O'Mahony Susan, Solanki Chandra K, Barber Robert W, Mortimer Peter S, Purushotham Arnie D, Peters A Michael
Cambridge Breast Unit, Addenbrooke's Hospital, Cambridge, UK.
AJR Am J Roentgenol. 2006 May;186(5):1349-55. doi: 10.2214/AJR.04.1341.
The disordered physiology that results from axillary lymph node clearance surgery for breast cancer and that leads to breast cancer-related lymphedema is poorly understood. Rerouting of lymph around the axilla or through new pathways in the axilla may protect women from breast cancer-related lymphedema. The aim of the study was to compare intradermal with subcutaneous injection of technetium-99m ((99m)Tc)-labeled human polyclonal IgG (HIG) with respect to lymphatic vessel imaging.
Six women with breast cancer-related lymphedema underwent unilateral upper limb lymphoscintigraphy, using a web space injection of (99m)Tc-labeled HIG, after intradermal and subcutaneous injections on separate occasions. Multiple sequential images were obtained of the affected upper limb and torso over 3 hr on each occasion. Accumulation of activity in blood was quantified from venous blood samples taken from the opposite arm.
Imaging after intradermal injection clearly showed discrete lymphatic vessels in five of six patients, in contrast to imaging after subcutaneous injection, which did not show any discrete vessels in any patient. Intradermal injection resulted in more rapid visualization of cutaneous lymph rerouting than subcutaneous injection in six of six patients. Recovery of injected (99m)Tc-labeled HIG in venous blood was greater after intradermal injection in six of six patients.
In patients with breast cancer-related lymphedema, lymphatic vessels are more clearly depicted after intradermal than subcutaneous injection as a result of direct access of radiotracer to dermal lymphatics. This finding has implications for imaging lymphatic vessel regeneration and lymph rerouting.
乳腺癌腋窝淋巴结清扫术后导致的生理紊乱进而引发乳腺癌相关淋巴水肿，目前对此了解甚少。腋窝周围或通过腋窝新路径进行淋巴改道可能会使女性免受乳腺癌相关淋巴水肿的困扰。本研究的目的是比较皮内注射与皮下注射99m锝（99mTc）标记的人多克隆IgG（HIG）在淋巴管成像方面的差异。
6例患有乳腺癌相关淋巴水肿的女性患者，在不同时间分别进行皮内和皮下注射后，采用指蹼间隙注射99mTc标记的HIG进行单侧上肢淋巴闪烁显像。每次在3小时内对患侧上肢和躯干获取多个连续图像。从对侧手臂采集静脉血样，对血液中的活性物质蓄积进行定量分析。
与皮下注射后的成像相比，皮内注射后成像清晰显示6例患者中有5例存在离散的淋巴管，而皮下注射后在任何患者中均未显示任何离散的淋巴管。6例患者中，皮内注射比皮下注射能更快显示皮肤淋巴改道。6例患者中，皮内注射后静脉血中注入的99mTc标记的HIG回收率更高。
在患有乳腺癌相关淋巴水肿的患者中，由于放射性示踪剂可直接进入真皮淋巴管，皮内注射比皮下注射能更清晰地显示淋巴管。这一发现对淋巴管再生成像和淋巴改道具有重要意义。
