Skip to main content

Advertisement

SpringerLink
Log in

Procedural Recommendations for Lymphoscintigraphy in the Diagnosis of Peripheral Lymphedema: the Genoa Protocol

  • Perspective
  • Published:
Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Introduction

Lymphoscintigraphy is the gold standard for imaging in the diagnosis of peripheral lymphedema. However, there are no clear guidelines to standardize usage across centers, and as such, large variability exists. The aim of this perspectives paper is to draw upon the knowledge and extensive experience of lymphoscintigraphy here in Genoa, Italy, from our center of excellence in the assessment and treatment of lymphatic disorders for over 30 years to provide general guidelines for nuclear medicine specialists.

Method

The authors describe the technical characteristics of lymphoscintigraphy in patients with limb swelling. Radioactive tracers, dosage, administration sites, and the rationale for a two-compartment protocol with the inclusion of subfascial lymphatic vessels are all given in detail.

Results

Examples of lymphoscintigraphic investigations with various subgroups of patients are discussed. The concept of a transport index (TI) for semi-quantitative analysis of normal/pathological lymphatic flow is introduced. Different concepts of injection techniques are outlined.

Discussion

It is past time that lymphoscintigraphy in the diagnosis of lymphatic disorders becomes standardized. This represents our first attempt to outline a clear protocol and delineate the relevant points for lymphoscintigraphy in this patient population.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Weissleder H, Weissleder R. Lymphedema: evaluation of qualitative and quantitative lymphoscintigraphy in 238 patients. Radiology. 1988;167:729–35.

    Article  CAS  PubMed  Google Scholar 

  2. Bräutigam P, Földi E, Schaiper I, Krause T, Vanscheidt W, Moser E. Analysis of lymphatic drainage in various forms of leg edema using two compartment lymphoscintigraphy. Lymphology. 1998;31:43–55.

    PubMed  Google Scholar 

  3. Logan V. Incidence and prevalence of lymphoedema: a literature review. J Clin Nurs. 1995;4:213–9.

    Article  CAS  PubMed  Google Scholar 

  4. Szuba A, Shin WS, Strauss HW, Rockson S. The third circulation: radionuclide lymphoscintigraphy in the evaluation of lymphedema. J Nucl Med. 2003;44:43–57.

    PubMed  Google Scholar 

  5. Segerstrom K, Bjerle P, Graffman S, Nystrom A. Factors that influence the incidence of brachial oedema after treatment of breast cancer. Scand J Plast Reconstr Surg Hand Surg. 1992;26:223–7.

    Article  CAS  PubMed  Google Scholar 

  6. Chatani M, Nose T, Masaki N, Inoue T. Adjuvant radiotherapy after radical hysterectomy of the cervical cancer: prognostic factors and complications. Strahlenther Onkol. 1998;174:504–9.

    Article  CAS  PubMed  Google Scholar 

  7. Rainwater LM, Zincke H. Radical prostatectomy after radiation therapy for cancer of the prostate: feasibility and prognosis. J Urol. 1988;140:1455–9.

    Article  CAS  PubMed  Google Scholar 

  8. Solsona E, Iborra I, Monros JL, Ricos JV, Mazcunan F, Vazquez C. Penile and scrotal lymphedema of radiation origin: its surgical treatment. Actas Urol Esp. 1986;10:45–8.

    CAS  PubMed  Google Scholar 

  9. Moghimi SM, Bonnemain B. Subcutaneous and intravenous delivery of diagnostic agents to the lymphatic system: applications in lymphoscintigraphy and indirect lymphography. Adv Drug Deliv Rev. 1999;37:295–312.

    Article  CAS  PubMed  Google Scholar 

  10. Yoshida RY, Kariya S, Ha-Kawa S, Tanigaw N. Lymphoscintigraphy for imaging of the lymphatic flow disorders. Tech Vasc Interv Radiol. 2016;19(4):273–6.

    Article  PubMed  Google Scholar 

  11. Williams WH, Witte CL, Witte MH, McNeill GC. Radionuclide lymphangioscintigraphy in the evaluation of peripheral Lymphoedema. Clin Nucl Med. 2000;25:451–64.

    Article  CAS  PubMed  Google Scholar 

  12. Berenji GR, Iker E, Glass EC. Lymphoscintigraphic findings in chylous reflux in a lower extremity. Clin Nucl Med. 2007;32:725–8.

    Article  PubMed  Google Scholar 

  13. Baulieu F, Baulieu JL, Mesny J, et al. Visualization of the thoracic duct by lymphoscintigraphy. Eur J Nucl Med. 1987;13:264–5.

    Article  CAS  PubMed  Google Scholar 

  14. ICRP. Radiation dose to patients from radiopharmaceuticals. ICRP Publication 53. Ann ICRP. 1988;18(1–4).

  15. Keleher A, Wendt R 3rd, Delpassand E, Stachowiak AM, Kuerer HM. The safety of lymphatic mapping in pregnant breast cancer patients using Tc-99m sulfur colloid. Breast J. 2004;10:492–5.

    Article  PubMed  Google Scholar 

  16. British Nuclear Medicine Society. BNMS clinical guidelines—lymphoscintigraphy. 2011. https://www.bnms.org.uk/images/Lymphoscintigraphy_2016_NEW.pdf.

  17. Mostbeck A, Partsch H. Isotope lymphography: possibilities and limits in evaluation of lymph transport. Wien Med Wochenschr. 1999;149:87–91.

    CAS  PubMed  Google Scholar 

  18. Brautigam P, Vanscheidt W, Foldi E, Krause T, Moser E. The importance of the subfascial lymphatics in the diagnosis of lower limb edema: investigations with semiquantitative lymphoscintigraphy. Angiology. 1993;44:464–70.

