Characterizing Normal Upper Extremity Lymphatic Flow with 99mTc In-House Dextran: A Retrospective Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Population
- Aged 18 years and older.
- Patients with at least one normal arm.
- No previous diagnosis of lymphedema in the included arm.
- History of arm or breast surgery on the included side.
- Prior radiotherapy to the included arm.
- Presence of cellulitis during examination.
- History of significant trauma to the included arm.
- History of cancer metastasizing to the included arm.
- Generalized edema.
- Peripheral vascular disease.
- History of bilateral breast cancer.
- Family history of congenital lymphedema.
2.2. Radiopharmaceutical Preparation and Administration
2.3. Lymphoscintigraphy Imaging Procedure
2.4. Qualitative (Visual) Analysis
- Axillary lymph nodes;
- Forearm (Epitrochlear of Brachial) lymph nodes;
- Upper extremity lymphatic tract and associated organs, i.e., liver, kidney, urinary bladder.
2.5. Quantitative Analysis
2.5.1. Percentage of Axillary Lymph Node Uptake (%ANU) [29]
- ANU: Uptake of axillary node (counts)
- IIS: Initial uptake in the injection site (counts)
- DF: Technetium-99m’s decay factor
2.5.2. Percentage of Radiopharmaceutical Clearance at Injection Site (%RC) [29]
- IIS: Initial uptake in the injection site (counts)
- LIS: Later uptake in the injection site at imaged time-points up to 1 h (counts)
- DF: Technetium-99m’s decay factor at imaged time-points up to 1 h
2.6. Statistical Analysis
3. Results
3.1. Population Studied
3.2. Population Characteristics
3.3. Qualitative Analysis
- Axillary lymph node detection rates were 46% within 15 min, rising to 68% between 16 and 30 min, and approximately 86% within the first hour.
- Most identified axillary nodes were solitary, with 13% exhibiting two nodes and 5% showing three or more (Figure 3A).
- Detection in the elbow (Epitrochial/brachial) node was rare, around 4% within an hour, typically involving two or fewer nodes (Figure 3C).
- Delayed imaging up to 4 h further revealed lymph nodes in the axillary region for 10 out of 12 patients initially without detected axillary nodes within the first hour. The remaining two patients did not undergo delayed imaging beyond 2 h.
- Upper extremity lymphatic tracts can be detected at approximately 61% within 15 min and up to 92% within 31–45 min.
- Organs such as the liver, kidney, and urinary bladder show detection rates of 54%, 71%, and 93%, respectively, within the first hour (Figure 3B).
- The radiopharmaceutical persists in these organs and lymphatic pathways, with increasing activity observed continuously beyond 50% probability thresholds. Specifically, liver, kidney, and urinary bladder detection thresholds are reached at least 46 min, 31 min, and 16 min, respectively.
3.4. Quantitative Analysis
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Normal Upper Extremity | Qualitative Analysis (n= 84) | Quantitative Analysis (n = 24) |
---|---|---|
Age (years), mean ± SD | 59.96 ± 12.15 | 62.87 ± 11.92 |
Weight (kg), mean ± SD | 64.36 ± 12.20 | 65.41 ± 10.66 |
Height (cm), mean ± SD | 154.26 ± 6.00 | 154.26 ± 6.39 |
