Page 47 - VOL 26 N. 72 - 2015

June 5, 2015 - Auditoire C. Roux
MODERATED POSTER SESSION 4
FLUORESCENCE MICROLYMPHOGRAPHY: OFFICE-BASED DIAGNOSTIC POTENTIAL FOR DETECTING L YMPHOEDEMA
HONG H. KEO, MD, MS 1; SIL VIA B. GRETENER, MD 2
1 Kantonsspital Aarau Ag, Medizinische Universitätsklinik, Abteilung für Angiologie, Aarau, Switzerland 2 Angiologie Oberaargau, Langenthal, Switzerland
Introduction: Lymphoedema is a chronic, progressive and common but often unrecognized condition. The clinical diagnosis of lymphatic disease in the early stage remains a challenge.
Decades ago direct contrast lymphangiography has been used to investigate lymphatic disorders by direct cannulation of lymph vessels. However, it has been largely abandoned because of the technical complexity of the procedure, the challenge to repeat the test and the unacceptable complications. Conventional MRI and CT scan can be used to evaluate the presence and severity of oedema, but differentiation of lymphedema from oedema associated with other internal medical diseases is not possible. Lymphoscintigraphy, which has been reported to be 100% specific and 92% sensitive for detecting lymphedema has been challenged in recent publication. Ideally, an office-based test without exposure to ionizing radiation is needed to rule out or confirm lymphatic disease prior to sophisticated and expensive alternative testing.
Material & Methods: Literature review
Results: Fluorescence microlymphography (FML) is a useful office-based test in evaluating lymphedema and has been introduced in the early eighties by Bollinger and collegues. This test has been used in Switzerland for more than 30 years and is reimbursed by health insurance. Current research confirms its important diagnostic role. The principle is based on the fact that large molecules in the interstitial space are primarily drained into and via the lymphatic system. In order to detect the fluid and the lymphatic system fluorescent tracer attached to a macromolecule injected into the interstitial space of the skin was proposed. The sensitivity and specificity of this test has recently been reported to be 91.4% and 85.7%, respectively.
Conclusion: In this review, we provide a comprehensive summary of FML as a practical office-based diagnostic tool for detecting lymphoedema in uncertain cases.
PATHOPHYSIOLOGICAL CONSIDERATIONS ABOUT RADIOCOLLOID KINETICS IN LYMPHOEDEMA OF LOWER EXTREMITIES
VILLA G., BOCCARDO F., MOLINARI L., DESSALVI S., CAMPISI C.
IRCCS S. Martino – IST National Cancer Institute, University of Genoa, Italy
Introduction: Lymphoedema of the lower extremities is a relatively common chronic and incurable disease. Early diagnosis and treatment is essential in preventing the progression of the disease and its complications. Lymphoscintigraphy is the preferred and noninvasive diagnostic modality of lymphoedema. However, there are problems concerning the reliability of the interpretation of this procedure. Qualitative interpretation of the images alone is very observer dependent. Quantitative lymphoscintigraphy, where the lymph transport capacity is being estimated, offers an objective measure for lymphatic function and has been shown to have higher sensitivity and specificity. Kleinhans developed a transport index in which time for transport to regional lymph nodes, appearance of lymph vessels and nodes and distribution pattern were scored. Another objective measure of dynamic lymphatic function is the determination of the rate of movement of the tracer from the extracellular matrix through the lymph capillaries. Understanding of physiological mechanisms of the lymphatic kinetics is very relevant in order to obtain quantitative parametrs.
Materials and methods: Twentyfour subjects suffering from monolateral of bilateral lymphedema of lower extremities underwent lymphoscintigraphy. It was performed in different days by injecting 37 MBq of technetium 99m-nanocolloid subcutaneously into the first interdigital space of the feet and subfascially in the plants, in order to explore superficial and deep lymphatic circuits. Total body images were recorded after 1 and 24 hours from the injections. Uptake in inguinal nodes and sites of injection were calculated and corrected for radioisotopic decay.
Results: After epifascial injection (superficial circulation), in affected and healthy extremities inguinal nodes/sites of injection uptake ratio increased respectively from 3.1% and 6.2% at 1 hour to 45.2% and 57.8% after 24 hours. Mean decay corrected counts from injection site reduce by 50% in 24 hours and in inguinal nodes increase by 700%. After subfascial injection (deep circulation), affected and healthy extremities inguinal nodes/sites of injection uptake ratio were respectively 16.4% and 31% at 1 hour.
Conclusions: Inguinal nodes/injection site uptake ratio is significantly higher in healthy than in affected extremities, as expected. Our results demonstrate a washout from the injection site correlated to a very considerably increases of radioactivity in the draining nodes. The washout from the depot is significantly faster when subfascial injection was performed, indicating an high-speed flow through the deep channel of the limb. We underline that the arrival from the injection site into the nodes compensates for the radioactive decay up to 24 hours. This finding could be of great interest for the radioguided surgery, in order to assess the best timing of the tracer injection.
44
THE EUROPEAN JOURNAL OF LYMPHOLOGY - Vol. XXVI - Nr. 72 - 2015