Lymph Drainage Scintigraphy

Lymph drainage scintigraphy enables the visualization of lymph pathways and lymph nodes, through which the tissue fluid (lymph) flows. Lymph nodes can thus be precisely localized; on the other hand, a delay or interruption in lymph drainage can also be identified. As a result, this examination is used prior to a tumor surgery to identify the sentinel or “first station” lymph node(s), which (when free of disease) may avoid an extensive lymph node extirpation. Lymph drainage scintigraphy can also be used to identify or exclude congenital or acquired lymph flow disorders.

Rationale for a sentinel lymph node scintigraphy

"Guardian" or "sentinel" lymph nodes are one or more lymph nodes, through which the lymph is initially drained from a specific area of the body, Lymph drainage scintigraphy can be used to visualize the guardian lymph node of the tumor area. This examination is most frequently performed for patients with breast cancer or pigmented skin cancer (malignant melanoma). By means of identification and removal of the guardian lymph nodes and their histopathological examination, it is possible to avoid a more comprehensive removal of lymph nodes if no metastasis is found on the guardian lymph node.

Do I need to prepare for the examination?

No special preparation is required. Since the examination involves applying skin markings with a marker pen that could be blurred during washing or showering, you should preferably take a shower before the examination and then avoid doing so until the operation.

The procedure of the examination?

Weakly radioactively labeled protein particles are injected into the skin very superficially around the scar of the previously surgically removed malignant melanoma. In breast cancer, the radioactively labeled protein particles are injected at 4 sites around the nipple of the diseased breast. This procedure is at worst case unpleasant, but usually not painful.

The marked protein particles emit low-level gamma rays, which are recorded with a gamma camera and displayed on a computer (scintigraphy).

These scintigraphic images are taken immediately after injection and after a few hours on the same day. Thereby the position of the lymph nodes will be marked on the skin. You will be then given an examination report as well as the image copies to be taken to your surgeon. The skin markings serve as orientation for the surgeon and must therefore not be wiped away. Usually, the lymph nodes marked in this way are then surgically removed with the aid of a gamma counter probe on the following day during the operation and examined histopathologically.

Unfortunately, it is not possible to recognize tumor metastases in the lymph node on the scintigraphic images. The sole purpose of the examination is to locate the sentinel lymph node(s).

Lymph sequence scintigraphy

Lymphedema of the arms or legs may develop as a result of disorders of the tissue fluid drainage, which can be caused by a congenital lack of lymph vessels or damage to lymph vessels secondary to therapy.

How do you have to prepare for the examination?

No special preparation is required.

How does the examination proceed?

Radioactively labeled protein particles with low level radiation are injected under the skin between the toes. These radioactively labeled protein particles emit gamma rays with low-level radiation, which are recorded using a gamma camera and displayed on a computer (scintigraphy).

After the injection, scintigraphic images are acquired on a gamma camera for 15 minutes. You will then be asked to close the fist of the affected arm or move the foot of the affected leg for 15 minutes. During this time, additional images are taken.

Following the examination, the nuclear medicine physician evaluates the images taken in this way and informs your attending medical doctor of the findings.