cancer patients. J Natl Cancer I 2001;93(2):96-111. [CrossRef] google scholar
11. 11. Suami H, Koelmeyer L, Mackie H, Boyages J. Patterns of lymphatic drainage after axillary node dissection impact arm lymphoedema severity: A review of animal and clinical imaging studies. Surg Oncol 2018;27(4):743-50. [CrossRef] google scholar
12. 12. Warren AG, Brorson H, Borud LJ, Slavin SA. Lymphedema: a comprehensive review. Ann Plas Surg 2007;59(4):464-72. [CrossRef] google scholar
13. 13. Du X, Liu C. Application of imaging in lymphedema surgical therapies. Gland Surg 2020;9(2):582. [CrossRef] google scholar
14. 14. Kinmonth JB. Lymphangiography in man; a method of outlining lymphatic trunks at operation. Clin Sci 1952;11(1):13-20. google scholar
15. 15. Weissleder H, Weissleder R. Interstitial lymphangiography: initial clinical experience with a dimeric nonionic contrast agent. Radiology 1989;170(2):371-4. [CrossRef] google scholar
16. 16. Yoshida RY, Kariya S, Ha-Kawa S, Tanigawa N. Lymphoscintigraphy for imaging of the lymphatic flow disorders. Tech Vasc Interv Radiol 2016;19(4):273-6. [CrossRef] google scholar
17. 17. Suehiro K, Morikage N, Murakami M, Yamashita O, Samura M, Hamano K. Significance of ultrasound examination of skin and subcutaneous tissue in secondary lower extremity lymphedema. Ann Vasc Dis 2013;6(2):180-8. [CrossRef] google scholar
18. 18. Shin SU, Lee W, Park E-A, Shin C-I, Chung JW, Park JH. Comparison of characteristic CT findings of lymphedema, cellulitis, and generalized edema in lower leg swelling. Int J Cardiovasc Imaging 2013;29:135-43. [CrossRef] google scholar
19. 19. Carroll BJ, Singhal D. Advances in lymphedema: An underrecognized disease with a hopeful future for patients. Vasc Med 2024;29(1):70-84. [CrossRef] google scholar
20. 20. White R, Weir-McCall J, Budak M, Waugh S, Munnoch D, Sudarshan T. Contrast-enhanced magnetic resonance lymphography in the assessment of lower limb lymphoedema. Clin Radiol 2014;69(11):e435-e44. [CrossRef] google scholar
21. 21. Unno Na, Nishiyama M, Suzuki M, Yamamoto N, Inuzuka K, Sagara D, et al. Quantitative lymph imaging for assessment of lymph function using indocyanine green fluorescence lymphography. Eur J Vasc Endovasc Surg 2008;36(2):230-6. [CrossRef] google scholar
22. 22. Ohtake E, Matsui K. Lymphoscintigraphy in patients with lymphedema. A new approach using intradermal injections of technetium-99m human serum albumin. Clin Nucl Med 1986;11(7):474-8. [CrossRef] google scholar
23. 23. Henze E, Schelbert H, Collins J, Najafi A, Barrio J, Bennett L. Lymphoscintigraphy with Tc-99m-labeled dextran. J Nucl Med 1982;23(10):923-9. google scholar
24. 24. Svensson W, Glass D, Bradley D, Peters A. Measurement of lymphatic function with technetium-99m-labelled polyclonal immunoglobulin. Eur J Nucl Med Mol Imaging 1999;26:504-10. [CrossRef] google scholar
25. 25. Partsch H. Assessment of abnormal lymph drainage for the diagnosis of lymphedema by isotopic lymphangiography and by indirect lymphography. Clin Dermatol 1995;13(5):445-50. [CrossRef] google scholar
26. 26. Pappalardo M, Cheng MH. Lymphoscintigraphy for the diagnosis of extremity lymphedema: Current controversies regarding protocol, interpretation, and clinical application. J Surg Oncol 2020;121(1):37-47. [CrossRef] google scholar
27. 27. Baulieu F, Bourgeois P, Maruani A, Belgrado J, Tauveron V, Lorette G, et al. Contributions of SPECT/CT imaging to the lymphoscintigraphic investigations of the lower limb lymphedema. Lymphology 2013;46(3):106-19. google scholar
