Detection of sentinel lymph node in early cervical cancer

CervicalcancerwasoncerankedinsecondpositionamongthemostcommonmalignanttumorinChinesewomen.Theincidencerateofthecervicalcancerwasremarkablyreducedduetothenewlydevelopedmedicaltechniquesandthesocalledthethreeearly?po1icy:earlyprevention,earlydiagnosisandearlytreatment.Thedeathrateofcervicalcancerdescendedby10.3/100000in1970to3.3/1000001990.However,thetrendoftheincidencerateofear1ycervica1cancerissignificantlyincreasedamongtheyoungerwomenpopulation.Thestandardtechniqueofthesurgicaltreatmentforea…     

~(99m)Tc-葡聚糖乳内淋巴显像及其临床评价

本文报告26例正常人和35例乳腺包块~(99m)Tc-葡聚糖乳内淋巴显像的结果。正常人绝大多数双侧淋巴结数和(或)显影浓淡不对称,并发现左右交叉引流和先天性单链各2例;乳癌乳内淋巴转移者双侧或单侧淋巴链不显影,或一侧淋巴链仅低位淋巴结显影而高位缺如。本法判断淋巴受累的灵敏度为100％,特异性为85.2％,准确性为88.6％,假阳性为14.8％,假阴性为零。     

Thighplasty After Bariatric Surgery: Evaluation of Lymphatic Drainage in Lower Extremities

BACKGROUND: Bariatric surgery for morbid obesity achieves an accentuated weight loss, with skin and soft tissue redundancy in some corporal segments, including the thighs. The thigh lift is a plastic surgery that improves this redundant tissue in the medial thigh area, but this surgical procedure may have complications, such as inferior migration of the scar, delayed wound healing, vulvar distortion, and lymphatic system alterations. METHODS: To evaluate the effect of the thighplasty on the lymphatic system, 14 patients were prospectively included in this study. Lymphoscintigraphy was performed before thighplasty, and this result was compared to the new examination performed 6 months after thighplasty. The exclusion standards include patients with clinical alterations and abnormal lymphoscintigraphy in previous surgery. RESULTS: The statistical analysis was performed on 26 inferior members, according to exclusion standards. All the members had normal lymphoscintigraphy in the preoperative period. After thighplasty, eight members (30.8%) demonstrated abnormal lymphoscintigraphy (p = 0.008) resulting in significant functional and anatomic alterations in the lymphatic system. CONCLUSION: The thigh lift changes lymphatic drainage in lower extremities according to lymphoscintigraphy analyses.     

The Lymphatic Anatomy of the Breast and its Implications for Sentinel Lymph Node Biopsy: A Human Cadaver Study

Background Current understanding of the lymphatic system of the breast is derived mainly from the work of the anatomist Sappey in the 1850s, with many observations made during the development and introduction of breast lymphatic mapping and sentinel node biopsy contributing to our knowledge. Methods Twenty four breasts in 14 fresh human cadavers (5 male, 9 female) were studied. Lymph vessels were identified with hydrogen peroxide and injected with a lead oxide mixture and radiographed. The specimens were cross sectioned and radiographed to provide three dimensional images. Lymph (collecting) vessels were traced from the periphery to the first-tier lymph node. Results Lymph collecting vessels were found evenly spaced at the periphery of the anterior upper torso draining radially into the axillary lymph nodes. As they reached the breast some passed over and some through the breast parenchyma, as revealed in the cross-section studies. The pathways showed no significant difference between male and female specimens. We found also perforating lymph vessels that coursed beside the branches of the internal mammary vessels, draining into the ipsilateral internal mammary lymphatics. In some studies one sentinel node in the axilla drained almost the entire breast. In most more than one sentinel node was represented. Conclusion These anatomical findings are discordant with our current knowledge based on previous studies and demand closer examination by clinicians. These anatomical studies may help explain the percentage of false-negative sentinel node biopsy studies and suggest the peritumoral injection site for accurate sentinel lymph node detection.     

