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

  • G. Villa
  • C. C. Campisi
  • M. Ryan
  • F. Boccardo
  • P. Di Summa
  • M. Frascio
  • G. Sambuceti
  • C. Campisi



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.


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.


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.


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.


Lymphoscintigraphy Epifascial and subfascial lymphatic vessels Semi-quantitative transport index Limb swelling 




Compliance with Ethical Standards

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.


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Copyright information

© Korean Society of Nuclear Medicine 2019

Authors and Affiliations

  1. 1.U.O. of Nuclear MedicinePolyclinic Hospital ‘San Martino’GenoaItaly
  2. 2.Reconstructive and Aesthetic Surgery—GVM Care & ResearchPrivate Hospitals, Reggio Emilia, Rapallo (GE)TurinItaly
  3. 3.Department of Surgery (DISC), Unit of Lymphatic Surgery & MicrosurgeryPolyclinic Hospital ‘San Martino’GenoaItaly
  4. 4.Department of Plastic and Reconstructive SurgeryUniversity Hospital of Lausanne CHUVLausanneSwitzerland
  5. 5.Department of Surgery (DISC)Polyclinic Hospital ‘San Martino’GenoaItaly

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