National Inventory of Lymphoscintigraphy Procedure
Main Article Content
Abstract
Mojgan Ebrahim and Rimma Axelsson
Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet and Radiology department at Karolinska University hospital, Huddinge, Stockholm, Sweden
ABSTRACT
Lymphoscintigraphy is a non-invasive technique for the evaluation of lymphatic function in patients with swollen legs. In spite of the fact that this technique has been used worldwide since the 1990s, there remains a lack of national or international procedure guidelines. The purpose of the study was to perform a Swedish national inventory on lymphoscintigraphic procedures for examining patients with swollen legs.
A survey was distributed to all 30 Swedish departments of nuclear medicine. The questionnaire comprised the number of lymphoscintigraphic examinations per year, the investigation procedure, and an evaluation of findings. The data obtained was analyzed and computed in terms of frequencies and diagrams using STATISTICA version 10.0.
There was an 86.6% response rate. Eleven respondents stated that they never performed lymphoscintigraphy, resulting in an analysis of 15 surveys. While the choice of radiotracer amount and type and site of injection varied between two different doses and compartments, the imaging time points were more inconsequent. Most respondents (73.3%) avoided stocking during an imaging session, while only half of the clinics performed imaging in both passive and stressed conditions. The majority (93.3%) of respondents used only visual lymphoscintigram interpretation, without the application of either a grading system or a quantitative evaluation.
This inventory indicates a national need for a standardized investigation procedure in patients with swollen legs.
Article Details
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
Board of Swedish Edema Association. 2006. “Statistik över lymfödem” in the Swedish journal Lymfan, Volume 8 Number 2.
British Nuclear Medicine Society (BNMS) “Generic guidelines Lymphoscintigraphy”. (http://www.bnms.org.uk/images/stories/Procedures_and_Guidelines/Lymphoscintigraphy_with_referencesCF.pdf)
Burnand KM, Glass DM, Sundaraiya S, Mortimer PS, Peters AM. 2011, “Popliteal node visualization during standard pedal lymphoscintigraphy for a swollen limb indicates impaired lymph drainage. “AJR Am J Roentgenol 197(6):1443-8.
Campisi C, Boccardo F, Maccio A, Zilli A & Schenone F. 2003. “Current use of microsurgery in lymphedema”. Phlebolymphology. 43:216-219.
Dąbrowski J, Merkert R, Kuśmierek J. 2008. “Optimized lymphoscintigraphy and diagnostics of lymphatic oedema of the lower extremities”. Nucl Med Rev Cent East Eur. 11(1):26-9.
Damstra RJ, van Steensel MA, Boomsma JH, Nelemans P, Veraart JC. 2008.”Erysipelas as a sign of subclinical primary lymphoedema: a prospective quantitative scintigraphic study of 40 patients with unilateral erysipelas of the leg”. Br J Dermatol.158 (6):1210-5.
de Godoy JM, Lopes Pinto R, Pereira de Godoy AC, de Fátima Guerreiro Godoy M. 2014. “Synergistic effect of adjustments of elastic stockings to maintain reduction in leg volume after mechanical lymph drainage”. Int J Vasc Med. 640189.
Ikomi F, Hanna GK, Schmid-Schönbein GW.1995. ”Mechanism of colloidal particle uptake into the lymphatic system: basic study with percutaneous lymphography”. Radiology. 196(1):107-13.
International Society of Lymphology. 2009. “The diagnosis and treatment of peripheral lymphedema. 2009 Concensus Document of the International Society of Lymphology”. Lymphology. 42(2):51-60.
Jensen MR1, Simonsen L, Karlsmark T, Bülow J. 2010.”Lymphoedema of the lower extremities--background, pathophysiology and diagnostic considerations”. Clin Physiol Funct Imaging. 30(6):389-98.
Keeley, V. 2006. “The use of lymphoscintigraphy in the management of chronic oedema”. Journal of lymphedema. 1(1): p. 42-57.
Keramida G, Humphrys M, Ryan N, Peters AM. 2014. "Stocking effect in lymphoscintigraphy”. Lymphat Res Biol. 12(3):194-6.
Kim YB, Hwang JH, Kim TW, 2012. “Would complex decongestive therapy reveal long‐term effect and lymphoscintigraphy predict thoutcome of lower‐limb lymphedema related to gynecologic cancer treatment?” Gynecol Oncol 127:638–642.
Larcos G & Foster DR. 1995. “Interpretation of lymphoscintigrams in suspected lymphoedema: contribution of delayed images”. Nuclear Med Comm 16: 683–6
Lee B, Andrade M, Bergan J, Boccardo F, Campisi C, Damstra R, et al. International Union of Phlebology. 2010. “Diagnosis and treatment of primary lymphedema. Consensus document of the International Union of Phlebology (IUP)”- Int Angiol. 29(5):454-70.
MacDonald A, Burrell S. 2009. “Infrequently performed studies in nuclear medicine: part 2”. J Nucl Med Technol. 37(1):1-13.
Partsch H: 2003. “Practical aspects of indirect lymphography and lymphoscintigraphy”. Lymphat Res Biol. 1:71–73.
Sadeghi R, Kazemzadeh G, Keshtgar M. 2010. “Diagnostic application of lymphoscintigraphy in the management of lymphedema”. Hell J Nucl Med. 13(1):6-10.
Scarsbrook AF, Ganeshan A, Bradley KM. 2007.”Pearls and pitfalls of radionuclide imaging of the lymphatic system. Part 2: evaluation of extremity lymphedema”. Radiol. 280(951):219-26.
Swanson TN, Troung DT, Paulsen A, Hruska CB, O'Connor MK. 2013. “Adsorption of 99mTc-sestamibi onto plastic syringes: evaluation of factors affecting the degree of adsorption and their impact on clinical studies”. J Nucl Med Technol. 41(4):247-52.
Szuba A, Strauss W, Sirsikar SP. 2002.” Quantitative radionuclide lymphoscintigraphy predicts outcome of manual lymphatic therapy in breast cancer‐related lymphedema of the upper extremity”. Nucl Med Commun. 23:1171–1175.
Szuba A, Shin WS, Strauss HW. 2003.” The third circulation: Radionuclide lymphoscintigraphy in the evaluation of lymphedema”. J Nucl Med 44:43–57.
Tiwari A, Myint F, Hamilton G. 2006. “Management of lower limb lymphoedema in the United Kingdom”. Eur J Vasc Endovasc Surg. 31(3):311-5.
Vaqueiro M, Gloviczki P, Fisher J, Hollier LH, Schirger A, Wahner HW. 1986. “Lymphoscintigraphy in lymphedema: an aid to microsurgery”. J Nucl Med. 27(7): 1125–30
Walter HW, Charles LW, Marlys HW. 2000.” Radionuclide lymphangioscintigraphy in the evaluation of peripheral lymphedema”. Clin Nucl Med. 25:451–464.
Weissleder H, Weissleder R: 1998. “Lymphedema: Evaluation of qualitative and quantitative lymphoscintigraphy in 238 patients”. Radiology. 167:729–735.
Yoo J, Choi JY, Hwang JH, Kim DI. 2014. “Prognostic value of lymphoscintigraphy in patients with gynecological cancer-related lymphedema”. J Surg Oncol. 109(8):760-3.
Yuan Z, Chen L, Luo Q, Zhu J, Lu H, Zhu R. 2006.”The role of radionuclide lymphoscintigraphy in extremity lymphedema”. Ann Nucl Med. 20(5):341-4.