skip to main content
OSTI.GOV title logo U.S. Department of Energy
Office of Scientific and Technical Information

Title: Lymphoscintigraphy as an adjunctive procedure in the perioperative assessment of patients undergoing microlymphaticovenous anastomoses

Abstract

Microlymphaticovenous anastomoses provide a potential for reducing lymphedema of the upper extremity complicating radical mastectomy or irradiation. Lymphoscintigraphy with technetium isotopes is a valuable investigative modality in the perioperative evaluation of patients undergoing this surgical procedure. The radionuclide studies provide information regarding structural change and physiologic derangement with a low radiation dose to the patient. It is a simple, painless procedure requiring minimal skill and no surgical intervention. In addition, a reproducible method for preparing a radiocolloid suitable for lymphatic imaging using an approved drug as a precursor has been developed.

Authors:
; ; ; ; ;
Publication Date:
OSTI Identifier:
6982250
Resource Type:
Journal Article
Resource Relation:
Journal Name: Clin. Nucl. Med.; (United States); Journal Volume: 8:7
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; 38 RADIATION CHEMISTRY, RADIOCHEMISTRY, AND NUCLEAR CHEMISTRY; LYMPHATIC SYSTEM; SCINTISCANNING; RADIOPHARMACEUTICALS; CHEMICAL PREPARATION; RADIOTHERAPY; SIDE EFFECTS; COLLOIDS; NEOPLASMS; PATIENTS; SULFUR COMPOUNDS; TECHNETIUM ISOTOPES; COUNTING TECHNIQUES; DIAGNOSTIC TECHNIQUES; DISEASES; DISPERSIONS; DRUGS; ISOTOPES; LABELLED COMPOUNDS; MEDICINE; NUCLEAR MEDICINE; RADIOISOTOPE SCANNING; RADIOLOGY; SYNTHESIS; THERAPY; 550601* - Medicine- Unsealed Radionuclides in Diagnostics; 400702 - Radiochemistry & Nuclear Chemistry- Properties of Radioactive Materials

