Contribution of Nuclear Medicine to Suspected Lymphoedema

Running head: NUCLEAR MEDICINE
Contribution of nuclear medicine to suspected lymphoedema
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Introduction- The term nuclear medicine refers to the medical speciality that involves
application of certain radioactive substances for the identification, and treatment of any illness.
The history of nuclear medicine can be traced back to artificial radioactivity discovery in 1934,
followed by the production of several radio-nucleotides for usage in medicine in 1946, by the
Oak Ridge National laboratory (1). This form of medical speciality involves the usage of minute
amounts of radioactive substances, commonly referred to as radiotracers that are generally
injected into the bloodstream swallowed or inhaled, which then travel through the area that is
being investigated, and radiate energy in the form of gamma rays (2). This essay will elaborate
on the contribution of nuclear medicine in management of suspected lymphoedema, a chronic
condition that results in swelling of the body tissues. The condition particularly arises when the
lymphatic system fails to work in an effective manner, thereby creating difficulties in fighting
infection and removing excess body fluids.
Discussion- Lymphoscintigraphy also referred to as Sentinel Lymph Node (SLN)
mapping refers to an imaging technique that is particularly used for the identification of lymph
drainage basin, determination of the quantity of sentinel node, differentiation of subsequent
nodes from sentinel nodes, marking sentinel node over skin for the purpose of biopsy, and
locating sentinel nodes in unexpected regions (3). The benefits of nuclear medicine can be
accredited to the fact that conduction of a sentinel lymph node biopsy (SLNB) helps in
determining whether melanoma breast cancer in the patient has spread to others and lymph
nodes. SLNB has substituted axillary lymph node (ALN) dissection in recent years, and has
begun to be used as the chief stage staging modality for suspected breast cancer and melanoma.
Reports from recently conducted multicenter randomised trials that comprised of breast cancer
patients failed to demonstrate any significant differences in overall or disease free survival rates,

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between ALND and SLNB. Nonetheless, usage of nuclear medicine through SLNB was also
correlated with significant decline in the mortality rates, when compared to the other diagnostic
techniques. Low false negative rates were also found in studies that were associated with usage
of pre-operative lymphoscintigraphy, thus establishing the benefits of nuclear medicine in
diagnostic imaging (4).
Research evidences also elaborate on the fact that metastatic nature of regional lymph
nodes is one of the most noteworthy prognostic factors in breast cancer melanoma, in contrast to
different solid tumours that have lymphatic spread. Pre-operative recognition of sentinel lymph
nodes has been conventionally performed with the use of radiotracer injection,
lymphoscintigraphy and Single Photon Emission Computed Tomography (SPECT). Owing to
the fact that use of radiocolloids such as nanocolloids facilitate greater rate of SLN detection
than conventional methods (as much as 95%), nuclear medicine can be used as an effective tool
for diagnostic purposes. The success of nuclear medicine can also be attributed to the capability
of radiocolloids to be retained for greater period of time, in the SLN, in combination with their
higher rates of detection (5). According to (6) upon investigating prognostic worth of qualitative
worth of lymphoscintigraphy, in relation to gynaecological cancer-associated lymphoedema, it
was found that an estimated 58.6% patients who underwent complex decongestive therapy
(CDT), manifested poor therapeutic response. This was concomitant with significant differences
between poor and good responders in therapy compliance, clinical status, pattern of lymphatic
vessel uptake, and dermal backflow severity, thus establishing lymphoscintigraphy beneficial in
predicting outcomes of such patients.
With the aim of exploring validity of quantitative lymphoscintigraphy for patients who
have undergone breast cancer surgery, 72 patients reporting lymphoedema were recruited,

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followed by implementation of quantitative asymmetry indices (QAI). Results suggested that
maximal circumference difference (MCD) was greater in qualitative obstruction patterns
(2.76±2.48), which was significantly different from decreased function pattern (1.65±1.17) and
normal pattern (0.69±0.78). With an increase in QAI of axillary LN, a significant decrease was
observed in MCD, which in turn was accompanied by high obstruction pattern of QAI in the
upper limbs (3.12±3.07). The findings of the study confirmed the use of quantitative
lymphoscintigraphy as an alternative diagnostic tool for identification of lymphoedema,
following breast cancer surgery (7).
Figure 1- Typical images of quantitative lymphoscintigraphic analysis of the upper
limb of a patient with breast cancer surgery including axillary lymph node (LN) dissection.
Source- (7)
Findings from another study that comprised of two groups having 16 patients with upper
limb/trunk melanoma for axillary SLN biopsy as the study subjects, and 10 healthy volunteers as
the control, respectively, demonstrated noteworthy differences. Asymmetry indices for