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INTEREST AND INDICATIONS OF SPECT-CT FOR THE LYMPHO-SCINTIGRAPHIC INVESTIGATIONS OF THE SECONDARY UPPER LIMB EDEMAS (ULE)
BOURGEOIS P.
Institute Jules Bordet, Brussels, Belgium
Introduction: The SPECT-CT approach has proven its interest in the management-definition of the SLN in various cancers but also of the lower limb edemas. To our knowledge, the interest and indications of SPECT-CT for the ULE have however not been analyzed. This is the aim of the present report.
Material and methods: From 2011 to now, 55 SPECT-CT were performed (in addition to the classical “planar” three phase of our protocol of lymphoscintigraphic investigations) in 53 patients with ULE (n=46) and/or “lymphocela” (n=4) and/or lymphorrea (n=5) and/or mammary edema (n=3) and/or “seroma” (n=4) (and in one case with Gorham’s disease). Planar imagings were analyzed and compared to the informations given by the SPECT-CT and the author tried to identify and define the situations for which SPECT-CT represented one additional value and why.
Results: In Gorham’s disease, SPECT-CT showed the osseous lesion in relation with lymphatic abnormalities.
In patients with foci of activity at the level of the arm on planar imagings, SPECT-CT defined more precisely the depth of the LN and these more precise localisations can be usefull for the physical therapists. However, such localisations raised no diagnostic problem. SPECT-CT appeared more interesting when LN foci of activity were seen in the apex of the axilla and/or in retro- and/or supra- clavicular areas sometimes with lymphatic vessel(s) seen “superficial” on planar imagings. In 11 patients, these LN could indeed be demonstrated to be not in the axilla but very superficial and in fact related to one superficial collateralisation lymphatic pathways (described By Caplan and Mascagni), what represent one important information for the physical therapists. In three additional cases, other kinds of lymphatic collateralisation (not obvious on planar imagings) could also be demonstrated in the same area.
Finally, SPECT-CT was also usefull in three patients for whose axillary foci of activity were confirmed to be related to one true lymphocela and not to LN.
Conclusions: Compared to planar imagings, SPECT-CT appears in our analysis of this series useful in at least 30% of the patients, especially in case of suspected lymphorrea-lymphocela and/or when planar imagings show foci of activity in the apex of the axilla and/or in retro- and/or supra-clavicular areas.
ON THE RELIABILITY OF TONOMETRY: A PILOT STUDY OF INTER-RATER CONSISTENCY AND RELATED PSYCHOSOCIAL FACTORS UNDERLYING THE FORMULATION OF TONOMETRIC JUDGMENTS
MICHELINI S. 1, CALDIROLA R. 2, MICHELOTTI L. 1. RICCI M. 3, CESTARI M. 4, CARDONE M. 1, PANTALEO G. 5
1 San Giovanni Battista Hospital - ACISMOM, Rome, Italy
2 San Leopoldo Hospital, Merate, Lecco, Italy
3 Azienda Ospedaliera Universitaria - Ospedali Riuniti di Ancona, Italy 4 Riabilitazione Territoriale ASL4, Terni, Italy
5 Università Vita-Salute di Milano, Italy
Introduction: Tonometric judgments are critical in the diagnosis and treatment of lymphedema. Yet, while some studies (e.g. Lye et al., 2006) claimed the reliability of particular mechanical tonometric instruments, in summarizing the main findings of their systematic review Oremus et al. (2010) recently concluded that “there is too little evidence to draw conclusions about the reliability of [diagnostic] tests such as tonometry.” (p. 4, emphasis added).
Materials and Methods: To fill this gap—a tangible lack of knowledge of great import both for the literature and even more for good clinical practice—we instructed a team of trained raters to independently supply distinct sets of tonometric judgments with respect to (a) patients with diagnosis of lymphedema (the clinical sample), and (b) their healthy counterparts (the comparison sample). Each judgment was supplemented by the assessment of two additional distinctive features lying at the core of any judgmental process—the degree of difficulty and the degree of certainty reported by the judge in formulating tonometric judgments.
Results and Conclusions: We will illustrate and report on the preliminary stage of this developing research endeavor, and possibly also suggest some initial conclusions on the basis of our earliest results.
Keywords: tonometric judgments, tonometry, inter-rater reliability, judgmental processes.
THE EUROPEAN JOURNAL OF LYMPHOLOGY - Vol. XXVI - Nr. 72 - 2015
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