SCIENTIFIC AND INFORMATION-ANALYTICAL MAGAZINE

ISSN 1024-6177 (Print), ISSN 2618-9615 (Online)

Medical Radiology and Radiation Safety. 2025. Vol. 70. № 4

DOI:10.33266/1024-6177-2025-70-4-87-95

E.A. Nikolaeva1, A.S. Krylov1, A.A. Ryzhkov1, 2, B.Ya. Narkevich1, A.V. Filimonov1

Indirect Radionuclide Lymphoscintigraphy in the Assessment of Upper Limb Lymphostasis after Breast Cancer Treatment

1 N.N. Blokhin National Medical Research Center of Oncology, Moscow, Russia

2 Russian Medical Academy of Continuous Professional Education, Moscow, Russia

Contact person: E.A. Nikolaeva, e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

 

ABSTRACT

Purpose: To evaluate the significance of quantitative and qualitative parameters of lymphoscintigraphy, their correlation with each other and with the clinical stage of lymphedema in patients undergoing surgery for breast cancer with advanced lymphodissection.

Material and methods: 285 patients with lymphedema were examined from October 2022 to July 2023. After intradermal injection of the radiopharmaceutical 99mTc-nanotope (particle size 5-80 nm) into the first interdigital spaces of both hands, 40 MBq per point, exercises with a rubber expander were performed for 30 minutes. Planar images were obtained 2 hours after injection on a gamma camera and a qualitative description of the images was performed. The quantitative asymmetry index (QIA) was also used, for which the areas of interest were outlined in ovals and shifted to the contralateral side: forearm, shoulder, axillary and subclavicular zones.

Results: In the first degree, lymph nodes of all groups are more often detected (p<0.001), there is no reflux in the shoulder and forearm (p<0.001), more often with intact lymph ducts. In the second degree, reflux in the shoulder and forearm is significantly more often visualized (p<0.001). In the third degree, lymph nodes of all groups are more often not detected and reflux into the subcutaneous lymph networks of the shoulder and forearm is not visualized (p<0.001), more often without visualization of the lymph ducts. The disease was statistically significantly diagnosed at an earlier stage at a younger age (p=0.01). Also, a more severe degree of lymphedema was detected with an increase in BMI (p<0.001). Statistically significantly, with a previous history of remote radiation therapy, lymph nodes in the supra/subclavian region were detected less frequently (p=0.007). In the presence of reflux in the forearm area, the median of the QIA values ​in the forearm area was significantly higher than in the absence of reflux: Me=5 versus Me=1. In the presence of reflux in the shoulder area, the QIA in the forearm area was significantly higher than in the absence of reflux: Me=3 versus Me=1, respectively. Also, in the presence of reflux in the shoulder area, the median of the QIA in the forearm area was significantly higher than in the absence of reflux: Me=6 versus Me=2, respectively.

Conclusions: Statistically significant correlation indicators were obtained between quantitative and qualitative parameters of lymphoscintigraphy with each other and with the clinical stage of lymphedema, which made it possible to develop criteria for staging the severity of lymphostasis based on them. Lymphoscintigraphy also allows you to determine the nature of the increase in the volume of the upper limb (lymphatic, fibrous), which is a necessary criterion for choosing a  plan of rehabilitation measures.

Keywords: lymphostasis, lymphoscintigraphy, radionuclide diagnostics

For citation: Nikolaeva EA, Krylov AS, Ryzhkov AA, Narkevich BYa, Filimonov AV. Indirect Radionuclide Lymphoscintigraphy in the Assessment of Upper Limb Lymphostasis after Breast Cancer Treatment. Medical Radiology and Radiation Safety. 2025;70(4):87–95. (In Russian). DOI:10.33266/1024-6177-2025-70-4-87-95

 

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Conflict of interest. The authors declare no conflict of interest.

Financing. The study had no sponsorship.

Contribution. Article was prepared with equal participation of the authors.

Article received: 20.03.2025. Accepted for publication: 25.04.2025.

 

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