28. 28. Villa G, Campisi C, Ryan M, Boccardo F, Di Summa P, Frascio M, et al. Procedural recommendations for lymphoscintigraphy in the diagnosis of peripheral lymphedema: the Genoa protocol. Nucl Med Mol Imaging 2019;53:47-56. [CrossRef] google scholar
29. 29. Nagy BI, Mohos B, Tzou C-HJ. Imaging Modalities for Evaluating Lymphedema. Medicina 2023;59(11):2016. [CrossRef] google scholar
30. 30. Yoon H-J, Woo K-J, Kim J-Y, Kang SY, Moon BS, Kim BS. The added value of SPECT/CT lymphoscintigraphy in the initial assessment of secondary extremity lymphedema patients. Sci Rep 2023;13(1):19494. [CrossRef] google scholar
31. 31. Scarsbrook AF, Ganeshan A, Bradley KM. Pearls and pitfalls of radionuclide imaging of the lymphatic system. Part 2: evaluation of extremity lymphoedema. Brit J Radiol 2007;80(951):219-26. [CrossRef] google scholar
32. 32. Kleinhans E, Baumeister RG, Hahn D, Siuda S, Büll U, Moser E. Evaluation of transport kinetics in lymphoscintigraphy: follow-up study in patients with transplanted lymphatic vessels. Eur J Nucl Med Mol Imaging 1985;10:349-52. [CrossRef] google scholar
33. 33. Cambria RA, Gloviczki P, Naessens JM, Wahner HW. Noninvasive evaluation of the lymphatic system with lymphoscintigraphy: a prospective, semiquantitative analysis in 386 extremities. J Vasc Surg 1993;18(5):773-82. [CrossRef] google scholar
34. 34. Partsch H. Practical aspects of indirect lymphography and lymphoscintigraphy. Lymphat Res Biol 2003;1(1):71-4. [CrossRef] google scholar
35. 35. Weissleder H, Weissleder R. Lymphedema: evaluation of qualitative and quantitative lymphoscintigraphy in 238 patients. Radiology 1988;167(3):729-35. [CrossRef] google scholar
36. 36. Ter S-E, Alavi A, Kim CK, Merli G. Lymphoscintigraphy A reliable test for the diagnosis of lymphedema. Clin Nucl Med 1993;18(8):646-54. [CrossRef] google scholar
37. 37. Hassanein AH, Maclellan RA, Grant FD, Greene AK. Diagnostic accuracy of lymphoscintigraphy for lymphedema and analysis of false-negative tests. Plast Reconstr Surg Glob Open 2017;5(7):e1396. [CrossRef] google scholar
38. 38. Donohoe KJ, Carroll BJ, Chung DK, Dibble EH, Diego E, Giammarile F, et al. Summary: Appropriate Use Criteria for Lymphoscintigraphy in Sentinel Node Mapping and Lymphedema/Lipedema. J Nucl Med 2023;64(4):525-8. [CrossRef] google scholar
39. 39. Bourgeois P, Frühling J, Henry J. Postoperative axillary lymphoscintigraphy in the management of breast cancer. Int J Radiat Oncol Biol Phys 1983;9(1):29-32. [CrossRef] google scholar
40. 40. Szuba A, Chachaj A, Koba-Wszedybylb M, Hawro R, Jasinski R, Tarkowski R, et al. Axillary lymph nodes and arm lymphatic drainage pathways are spared during routine complete axillary clearance in majority of women undergoing breast cancer surgery. Lymphology 2011;44(3):103-12. google scholar
41. 41. Forte AJ, Boczar D, Huayllani MT, Lu X. Lymphoscintigraphy for evaluation of lymphedema treatment: A systematic review. Cureus 2019;11(12):e6363. [CrossRef] google scholar
42. 42. Moon T, O’Donnell TF, Weycker D, Iafrati M. Lymphoscintigraphy is frequently recommended but seldom used in a “real world setting”. J Vasc Surg-Venous L 2023;12(2):101738. [CrossRef] google scholar
43. 43. Lurie F, Malgor RD, Carman T, Dean SM, Iafrati MD, Khilnani NM, et al. The American Venous Forum, American Vein and Lymphatic Society and the Society for Vascular Medicine expert opinion consensus on lymphedema diagnosis and treatment. Phlebology 2022;37(4):252-66. [CrossRef] google scholar