title: Peripheral lymphovenous communication in lymphoedema.
abstract: OBJECTIVE
  To investigate whether in lower extremity lymphoedema, lymph proteins enter blood before they do the thoracic duct.
  
  
  METHODS
  Retrospective analysis of routine lymphoscintigraphy in 69 adults imaged at 5, 45 and 150 min following bilateral subcutaneous web space injection of Tc-nanocolloid was carried out. Regions of interest were placed over the liver and ilioinguinal lymph nodes bilaterally on the anterior images at 45 and 150 min. Individual minor (0.5 point for each) and major (1 point for each) criteria of abnormal scintigraphy were applied to each limb and summed to give a lymphoscintigraphic abnormality score. An abnormal limb had a score ≥1.
  
  
  RESULTS
  The ratio of hepatic counts per pixel to total bilateral ilioinguinal counts (L/N ratio) was higher in patients with abnormal results on lymphoscintigraphy (median 6.2; interquartile range 4.0-15.6 pixels×10; n=48) compared with that in patients with normal lymphoscintigraphic results (2.5 [1.5-5.0] pixels×10; n=21; P<0.0002). In the abnormal group, the lymphoscintigraphic score (two limbs summed) correlated with the 150-min L/N ratio (r s=0.42; P<0.005). L/N ratios at 45 and 150 min correlated in the abnormal group (r s=0.44; P<0.005) but not in the normal group (r s=0.3; P>0.05). The 45-min activity, as a percentage of the 150-min activity, was higher in lymph nodes than in the liver in both the abnormal (35.0 [8.2-50.0] vs. 10.6 [5.8-30.0]%; P<0.0001]) and normal groups (38.3 [18.4-63.5] vs. 23.3 [12.4-33.1]%; P<0.05), and, with respect to the liver, was higher in the normal group (P<0.01).
  
  
  CONCLUSIONS
  In lymphoedema, more lymph proteins enter blood proximal to the thoracic duct. The time courses of nodal and hepatic activities suggest that access may occur within nodes themselves.
authors.affiliation: Brighton and Sussex Medical School, UK.
authors.forename: Gregory Francis William
authors.initials: GF
authors.lastname: Stamp
authors.forename: Adrien Michael
authors.initials: AM
authors.lastname: Peters
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001798:Blood Proteins / Q000032:analysis*; D016022:Case-Control Studies; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging*; D008209:Lymphedema / Q000000981:diagnostic imaging*; D061305:Lymphoscintigraphy / Q000379:methods; D008875:Middle Aged; D015609:Organotechnetium Compounds; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D001798:Blood Proteins; D015609:Organotechnetium Compounds