Value of isotope lymphography in the diagnosis of lymphoedema of the leg.
BACKGROUND
Isotope lymphography has largely replaced contrast lymphography in the diagnosis of lymphoedema. Its accuracy has only been assessed in small studies and it is not known if it can identify patients with a proximal lymphatic obstruction who may be suitable for lymphatic bypass surgery.


METHODS
Three hundred and ninety-five patients suspected to have lymphoedema were investigated by isotope lymphography between 1985 and 1995. Contrast lymphography was also carried out in 29 of these patients because the isotope results were thought to be misleading, or because lymphatic bypass surgery was being considered.


RESULTS
In the 29 patients who had both investigations isotope lymphography detected 20 of 24 abnormal lymphatic systems. Four legs with obstructed groin lymphatics were reported as normal. Two legs with normal contrast lymphograms were erroneously diagnosed as having lymphoedema in the isotope study. Detectable groin nodes on the scintigrams were indicative of either normal lymphatics or proximal lymphatic obstruction. An increase in isotope uptake over 30-60 min of less than 50 per cent, or a total absence of isotope within groin nodes, was a sensitive indicator that patients were unsuitable for lymphatic bypass surgery.


CONCLUSIONS
Isotope lymphography is a moderately sensitive test for lymphoedema, which will mistakenly classify some normal legs as lymphoedematous. It will usually correctly identify patients who are suitable for lymphatic bypass surgery.
Burnand
K G
KG
Department of Surgery, St Thomas' Hospital, London, UK. kevin.burnand@kcl.ac.uk
McGuinness
C L
CL
Lagattolla
N R F
NR
Browse
N L
NL
El-Aradi
A
A
Nunan
T
T
D003287:Contrast Media; D006801:Humans; D007264:Inguinal Canal; D007866:Leg; D008209:Lymphedema / Q000000981:diagnostic imaging*; D008220:Lymphography / Q000379:methods; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012211:Rhenium; D013671:Technetium Tc 99m Sulfur Colloid
D003287:Contrast Media; D019275:Radiopharmaceuticals; C030406:technetium Tc rhenium-sulfur colloid; D013671:Technetium Tc 99m Sulfur Colloid; D012211:Rhenium