Lymphoscintigraphy

Lymphoscintigraphy is a special type of nuclear medicine imaging study; it provides images of the lymphatic system. A radio tracer is used to obtain the images. The images are known as scintigrams. Lymph nodes act like a filter for foreign bodies such as viruses, pollen and germs. Lymphoscintigraphy is used as an imaging study in people suffering from any of the following - breast cancer, malignant melanoma (stage 1&2), head, neck gastric, thyroid, vulvar, and penile cancers. The procedure is carried out by a certified nuclear imaging technician. Lymphoscintigraphy is performed to

• Identify the sentinel lymph node i.e. the first node that drains a tumor.
  
• Identify the number of sentinel nodes.
  
• Mark the sentinel node over the skin for biopsy.
  
• Locate the sentinel in unexpected locations.
  
• Differentiate sentinel node from other subsequent nodes.
  
• Plan a or surgery that helps assess the stage of cancer so as to plan treatment.
  
• Identify points of blockage in the lymphatic system.

The study of the sentinel node is highly significant for the following reasons:

• It is the first node to receive metastatic deposits in a malignancy.
  
• A radio active channel leads to this node.
  
• It is the node close to the primary lesion.
  
• It is the first node to be visible during the lymphoscintigraphy study.

Lymphoscintigraphy became much sought after, after it was used to identify and study the breast sentinel nodes. This procedure is an important procedure because if the sentinel node is free of metastasis, then the subsequent nodes are also most likely to be disease free. This procedure permits the patient to skip axillary clearance surgery if the sentinel node shows negative for metastatic disease. This procedure becomes very useful for scores of people suffering from breast cancer across the world as it avoids a painful surgical procedure.

The patient is injected with the radioactive material; this radioactive material gives off gamma rays that are picked by the gamma camera. Pictures are taken for 1 hour to show the flow of the material through the lymph nodes. Anesthesia is not required, the patient is made to lie on a table and the gamma camera is positioned accordingly. As the gamma camera moves, it follows the radiation being emitted which in turn is mapped into a series of images. The doctor marks the skin at the sentinel node sites and these marks are later used during the surgery. The body passes out the small levels of radioactive material naturally.

Lymphedema

Lymphatic system is a major part of the circulatory and immune system that transports lymph fluid from tissues to the blood stream. Lymph fluid contains white blood cells that protect the body against infections and help the body detoxify. When lymph fluid is not drained properly and starts to build and cause swelling, it is called Lymphedema. Any part of the body can be affected by Lymphedema, but it usually occurs in the arms, legs and very rarely it can occur on the neck, head, groin and genital areas.

Primary Lymphedema is congenital and is caused by the defective lymphatic system present during the birth. Sometimes primary Lymphedema, though present during the birth, may surface only after puberty.

Secondary Lymphedema is an acquired lymphedema due to infection, trauma, injury or cancer that has disturbed the lymphatic system. Apart from such conditions, radiation therapy and surgery involving lymph nodes also results in malfunction of lymphatic system giving rise to Lymphedema. Women who are treated for breast cancer are at high risk for Lymphedema. Breast cancer surgery normally involves removal of one or two lymph nodes and thus disturbs the pathway of the lymphatic system. Hence breast cancer patients should be watchful of any swelling under arms or around the breast region after the surgery.

Symptoms of Lymphedema

1. Pain and heaviness in the arms, legs, chest and breast.
2. Swelling in the arms and legs including fingers and toes.
3. Hardening and redness on the skin of the affected limbs.
4. Tingling sensation or pins and needles feeling in the arms and legs.
5. Sore feeling in elbow.
6. Trouble in wearing jackets, watches, bracelets and rings.
7. Difficulty in moving the limbs.
8. Discolored skin associated with rash.
9. Skin indentation after pressing the affected region.
10. Fever

Diagnosing Lymphedema

Doctor evaluates the patient through clinical examination and also checks family and medical history of the patient. He will also look for risk factors such as history of a cancer or a surgery. Doctor may also look for pitting by gently applying the pressure on the swelling. If skin indentation occurs, it needs to be examined further. Certain imaging tests like CT scan, MRI, Lymphoscintigraphy and ultrasonography may be carried on to confirm Lymphedema.

Lymphedema treatment

Treatment for Lymphedema depends upon the extent of progression and severity of the disease. However, the following methods are broadly followed to treat Lymphedema:

Manual lymph drainage: Manual lymph drainage is a massage technique that allows the flow of lymph from affected limb. This technique helps to heal the diseased portion, restore the health of the skin and also treat the infection.

Wrapping/Bandaging: Wrapping the arm or leg with layered bandage is the most effective way of treating Lymphedema. Lymph vessels lie below the skin and take the help of the muscles to drain the lymph. The bandage wrapped around the limb provides good support to the muscles and thus fluid is pumped out easily. Bandages should be wrapped tightly around the fingers and toes and loosened as you go up the arm.

Compression garments: Compression garments are specially designed garments and they work much the way as wraps do. These garments reduce the swelling and also prevent it from recurring. They help the muscles in pushing the lymph into lymph vessels by providing firm support. Compression garments should be picked up under professional guidance with utmost care as the proper fit is essential in treating the Lymphedema. Once purchased, they should be worn regularly and all day long for speedy results.

Exercise: Certain decongestive exercises increase the lymph flow and allow it to flow back into the blood stream. Exercise sets in the movement in muscles and thereby helps in draining the lymph fluid easily. The rate of lymph flow is 15 times higher during exercise when compared to the resting period. Thus, swelling eases faster with specified exercise regimen. Always take the help of the Lymphedema therapist before starting the exercises as not all types of exercises are suitable for Lymphedema patients.

Pneumatic compression: This is a new compression device that works towards reducing swelling rapidly. It is a plastic garment with electrical pumping unit which inflates with pumped air and thus applies pressure on the muscles. These muscles in turn work on the lymphatic flow and thus reduce the swelling.

Drugs: If the affected area is infected, doctor may prescribe antibiotics to control the infection. Painkillers are also administered to relieve the patient from pain.