Lymphoscintigraphy cannot diagnose breast cancer

An evaluation of pelvic lymphoscintigraphy in the staging of colorectal carcinoma

Lymphoscintigraphy was used to delineate the lymphatic drainage of the rectum and distal colon in 18 patients with carcinoma of the rectum or sigmoid colon, in four with inflammatory disease of the large bowel and in 20 controls without colorectal pathology. Abdominal imaging was performed after submucosal injection of either 4 mCi 99mTc-antimony sulphide colloid or 0.5 mCi 99mTc-dextran into the rectum through a proctoscope. In nine patients with colorectal carcinoma, abdominal imaging was performed immediately pre-operatively and the excised specimen of large bowel was also imaged in vitro immediately postoperatively. The presence or absence of nodal uptake of radionuclide on abdominal scanning did not discriminate between normal and diseased large bowel, and the extent of nodal uptake demonstrated either by abdominal scans or by in vitro scans of excised specimens bore no relationship to the presence or absence of nodal metastases demonstrated histologically in the cancer patients. Pelvic lymphoscintigraphy as performed in this study has no demonstrable value in the diagnosis or staging of colorectal cancer.

The preoperative detection of axillary lymph node metastases in breast cancer by isotope imaging

Axillary lymphoscintigraphy using 99Tcm-labelled liposomes was carried out in 40 patients with breast cancer as a part of pretreatment staging in an attempt to improve the accuracy of axillary evaluation. Patients were injected interstitially in the periareolar region of each breast with 250–300 μCi of 99Tcm-labelled liposomes. Subsequently the patients were imaged with a gamma-camera using computerized data processing. Interpretation of images was based on prior experimental data; a diminished uptake of isotope by the primary regional lymph node (PRLN) and the group of axillary regional lymph nodes (RLN) draining the tumour, when compared to the control side, was considered to be abnormal and to suggest node metastases. An equal or enhanced uptake by the PRLN or RLN draining the tumour, when compared to the control side, was considered normal, indicating an absence of lymph node metastases. Eighteen patients (45 per cent) had abnormal scans and 14 patients (35 per cent) had normal scans. Eight patients (20 per cent) had technically unsatisfactory images where axillary nodes could not be identified. Twenty-two patients of the 32 with evaluable scans had correlation of preoperative images with postsurgical axillary lymph node histopathology. One patient out of 12 with an abnormal scan had normal lymph nodes on serial sectioning, and 2 patients out of 10 with normal scans had lymph node metastases. Eight of the 32 patients (25 per cent) with evaluable images had enhanced uptake of isotope by the PRLN and RLN draining the tumour. In 3 of these cases a marked reactive hyperplasia only was shown on histopathological examination, in 2 cases the reactive hyperplasia was associated with lymph node metastases, accounting for the 2 false negative interpretations. This preliminary study suggests that axillary lymphoscintigraphy may be of value in preoperative staging in breast cancer. Long term studies are needed to evaluate the prognostic potential of such a test as a measure of macrophage function. Further studies, by blind replication, are required to evaluate the accuracy of axillary lymph node imaging.

Lymphoscintigraphy--techniques and applications in the management of breast carcinoma

Radiocolloid lymphoscintigraphy is a versatile, simple technique which has been utilized extensively in the assessment of lymphatic function and structure in anatomic regions accessible to neither clinical examination nor radiocontrast lymphography, as well as in circumstances where radiocontrast lymphography is not feasible. The most important requirement for an effective study are: (a) Determination of the appropriate injection site for reproducibly visualizing the majority of the lymphatics under study and, (b) use of an agent with the optimum properties of a preformed small, uniform, well-dispersed particle colloid. Multiple applications of lymphoscintigraphy in the patient with breast carcinoma have demonstrated its value in distinguishing abnormalities of the internal mammary lymphatics shown to have significant prognostic implications, in providing accurate localization of the parasternal lymphatics for radiation therapy and its potential for determining the status of axillary lymphatics in lieu of surgical intervention. The following review is based on an experience of over 6500 studies in 5550 patients with breast carcinoma.

Axillary lymphoscintigraphy: current status in the treatment of breast cancer

Postoperative axillary lymphoscintigraphy has been performed after time-differentiated intercostal and interdigital injections of a 99Tc-labeled sulfur microcolloid in 313 patients suffering from breast cancer who underwent radical surgery with axillary dissection. As demonstrated by the absence of visualized lymph nodes after both injections, the axillary dissection could be considered as complete in only 34.6% of the investigated patients. The greatest part of lymph nodes, remaining after surgery, corresponds to the inferior and central groups (after interdigital injection). In 15% of the cases the intercostal injection leads to the demonstration of external mammary lymph nodes. According to the analysis of 202 cases with at least 1 year follow-up, the existence of visualized residual lymph nodes represents a factor of risk to develop nodal relapse especially in patients with positive peroperative axillary lymph node status who did not receive postoperative X-ray treatment. Upper limb edema occurs in 22.5% of the cases; mainly in patients with negative lymphoscintigraphic findings (demonstrating the interruption of the axillary lymphatic flux) and without nodal irradiation. Postoperative axillary lymphoscintigraphic findings should be evaluated in connection with the peroperative axillary lymph node status as established according to the histological analysis, and should take into account the number of removed lymph nodes. Preoperative axillary lymphoscintigraphy seems to be a less contributive examination technique.

Prediction of axillary metastases in breast cancer by lymphoscintigraphy

A new technique of axillary lymphoscintigraphy has been investigated in thirty patients with breast carcinoma. Intradermal injection of 100 muCi technetium-99m antimony sulphide colloid in 0.1 ml buffer produced satisfactory scans of axillary lymph-nodes in twenty-seven patients (90%). Ten patients with node metastases from breast cancer (9 confirmed histologically) had a defect in the lower axillary uptake on the side of the lesion. Three of the remaining seventeen patients with breast cancer and normal scans had nodal metastases seen histologically, but in two these were micro-metastases only. Axillary lymphoscintigraphy improved considerably the clinical assessment of node status, and corrected the clinical classification in five of six patients who had been misclassified by clinical examination.