Citation Formats

Sacks, G.A., Sandler, M.P., Born, M.L., Clanton, J.A., Franklin, J.D., and Partain, C.L. Lymphoscintigraphy as an adjunctive procedure in the perioperative assessment of patients undergoing microlymphaticovenous anastomoses. United States: N. p., 1983. Web. doi:10.1097/00003072-198307000-00006.
Sacks, G.A., Sandler, M.P., Born, M.L., Clanton, J.A., Franklin, J.D., & Partain, C.L. Lymphoscintigraphy as an adjunctive procedure in the perioperative assessment of patients undergoing microlymphaticovenous anastomoses. United States. doi:10.1097/00003072-198307000-00006.
Sacks, G.A., Sandler, M.P., Born, M.L., Clanton, J.A., Franklin, J.D., and Partain, C.L. 1983. "Lymphoscintigraphy as an adjunctive procedure in the perioperative assessment of patients undergoing microlymphaticovenous anastomoses". United States. doi:10.1097/00003072-198307000-00006.
@article{osti_6982250,
title = {Lymphoscintigraphy as an adjunctive procedure in the perioperative assessment of patients undergoing microlymphaticovenous anastomoses},
author = {Sacks, G.A. and Sandler, M.P. and Born, M.L. and Clanton, J.A. and Franklin, J.D. and Partain, C.L.},
abstractNote = {Microlymphaticovenous anastomoses provide a potential for reducing lymphedema of the upper extremity complicating radical mastectomy or irradiation. Lymphoscintigraphy with technetium isotopes is a valuable investigative modality in the perioperative evaluation of patients undergoing this surgical procedure. The radionuclide studies provide information regarding structural change and physiologic derangement with a low radiation dose to the patient. It is a simple, painless procedure requiring minimal skill and no surgical intervention. In addition, a reproducible method for preparing a radiocolloid suitable for lymphatic imaging using an approved drug as a precursor has been developed.},
doi = {10.1097/00003072-198307000-00006},
journal = {Clin. Nucl. Med.; (United States)},
number = ,
volume = 8:7,
place = {United States},
year = 1983,
month = 7
}
  • To assess the incidence of perioperative myocardial infarction, 214 consecutive patients were evaluated 1 to 5 days after coronary bypass surgery, using Tc-99m pyrophosphate (TcPPi) myocardial imaging, serial electrocardiograms (ECG), and enzyme levels (SGOT, LDH, CPK). On the basis of the clinical course and scintigraphic, enzymatic, and ECG changes, the diagnosis of perioperative infarction was definite in 17 of 214 cases (7.9%) and probable in six of 214 (2.8%). In all of these 23 patients, TcPPi scans were abnormal; one additional patient had a false-positive scintigram. Only 13 of the 23 had ECG evidence of infarction, but there were nomore » false positives. We set the threshold for abnormality of enzyme changes quite high, owing to experience in more than 900 postoperative patients (SGOT > 200, LDH > 500, CPK > 500 on the same day). Using these criteria, 22 of the 23 infarct patients had abnormal enzymes, and six others were falsely positive. These results indicate a relatively low sensitivity for the ECG in diagnosing perioperative infarction, but the lack of false positives suggests high specificity. The sensitivity and specificity of the enzymes and the TcPPi image were both excellent and quite similar; the main difference was a reduction of certainty of infarction with the enzyme criteria, caused by the six patients whose enzyme values were falsely positive. Considering its sensitivity,specificity, and ability to locate and to a certain extent quantitate necrosis, TcPPi imaging is probably the most valuable means of diagnosing perioperative myocardial infarction.« less
  • Radiocolloid internal mammary lymphoscintigraphy (ILM) was evaluated in 364 patients with ovarian carcinoma to determine the frequency of abnormalities in post-operative patients, the association between the results of the lymphoscintigram and known clinical prognostic variables, and to establish whether IML yielded predictive information independent of these variables. Results of IML showed a correlation with established clinical prognostic features and yielded independent prognostic information. The sensitivity and specificity of IML in predicting relapse are 51% and 71% respectively, indicating that a single post-operative IML does not predict relapse or freedom from relapse with sufficient accuracy to make it a clinically usefulmore » test even though it provides an independent prediction of relapse.« less
  • The prime objective of nutritional surveillance of cancer patients is to set up screening criteria for those who are likely to be at risk of nutrition problems and to further assess those so identified. Interventions to improve nutritional status or comfort are called for. The single most useful item with respect to screening is careful weight measurement at every visit. Subjective reports of appetite and food intake, 24-hour recalls of dietary intake, and therapy being undergone by the patient are also useful. Assessment involves obtaining the 24-hour recall data and in some cases keeping food records, and determining the patients'more » food likes and dislikes. Taken together, dietary, biochemical, clinical, anthropometric, and patient history data permit us to achieve greater certainty as to the problem. Usually energy intakes are problematic, but other nutrition difficlties may also be present. Intervention with respect to diet may involve therapeutic diets, special nutrition advice, or general advice. Food assistance, help with food managemnt, and general health education may also be necessary. Constant surveillance consisting of short encounters and follow-up are mandatory. Examples of these principles as they apply to head-neck cancers are presented.« less
  • Introduction: We have assessed the planning target volume (PTV) margins required for adequate treatment of the prostate in the absence of daily localization imaging based on the statistical analysis of a large data set obtained from 5 years of use of a two-dimensional ultrasound pretreatment localization device. Methods and Materials: Data from 387 prostate patients were analyzed retrospectively. Every patient in the study received daily pretreatment localization resulting in a total of 10,327 localizations, each comprising an isocenter displacement in three directions: anteroposterior, right-left lateral, and superior-inferior. The mean displacement for each direction for each patient was computed from dailymore » treatment records, and a mean of the means was used in the analysis. Results: The mean displacements required to shift the target to the required position were 6.1 mm posterior (4.4 mm SD), 2.1 mm superior (4.5 mm SD), and 0.5 mm right (3.6 mm SD). The 6.1-mm shift posterior is indicative of a systematic uncertainty. Differences in planning conditions between the computed tomography simulation and the treatment room may account for this discrepancy. Conclusion: Our study has revealed systematic intertreatment uncertainties that would have required a nonuniform PTV margin ranging in dimensions between 2.7 mm anterior, 14.9 mm posterior, 7.7 mm right, 6.7 mm left, 11 mm superior, and 7 mm inferior to encompass the prostate for 95% of our sample if the ultrasound localization system were not used. In the absence of systematic uncertainties, a uniform PTV margin of 9 mm would suffice.« less
  • Purpose: On-board cone-beam computed tomography (CBCT) provides soft tissue information that may improve setup accuracy in patients undergoing accelerated partial breast irradiation (APBI). We used CBCT to assess the residual error in soft tissue after two-dimensional kV/MV alignment based on bony anatomy. We also assessed the dosimetric impact of this error. Methods and Materials: Ten patients undergoing APBI were studied as part of an institutional review board-approved prospective trial. Patients were aligned based on skin/cradle marks plus orthogonal kV/MV images registered based on bony landmarks to digitally reconstructed radiographs from the planning CT. A subsequent CBCT was registered to themore » planning CT using soft tissue information. This 'residual error' and its dosimetric impact was measured. Results: The root-mean-square of the residual error was 3, 4, and 4 mm, in the right-left, anterior-posterior, and superior-inferior directions, respectively. The average vector sum was 6 {+-} 2 mm. Average reductions in mean dose to the lumpectomy cavity, clinical target volume (CTV), and planning target volume were 0.1%, 0.4%, and 1%, respectively. The mean difference in the clinical target and planning target volumes that received 95% of the prescribed dose (V95) were 1% and 4%. Conclusions: In this initial study with a modest number of patients, the residual error in soft tissue was typically <5 mm, and with the field margins used, the resultant dosimetric consequences were modest. In patients immobilized in a customized cradle, setup using orthogonal kV images thus appears accurate and reproducible. The CBCT technique may have particular utility in patients with larger breast volumes or breast deformations. Further studies involving larger numbers of patients are needed to further assess the utility of CBCT.« less