BMI (kg/m2), mean ± SD | 26.92 ± 4.64 | 27.20 ± 4.14 |
Gender - Female, n (%) | 81 (96%) | 24 (100%) |
Normal arm - Right, n (%) | 42 (50%) | 11 (45%) |
Underlying breast cancer, n (%) | 77 (92%) | 23 (96%) |
Time Interval (min) | Nodal Number | Regions | |
---|---|---|---|
Axillary, n (%) | Epitrochial/brachial, n (%) | ||
≤15 | 0 | 45 (54%) | 83 (99%) |
1 | 33 (39%) | 1 (1%) | |
2 | 4 (5%) | - | |
≥3 | 2 (2%) | - | |
16–30 | 0 | 27 (32%) | 82 (98%) |
1 | 45 (53%) | 1 (1%) | |
2 | 9 (11%) | 1 (1%) | |
≥3 | 3 (4%) | - | |
31–45 | 0 | 16 (19%) | 81 (96%) |
1 | 54 (64%) | 2 (3%) | |
2 | 10 (12%) | 1 (1%) | |
≥3 | 4 (5%) | - | |
46–60 | 0 | 12 (14%) | 81 (96%) |
1 | 57 (68%) | 2 (3%) | |
2 | 11 (13%) | 1 (1%) | |
≥3 | 4 (5%) | - | |
240 (Up to 4 h) | 0 | 2 * (2%) | 81 (96%) |
1 | 59 (70%) | 2 (3%) | |
2 | 19 (23%) | 1 (1%) | |
≥3 | 4 (5%) | - |
Visualization | Time Interval (min) | |||
---|---|---|---|---|
≤15 | 16–30 | 31–45 | 46–60 | |
Upper extremity lymphatic tract activity, n (%) | 51 (61%) | 70 (83%) | 77 (92%) | 77 (92%) |
Liver activity, n (%) | 8 (10%) | 17 (20%) | 23 (27%) | 45 (54%) |
Kidney activity, n (%) | 10 (12%) | 31 (37%) | 45 (54%) | 60 (71%) |
Urinary bladder activity, n (%) | 23 (27%) | 65 (77%) | 73 (87%) | 78 (93%) |
Time Interval (min) | Study of Visualized Lymph Node, n (%) | Total Count [Median (Range)] | |
---|---|---|---|
Axillary Lymph Node | Injection Site | ||
≤15 | 14 (58%) | 199.62 (2377.43) | 325,377.06 (446,079.03) |
16–30 | 16 (67%) | 468.84 (4090.21) | 302,932.48 (467,057.55) |
31–45 | 18 (75%) | 508.01 (5794.04) | 272,720.90 (457,650.09) |
46–60 | 20 (83%) | 922.91 (6655.25) | 237,886.02 (398,128.31) |
Time Interval (min) | % Axillary Lymph Node Uptake (ANU) [Median (Range)] | % Radiopharmaceutical Clearance (RC) [Median (Range)] |
---|---|---|
≤15 | 0.05 (1.46) | 2.79 (4.19) |
16–30 | 0.10 (1.56) | 3.18 (56.96) |
31–45 | 0.14 (2.06) | 7.02 (83.71) |
46–60 | 0.33 (2.40) | 9.17 (50.03) |
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Katiyarangsan, W.; Charoenphun, P.; Chuamsaamarkkee, K.; Musikarat, S.; Kiranantawat, K.; Sakulpisuti, C.; Thamnirat, K.; Kositwattanarerk, A.; Sritara, C.; Chamroonrat, W. Characterizing Normal Upper Extremity Lymphatic Flow with 99mTc In-House Dextran: A Retrospective Study. Diagnostics 2024, 14, 1960. https://doi.org/10.3390/diagnostics14171960
Katiyarangsan W, Charoenphun P, Chuamsaamarkkee K, Musikarat S, Kiranantawat K, Sakulpisuti C, Thamnirat K, Kositwattanarerk A, Sritara C, Chamroonrat W. Characterizing Normal Upper Extremity Lymphatic Flow with 99mTc In-House Dextran: A Retrospective Study. Diagnostics. 2024; 14(17):1960. https://doi.org/10.3390/diagnostics14171960
Chicago/Turabian StyleKatiyarangsan, Wiroj, Putthiporn Charoenphun, Krisanat Chuamsaamarkkee, Suchawadee Musikarat, Kidakorn Kiranantawat, Chaninart Sakulpisuti, Kanungnij Thamnirat, Arpakorn Kositwattanarerk, Chanika Sritara, and Wichana Chamroonrat. 2024. "Characterizing Normal Upper Extremity Lymphatic Flow with 99mTc In-House Dextran: A Retrospective Study" Diagnostics 14, no. 17: 1960. https://doi.org/10.3390/diagnostics14171960