Sentinel Node Mapping of VX2 Carcinoma in Rabbit Thigh with CT Lymphography Using Ethiodized Oil

OBJECTIVE: To assess the feasibility of computed tomography (CT) lymphography using ethiodized oil for sentinel node mapping in experimentally induced VX2 carcinoma in the rabbit thigh. MATERIALS AND METHODS: This experiment received approval from the institutional animal use and care administrative advisory committee. Twenty-three rabbits with VX2 carcinoma in the thigh underwent CT before and after (1 hour, 2 hour) peritumoral injection of 2 mL ethiodized oil. After the CT examination, sentinel nodes were identified by peritumoral injection of methylene blue and subsequently removed. The retrieved sentinel and non-sentinel lymph nodes were investigated with radiographic and pathologic examinations. Based on the comparison of CT findings with those of radiographic and pathologic examinations, the diagnostic performance of CT for sentinel node identification was assessed. RESULTS: All 23 rabbits showed 53 ethiodized oil retention nodes on post-injection CT and specimen radiography, and 52 methylene blue-stained nodes at the right femoroiliac area. Of the 52 blue-stained sentinel nodes, 50 nodes demonstrated ethiodized oil retention. Thus, the sentinel node detection rate of CT was 96% (50 of 52). On pathologic examination, 28 sentinel nodes in 17 rabbits (nodes/rabbit, mean +/- standard deviation, 1.7 +/- 0.6) harbored metastasis. Twenty seven of the 28 metastatic sentinel nodes were found to have ethiodized oil retention. CONCLUSION: Computed tomography lymphography using ethiodized oil may be feasible for sentinel node mapping in experimentally induced VX2 carcinoma in the rabbit thigh.

Preoperative Imaging of Sentinel Lymph Nodes in Gastric Cancer Using CT Lymphography

PURPOSE: Preoperative identification of the sentinel lymph node (SLN) in gastric cancer (GC) patients may have great advantages for the minimally invasive treatment. This study was performed to evaluate the possibility of preoperative SLN detection using CT lymphography. MATERIALS AND METHODS: Fourteen patients with early GC were enrolled. CT images were obtained before and at 1, 3, and 5 minutes after endoscopic submucosal peritumoral injection of 2 mL iopamidol. For patients with clearly identified SLNs, to make comparisons with the CT lymphography results, intraoperative SLN detection was performed using subserosally injected Indocyanine green (ICG) lymphography and ex vivo ICG and iopamidol lymphography using mammography was also performed. RESULTS: CT lymphography clearly visualized draining lymphatics and SLNs in 4 (28.6%) out of 14 patients. All clearly visualized SLNs (one to three SLNs per patient) under preoperative imaging were detected in the same location by intraoperative ICG lymphography and ex vivo ICG and iopamidol lymphography using mammography. All preoperative SLN detections were observed with the primary tumors in the lower third of the stomach. CONCLUSION: Although our study demonstrated a SLN detection rate of less than 30%, CT lymphography with radio-contrast showed potential as a method of preoperative SLN detection for GC.

Linfocintigrafia pré-operatória em gama-câmara associada ao azul patente para biópsia do linfonodo sentinela no câncer de mama / Gamma-camera lymphoscintigrahy and blue dye for sentinel node biopsy in breast cancer

Apesar do gama-probe ser a técnica que possui os melhores resultados na identificação do linfonodo sentinela (LS), a sua maior difusão nos países em desenvolvimento ainda é limitada em razão de seu custo elevado. Assim, o propósito deste estudo, realizado entre outubro de 1999 e agosto de 2004, foi determinar a eficácia da associação da linfocintigrafia pré-operatória na gama-câmara com o azul patente para biópsia do LS, sem o uso do gama-probe. Caso o linfonodo não estivesse corado com o azul patente, então era realizada amostragem do lifonodo com a projeção marcada na pele pela gama-câmara. Foram incluídas 146 pacientes com carcinomas invasivos T1-2 N0M0. As primeiras 50 pacientes foram submetidas ao esvaziamento axilar, para verificar o índice de falso-negativo da técnica, que resultou em 5,9%. A média de idade foi de 58,1 anos e a média do tamanho tumoral foi de 20,7 mm. O LS foi identificado em 98,6% das pacientes. Em 6 (4,1%), o LS foi identificado apenas pela gama-câmara e, em 2 pacientes, apenas o azul patente identificou o LS. Esses resultados demonstraram que essa técnica é uma alternativa viável para biópsia do LS no nosso meio.

Gamma-probe is the most reliable technique for sentinel node (SN) biopsy, but is remains cost-limiting for its widespread use in development countries. Then, the purpose of this study, performed from October 1999 to August 2004, was to determine the efficacy of the association of preoperative gamma camera lymphoscintigraphy and blue dye for SN biopsy, without the use of the gamma- probe. If the blue node were not find at surgery, then axillary sampling should be done in SN projection designated by gamma-camera.146 T1-2, N0, M0, invasive breast cancer patients were enrolled in this trial. The first 50 patients were submitted to axillary dissection, in order to find the false-negative rate. It was 5.9%. The mean age was 58.1 years and the mean tumor size was 20.7 mm. SN was identified in 98.6% of patients. In 6 (4.1%)patients. SN was identification was supported only by the gamma-camera, and the blue dye identified the SN IN 2 (1,4%) gamma-camera failure. These data support it as a reliable and low cost technique for SN biopsy.

