ASSESSMENT OF LYMPHEDEMA WITH LYMPHOSCINTIGRAPHY: CAN NODAL QUANTIFICATION HELP?

Abstract

Lymphoscintigraphy with combined
qualitative and quantitative analysis is reported
to be a more sensitive approach to diagnose
lymphedema in comparison with the conventional
clinical analysis. Our study seeks to
evaluate the diagnostic performance of lower
limb lymphoscintigraphy with amalgamation of
qualitative and quantitative analysis by measuring
the ilio-inguinal nodal uptake. This
prospective observational study was comprised
of 86 patients (172 limbs) diagnosed with lower
limb lymphedema. After a thorough clinical
grading of edema, radionuclide lymphoscintigraphy
was performed as per a dedicated
institutional protocol. Ilio-inguinal nodal
quantification of tracer uptake was computed
along with the visual study of the scans.
Additionally, the corresponding mean nodal
uptake percentage for each grade of lymphedema
was assessed and a cut off nodal uptake
percentage to differentiate between normal and
abnormal limbs was defined. Although quantitative
analysis with nodal uptake percentage
provides objective criteria to diagnose lymphedema,
it can only act as an adjunct to qualitative
method without replacing it. Finally,
standardization of procedure for quantitative
lymphoscintigraphy is needed including the
potential for combining both rate of clearance
of tracer from injection site and nodal uptake
for quantification.