Szuba A, Strauss W, Sirsikar S P, Rockson S G
Stanford Center for Lymphatic and Venous Disorders, Division of Cardiovascular Medicine and Division of Nuclear Medicine, Stanford University School of Medicine, Stanford, CA 94306, USA.
Nucl Med Commun. 2002 Dec;23(12):1171-5. doi: 10.1097/00006231-200212000-00004.
Secondary lymphedema is a localized, acquired lymphatic microcirculatory disturbance that affects large numbers of patients after breast cancer therapy. There is a paucity of objective methods to quantitate lymphatic function and to anticipate the response to therapeutic interventions. We applied radionuclide lymphoscintigraphy to evaluate lymphatic transport and axillary lymph node visualization in women following breast cancer therapy to determine the utility of these data in these patients. Lymphoscintigraphy was performed after subcutaneous injection of 0.25 mCi of Tc-filtered sulfur colloid. Subcutaneous accumulation of radiotracer ('dermal backflow') and the visualization of axillary lymph nodes were graded using our own scoring system. The ratio of radioactivity within the affected to normal axillae (ARR) was also quantified. Nineteen patients with lymphedema after breast cancer therapy were evaluated. The disease severity was documented by serial measurements of the limb volume using the truncated cone formula. Responses to therapy were quantified after completion of the therapy. There was a correlation between the ARR and the percentage reduction in edema volume. The lymphoscintigraphic score correlated with the initial arm volume excess and with the durationof lymphedema. It can be concluded that quantitative and semi-quantitative assessment by radionuclide lymphoscintigraphy represents a potentially useful tool for the clinical assessment of upper extremity lymphedema.
继发性淋巴水肿是一种局部性、后天获得性的淋巴微循环障碍，在乳腺癌治疗后影响大量患者。目前缺乏客观方法来量化淋巴功能并预测对治疗干预的反应。我们应用放射性核素淋巴闪烁造影术来评估乳腺癌治疗后女性的淋巴转运和腋窝淋巴结显影情况，以确定这些数据在这些患者中的实用性。在皮下注射0.25毫居里的锝标记硫化胶体后进行淋巴闪烁造影术。使用我们自己的评分系统对放射性示踪剂的皮下积聚（“真皮回流”）和腋窝淋巴结的显影进行分级。还对患侧腋窝与正常腋窝内的放射性比值（ARR）进行了量化。对19例乳腺癌治疗后出现淋巴水肿的患者进行了评估。通过使用截头圆锥公式对肢体体积进行系列测量来记录疾病严重程度。在治疗完成后对治疗反应进行量化。ARR与水肿体积减少百分比之间存在相关性。淋巴闪烁造影评分与初始手臂体积超标以及淋巴水肿持续时间相关。可以得出结论，放射性核素淋巴闪烁造影术的定量和半定量评估是上肢淋巴水肿临床评估的一种潜在有用工具。
