Suehiro Kotaro, Morikage Noriyasu, Murakami Masanori, Yamashita Osamu, Samura Makoto, Hamano Kimikazu
Division of Vascular Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi, 755-8505, Japan,
Surg Today. 2014 Jun;44(6):1048-55. doi: 10.1007/s00595-013-0819-7. Epub 2013 Dec 29.
To re-evaluate whether qualitative lymphangioscintigraphy (LAS) findings are sensitive enough to diagnose or classify the clinical severity of lower extremity lymphedema.
LAS was performed in 78 extremities with lymphedema and 24 extremities without lymphedema between April, 2009 and March, 2012. We assessed the proportion of extremities in which there was no visual evidence of the ilioinguinal lymph nodes (LN-60) or the lymphatic trunk (Tr-60) 60 min after tracer injection, the number of visualized ilioinguinal lymph nodes (#LN), and the proportion of extremities with dermal backflow (pDBF) and lymph stasis (pLS). These were associated with the International Society of Lymphology (ISL) clinical stage.
LN-60, Tr-60, #LN, pDBF, and pLS, especially when extending into both the thigh and lower leg, were significantly associated with the ISL stage. The sensitivity of LN-60, Tr-60, and #LN <2 for diagnosing lymphedema was 49, 47, and 59 %, respectively, with no significant difference among these parameters for consecutive ISL stages.
None of the above measures was sufficiently sensitive to diagnose lymphedema or classify the severity of the disease; however, each of these criteria can aid in diagnosis, by excluding other diseases and assessing disease pathophysiology.
重新评估定性淋巴管闪烁造影（LAS）结果对于诊断或分类下肢淋巴水肿临床严重程度的敏感性。
在2009年4月至2012年3月期间，对78例有淋巴水肿的肢体和24例无淋巴水肿的肢体进行了LAS检查。我们评估了注射示踪剂60分钟后未见到髂腹股沟淋巴结（LN-60）或淋巴干（Tr-60）的肢体比例、可视化的髂腹股沟淋巴结数量（#LN）以及出现真皮回流（pDBF）和淋巴淤滞（pLS）的肢体比例。这些指标与国际淋巴学会（ISL）临床分期相关。
LN-60、Tr-60、#LN、pDBF和pLS，尤其是当累及大腿和小腿时，与ISL分期显著相关。LN-60、Tr-60和#LN<2对淋巴水肿诊断的敏感性分别为49%、47%和59%，在连续的ISL分期中这些参数之间无显著差异。
上述措施均不足以敏感地诊断淋巴水肿或对疾病严重程度进行分类；然而，这些标准中的每一项都可通过排除其他疾病和评估疾病病理生理学来辅助诊断。