    Article  CAS  PubMed  Google Scholar 

  19. Stanton AW, Mellor RH, Cook GJ, Svensson WE, Peters AM, Levick JR, et al. Impairment of lymph drainage in subfascial compartment of forearm in breast cancer-related lymphedema. Lymphat Res Biol. 2003;1:121–32.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. 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:e1396.

    Article  PubMed  PubMed Central  Google Scholar 

  21. de Godoy JM, Iozzi AJ, Azevedo WF Jr, Godoy MF. New method to assess manual lymph drainage using lymphoscintigraphy. Nucl Med Rev. 2012;15(2):140–2.

    Google Scholar 

  22. Suga K, Kume N, Matsunaga N, Motoyama K, Hara A, Ogasawara N. Assessment of leg oedema by dynamic lymphoscintigraphy with intradermal injection of technetium-99m human serum albumin and load produced by standing. Eur J Nucl Med. 2001;28(3):294–303.

    Article  CAS  PubMed  Google Scholar 

  23. Weiss M, Baumeister RG, Hahn K. Dynamic lymph flow imaging in patients with oedema of the lower limb for evaluation of the functional outcome after autologous lymph vessel transplantation: an 8-year follow-up study. Eur J Nucl Med Mol Imaging. 2003;30(2):202–6.

    Article  PubMed  Google Scholar 

  24. Baulieu F, Bourgeois P, Maruani A, Belgrado JP, Tauveron V, Lorette G, et al. Contributions of spect/ct imaging to the lymphoscintigraphic investigations of the lower limb lymphedema. Lymphology. 2013;46:106–19.

    CAS  PubMed  Google Scholar 

  25. Kleinhans E, Baumeister RGH, Hahn D, Siuda S, Bull U, Moser E. Evaluation of transport kinetics in lymphoscintigraphy: follow-up study in patients with transplanted lymphatic vessels. Eur J Nucl Med. 1985;10:349–52.

    Article  CAS  PubMed  Google Scholar 

  26. Weiss M, Baumeister RGH, Frick A, Wallmichrath J, Bartenstein P, Rominger A. Primary lymphedema of the lower limb: the clinical utility of single photon emission computed tomography/CT. Korean J Radiol. 2015;16:188–95.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Cambria RA, Gloviczki P, Naessen JM, Wahner HW. Noninvasive evaluation of the lymphatic system with lymphoscintigraphy: a prospective, semi-quantitative analysis in 386 extremities. J Vasc Surg. 1993;18:773–82.

    Article  CAS  PubMed  Google Scholar 

  28. Keramida G, Wroe E, Winterman N, Aplin M, Peters AM. Lymphatic drainage efficiency: a new parameter of lymphatic function. Acta Radiol. 2017.

  29. Dylke ES, McEntee MF, Schembri GP, Brennan PC, Bailey E, Ward LC, et al. Reliability of a radiological grading system for dermal backflow in lymphoscintigraphy imaging. Acad Radiol. 2013;20:758–63.

    Article  PubMed  Google Scholar 

  30. Baulieu F, Tauveron V, Erra B, Muller C, Courtehoux M, Venel Y, et al. Lymphoscintigraphy in limb lymphoedema: current methodology and interests. Méd Nucl. 2015;39:26–42.

    Article  Google Scholar 

  31. O'Donnell TF, Rasmussen JC, Sevick-Muraca EM. New diagnostic modalities in the evaluation of lymphedema. J Vasc Surg: Venous Lymphat Disord. 2017;5:261–73.

    Google Scholar 

Download references

Acknowledgements

None.

Author information

Authors and Affiliations

  1. U.O. of Nuclear Medicine, Polyclinic Hospital ‘San Martino’, Largo R. Benzi, 10, 16132, Genoa, Italy

    G. Villa & G. Sambuceti

  2. Reconstructive and Aesthetic Surgery—GVM Care & Research, Private Hospitals, Reggio Emilia, Rapallo (GE), Turin, Italy

    C. C. Campisi

  3. Department of Surgery (DISC), Unit of Lymphatic Surgery & Microsurgery, Polyclinic Hospital ‘San Martino’, Genoa, Italy

    M. Ryan, F. Boccardo & C. Campisi

  4. Department of Plastic and Reconstructive Surgery, University Hospital of Lausanne CHUV, Lausanne, CH, Switzerland

    P. Di Summa

  5. Department of Surgery (DISC), Polyclinic Hospital ‘San Martino’, Genoa, Italy

    M. Frascio

Authors
  1. G. Villa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C. C. Campisi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Ryan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. F. Boccardo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. P. Di Summa
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M. Frascio
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. G. Sambuceti
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. C. Campisi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to G. Villa.

Ethics declarations

Conflict of Interest

Giuseppe. Villa, Corrado C Campisi, Melissa Ryan, Francesco Boccardo, Pietro di Summa, Marco Frascio, Gianmario Sambuceti, and Corradino Campisi declare that they have no conflict of interest. There is no source of funding.

Ethical Statement

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

The institutional board of our Institution reviewed the study and approved it as a retrospective study, waiving the need for formal consent. Although no formal consent was required, patients gave their written consent to use their anonymous data.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Villa, G., Campisi, C.C., Ryan, M. et al. Procedural Recommendations for Lymphoscintigraphy in the Diagnosis of Peripheral Lymphedema: the Genoa Protocol. Nucl Med Mol Imaging 53, 47–56 (2019). https://doi.org/10.1007/s13139-018-0565-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13139-018-0565-2

Keywords

Search

Navigation