Evaluación de Dos Tipos de Medios de Contraste para Linfografía Directa en Perro / Evaluation of Two Contrast Media for Direct Lymphography in Dog

Se realizó una evaluación de dos medios de contraste para la linfografía directa en 24 caninos mestizos no acondroplásicos, clínicamente sanos. Se utilizó un medio de contraste hidrosoluble (diatrizoato de sodio y meglúmina) y un medio liposoluble (aceite de adormidera yodada), en dosis de 96 mg de yodo por kg de peso para el miembro torácico y de 192 mg de yodo por kg de peso para el miembro pélvico. Las imágenes se evaluaron de acuerdo al grado de contraste y definición de las estructuras evidenciables por esta técnica. En ambos medios de contraste el grado de definición obtenido en los miembros y en el sistema colector central fue bueno, sin embargo, se logró un grado de contraste superior con el medio liposoluble, principalmente a nivel de sistema linfático central. Algunos ejemplares evidenciaron la presencia de émbolos pulmonares al usar un medio liposoluble.

Two contrast media for direct lymphography in 24 healthy dogs not achondoplasic were evaluated. It used a hidrosoluble contrast media (sodium diatrizoato and meglumina) and another lyposoluble media (Ionided adormidera's oil) in dose of 96 mg/I/kg to the thoracic member and 192mg/I/kg for a rear member. The images were evaluated indeed of contrast level and definition of structures for each contrast media. The definition degree for each contrast media both the members and central collector system were good, however its was better for the lyposoluble contras media, especially in the central collector system. Some dogs show embolous in the lungs vessel when lyposoluble media was used.

Visualização linfocintigráfica da desembocadura do ducto torácico / Lymphoscintigraphic visualization of the thoracic duct confluence

OBJETIVO: Avaliar a sensibilidade da linfocintigrafia intersticial na visualização da desembocadura do ducto torácico. MÉTODO: Foram analisados 535 exames linfocintigráficos realizados no Serviço de Medicina Nuclear do Hospital das Clínicas, Universidade Federal de Pernambuco (UFPE), no período de 1993 a 1999. Todas as linfocintigrafias foram realizadas através da injeção subcutânea, no primeiro espaço interdigital de cada pé, de 1 ml da solução de Dextran 500 marcado com Tecnécio-99 metaestável. RESULTADOS: A desembocadura do ducto torácico foi visualizada em 424 pacientes, que representam 79,3 por cento das linfocintigrafias realizadas. Na avaliação por sexo, a desembocadura do ducto torácico foi visualizada em 191 pacientes do sexo feminino, representando 77 por cento dos casos. Nos pacientes do sexo masculino, a desembocadura foi visualizada em 233 casos (80,9 por cento). CONCLUSÃO: O presente estudo confirma a importância da linfocintigrafia como método de escolha na avaliação da circulação linfática e demonstra que esse exame apresenta uma alta sensibilidade para a visualização da desembocadura do ducto torácico.

Linfedema crónico primitivo / Primitive chronic Lymphedema

Se presenta el caso de una paciente de 51 años de edad con linfedema crónico primitivo no familiar, que afecta miembros superiores e inferiores. De acuerdo a la edad de aparición correspondería el tipo precoz (no congénito y anterior a los 35 años). Sus características clínicas e histopatológicas coinciden con los de la bibliografía. En vista de la imposibilidad para realizar la linfografía clásica utilizamos la linfocentellografía con Dextrán 500 y Tc-99 a través de la cual se demuestra el compromiso linfático de los miembros más afectados. Sugerimos este método de fácil aplicación en el estudio del drenaje linfático para aquellos casos que no cumplen con los criterios requeridos por la linfografía clásica

Ultrasound diagnosis of abdominal lymphadenopathy

In this work, the usefullness and limitations of U.S. as compared with lymphography, in the investigation of retroperitonial nodal disease were studied. 30 patients with suspected retroperitoneal nodal involvement were examined by both methods. The results and accuracy of each method was analyzed and discussed

Study of intrahepatic lymphatics in bilharzial hepatic fibrosis and their role in ascites formation

Hepatic lymphography and thoracic duct lymph flow and pressure study were done in 11 patients with pure bilharzial hepatic fibrosis and 5 cases of mixed cirrhosis. In mixed hepatic cirrhosis visualization of lymphatics of the liver and increased thoracic duct lymph flow and pressure can confirm that the liver shares in the formation of ascities. In pure bilharzial fibrosis hepatic lymphatics are not visualised because of the abscence of the outflow obstruction and in addition from the increased thoracic duct lymph flow and pressure, we can conclude that the liver is not responsible for excess lymph production in presinusoidal obstruction