title: Reproducibility of lymphoscintigraphic evaluation of the upper limb.
abstract: BACKGROUND
  Although reproducibility studies are missing, a lymphoscintigraphic evaluation of the upper limb is often used in routine practice to diagnose lymphedema and in clinical research, for example, to investigate the effect of a physical treatment. Therefore, the aim of the present study was to investigate the reproducibility of the lymphoscintigraphic evaluation of the upper limb.
  
  
  RESULTS
  In breast cancer patients, 20 lymphoscintigraphic evaluations of the upper limb were performed on two test occasions with an interval of 1 week. (99m)Tc nanocol was injected subcutaneously in the hand. A standardized protocol was applied. In the early phase, two static images of the injection places were taken and in between dynamic images of both axilla during 40 min (15 min rest, 15 min squeezing a ball, and 15 min rest). After a break of 70 min, a static image of the injection places and of the axilla was made. At the end, a partial whole body image was acquired. A strong reproducibility was found for the following quantitative variables (ICC 0.75 to 0.85): change of uptake in axilla during the break; change of extraction from hands during the break; and extraction and uptake in the late phase. The other quantitative variables (i.e., extraction form the hands in the early phase, time of arrival, accumulation rate, and uptake in axilla in the early phase) had weak to moderatie reproducibility (ICC 0.07 to 0.70). All qualitative variables (i.e., number of lymph nodes in the axilla, upper arm and elbow/lower arm, gradation of lymph collectors in upper or lower arm and of dermal backflow, and presence of lymph collaterals) had strong to very strong reproducibility (ICC 0.76 to 1.00).
  
  
  CONCLUSIONS
  A lymphoscintigraphy of the upper limb is a reproducible imaging tool to assess lymph transport quantitatively and qualitatively.
authors.affiliation: 1 Department of Physical Medicine and Rehabilitation, Rehabilitation Sciences, KU Leuven-University of Leuven, and University Hospitals Leuven , Leuven Lymphedema Center, Leuven, Belgium .
authors.forename: Nele
authors.initials: N
authors.lastname: Devoogdt
authors.forename: Tim
authors.initials: T
authors.lastname: Van den Wyngaert
authors.forename: Pierre
authors.initials: P
authors.lastname: Bourgeois
authors.forename: Michel
authors.initials: M
authors.lastname: Lambrechts
authors.forename: Marijke
authors.initials: M
authors.lastname: Van Kampen
authors.forename: An
authors.initials: A
authors.lastname: De Groef
authors.forename: Inge
authors.initials: I
authors.lastname: Geraerts
authors.forename: Patrick
authors.initials: P
authors.lastname: Neven
authors.forename: Ignace
authors.initials: I
authors.lastname: Vergote
authors.forename: Wiebren
authors.initials: W
authors.lastname: Tjalma
authors.forename: Marie-Rose
authors.initials: MR
authors.lastname: Christiaens
authors.forename: Sigrid
authors.initials: S
authors.lastname: Stroobants
mesh_terms: D000328:Adult; D000368:Aged; D001132:Arm / Q000000981:diagnostic imaging*; D001365:Axilla; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D061305:Lymphoscintigraphy / Q000592:standards*; D008875:Middle Aged; D015203:Reproducibility of Results