探测前哨淋巴结在乳腺癌、早期宫颈癌和头颈鳞癌中的应用

目的评价核素淋巴显像和γ探针定位在乳腺癌、宫颈癌和头颈鳞癌中确定前哨淋巴结(SLN)的应用价值。方法女性乳腺癌116例,体检腋窝未扪及肿块。应用99Tcm-DX37~74MBq(1~2mCi)经皮下注射,或术中注射专利兰1ml,术中用γ探针定位并行前哨淋巴结活检,与手术、病理对照。宫颈癌27例,体检盆腔未扪及肿块。应用99Tcm-DX74MBq(2mCi)在宫颈肿瘤周围2°或10°处或99Tcm-SC74MBq(2mCi)阴道镜直视下四点注射,行核素淋巴显像后,手术后的标本用γ探针行体外定位,并与病理的结果加以对照。N0头颈鳞癌10例,99Tcm-DX74MBq(2mCi)肿瘤周围成分下注射,术中用γ探针定位并行前哨淋巴结活检,与手术、病理对照。结果116例乳腺癌中活检SLN108例,灵敏度为92.6%(22/27例),特异性100%(81/81例)。27例宫颈癌中SLN的灵敏度为100%(6/6例),特异性100%(21/21例)。10例N0头颈鳞癌中SLN转移3例,NSLN转移1例。结论核素淋巴显像和γ探针定位应用于乳腺癌、宫颈癌和N0头颈鳞癌是切实可行和可能的,这是一种简便、安全、易被病人接受的探测前哨淋巴结的检查方法,对预测腋窝淋巴结、盆腔淋巴结等转移有很大的临床实用价值。     

Congenital chylothorax

Congenital chylothorax (CC) results from multiple lymphatic vessel anomalies or thoracic cavity defects and may accompany other congenital anomalies. Fetal chylothorax may increase the risk of death and complications from pleural space lymphatic fluid accumulation, which compromises lung development, pulmonary, and cardiovascular function and from complications arising from the loss of drained lymphatic contents. Prenatal interventions might improve survival in severe cases of fetal chylothorax. The neonatal treatment strategy is generally supportive with interventions that include thoracostomy drainage and attempts to decrease chyle flow using a stepwise approach that begins with the least invasive means. Evidence-based treatment choices are lacking and are much needed. Most cases of CC resolve with time even without specific lymphatic system studies to identify the exact pathology. Expertise in performing lymphatic studies is not universally available. Data on both efficacy and safety of the various therapeutic options are needed to determine the best approach to the treatment of CC.     

Evaluation of patient effective dose from sentinel lymph node lymphoscintigraphy in breast cancer: a phantom study with SPECT/CT and ICRP-103 recommendations

Objective

To evaluate the effective dose delivered to patients undergoing sentinel lymph node (SLN) lymphoscintigraphy by taking into account both the transmission dose using the CT component of a SPECT/CT system and the ^99mTc internal emission dose.

Materials and methods

An adult female humanoid phantom and a set of thermoluminescent dosimeters were used in dose measurement from the CT transmission irradiation. The choice of measurement organs in the humanoid was guided by the recommendations described in the International Commission on Radiological Protection report number 103 (ICRP-103). The effective doses due to ^99mTc internal emission source were re-calculated from measurement data reported in our previous study on the same subject with the use of tissue weighting factors of ICRP-103.

Results

CT transmission dose is the main contribution to the patient total effective dose for both 1-day and 2-day lymphoscintigraphy protocols and for different surgical procedures. Patients undergoing SLN lymphoscintigraphy receive about the same amount of total effective dose of about 3 mSv for both 1-day and 2-day protocol, regardless of whether the tissues containing radioactivity would be excised at surgery or not.

Conclusion

Although the total effective dose from using SPECT/CT is equivalent to the annual natural background radiation of about 3 mSv, nuclear medicine physicians should be aware of the increase in effective dose for SLN lymphoscintigraphy using hybrid imaging technique of SPECT/CT when compared to conventional planar ⁵⁷Co flood source for transmission scan. Results from the current study provide update information in radiation exposure to patients undergoing SLN lymphoscintigraphy with the use of SPECT/CT.