title: Evaluation of the Upper Limb Lymphatic System: A Prospective Lymphoscintigraphic Study in Melanoma Patients and Healthy Controls.
abstract: BACKGROUND
  Current research on the upper limb lymphatic system mainly studies breast cancer patients with unilateral lymphedema. Without preoperative lymphoscintigraphy, the contralateral limb is used as a control, assuming that it is functionally intact. Few lymphoscintigraphic studies investigate patients before any axillary surgery. The purpose of this study was to evaluate, through lymphoscintigraphy, the preoperative condition of the upper limb lymphatic system in melanoma patients and healthy controls.
  
  
  METHODS
  Two groups were studied: the study group (16 patients with trunk/upper limb melanoma candidates for axillary sentinel lymph node biopsy) and the control group (10 healthy volunteers). All subjects underwent upper limb lymphoscintigraphy. Lymphoscintigraphic images were classified into three patterns based on the tracer appearance time in the axillary nodes. Type I, 20 minutes; type II, 60 minutes; and type III, 120 minutes. Statistical analysis was used to assess the relationship between lymphoscintigraphic patterns and clinical variables and to compare patterns of distribution.
  
  
  RESULTS
  Lymphoscintigraphic patterns were asymmetric in 37.5 percent (study group) and 50 percent (control group). Type III was the most common pattern. There was no significant association between lymphoscintigraphic patterns and considered clinical variables. There was no significant difference in the lymphoscintigraphic pattern distribution of the two groups (p = 0.870).
  
  
  CONCLUSIONS
  The authors' findings show wide differences and an often "slow" tracer appearance time in patients with intact lymphatic system, questioning the use of contralateral limb as control and transportation time greater than 30 minutes as criteria for identification of lymphatic alterations.
  
  
  METHODS
  Diagnostic, IV.
authors.affiliation: Palermo, Italy; and Ghent, Belgium.|From Plastic Surgery, Department of Surgical, Oncological and Oral Sciences; Nuclear Medicine, Biomedical Department of Internal and Specialist Medicine, University of Palermo; and the Department of Plastic and Reconstructive Surgery, Ghent University Hospital.
authors.forename: Matteo
authors.initials: M
authors.lastname: Rossi
authors.affiliation: Palermo, Italy; and Ghent, Belgium.|From Plastic Surgery, Department of Surgical, Oncological and Oral Sciences; Nuclear Medicine, Biomedical Department of Internal and Specialist Medicine, University of Palermo; and the Department of Plastic and Reconstructive Surgery, Ghent University Hospital.
authors.forename: Rita
authors.initials: R
authors.lastname: Grassi
authors.affiliation: Palermo, Italy; and Ghent, Belgium.|From Plastic Surgery, Department of Surgical, Oncological and Oral Sciences; Nuclear Medicine, Biomedical Department of Internal and Specialist Medicine, University of Palermo; and the Department of Plastic and Reconstructive Surgery, Ghent University Hospital.
authors.forename: Renato
authors.initials: R
authors.lastname: Costa
authors.affiliation: Palermo, Italy; and Ghent, Belgium.|From Plastic Surgery, Department of Surgical, Oncological and Oral Sciences; Nuclear Medicine, Biomedical Department of Internal and Specialist Medicine, University of Palermo; and the Department of Plastic and Reconstructive Surgery, Ghent University Hospital.
authors.forename: Luigi
authors.initials: L
authors.lastname: Di Rosa
authors.affiliation: Palermo, Italy; and Ghent, Belgium.|From Plastic Surgery, Department of Surgical, Oncological and Oral Sciences; Nuclear Medicine, Biomedical Department of Internal and Specialist Medicine, University of Palermo; and the Department of Plastic and Reconstructive Surgery, Ghent University Hospital.
authors.forename: Salvatore
authors.initials: S
authors.lastname: D'Arpa
authors.affiliation: Palermo, Italy; and Ghent, Belgium.|From Plastic Surgery, Department of Surgical, Oncological and Oral Sciences; Nuclear Medicine, Biomedical Department of Internal and Specialist Medicine, University of Palermo; and the Department of Plastic and Reconstructive Surgery, Ghent University Hospital.
authors.forename: Francesco
authors.initials: F
authors.lastname: Moschella
authors.affiliation: Palermo, Italy; and Ghent, Belgium.|From Plastic Surgery, Department of Surgical, Oncological and Oral Sciences; Nuclear Medicine, Biomedical Department of Internal and Specialist Medicine, University of Palermo; and the Department of Plastic and Reconstructive Surgery, Ghent University Hospital.
authors.forename: Adriana
authors.initials: A
authors.lastname: Cordova
mesh_terms: D000328:Adult; D000368:Aged; D001365:Axilla; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008208:Lymphatic System / Q000033:anatomy & histology / Q000000981:diagnostic imaging* / Q000502:physiology; D008209:Lymphedema / Q000209:etiology; D061305:Lymphoscintigraphy; D008297:Male; D008545:Melanoma / Q000601:surgery*; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D018570:Risk Assessment; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000601:surgery*; D034941:Upper Extremity / Q000033:anatomy & histology / Q000000981:diagnostic imaging* / Q000502:physiology