Imaging of Lymphatic Vessels in Breast Cancer–Related Lymphedema: Intradermal Versus Subcutaneous Injection of ^99mTc-Immunoglobulin

Abstract

In patients with breast cancer-related lymphedema, lymphatic vessels are more clearly depicted after intradermal than subcutaneous injection as a result of direct access of radiotracer to dermal lymphatics. This finding has implications for imaging lymphatic vessel regeneration and lymph rerouting.

Repeated low-dose intradermal allergen injection suppresses allergen-induced cutaneous late responses

“…In an animal study radiotracer clearance from the skin to the lymph nodes was between 10-and 100-fold more rapid after intradermal than subcutaneous injection, 34 a finding that is consistent with imaging studies in human subjects. 35 Therefore intradermal allergen injection might represent a means for efficient antigen pulsing of lymph node DCs analogous to intralymphatic grass pollen immunotherapy administered as 3 injections. 36 However, although intralymphatic immunotherapy is unquestionably low dose (cumulative dose 3000 SQ-U) compared with subcutaneous treatment, the cumulative allergen administered in the 6 intradermal injections of our study was still 15-fold less (ie, 200 SQ-U, which is equivalent to 60 BU in total).…”

Tc-99m-Human Serum Albumin Transit Time as a Measure of Arm Breast Cancer-Related Lymphedema

“…18–20 Despite the use of a fast tracer and intradermal injection technique, a decline in arm activity during our 5-hour scan time was not observed in 2 patients, meaning that sometimes the MTT cannot be calculated and only a minimum value can be obtained. In addition, in case of very limited tracer migration from injection depot, the MTT through the arm is determined with great uncertainty; however, this was not the case in any of the examined patients.…”

Imaging the lymphatic system

“…Single-photon emission computed tomography (SPECT) uses triangulated information from multiple detectors to reconstruct 3D images of radioactive tracers (Barrett et al, 2006; Mar et al, 2007; O'Mahony et al, 2006). It is advantageous to add conventional x-ray CT to this method, to perform SPECT/CT, which localizes the lymphatic tracer at relatively low resolution (1–2 cm), but in relation to the high-resolution anatomy provided by the CT scan (Basu and Alavi, 2009; Tseng et al, 2014; Vermeeren et al, 2009).…”