Lymphangiography
Lymphangiography is a medical imaging technique that involves injecting a dye or radioactive material into the lymphatic system to visualize the condition of lymph nodes and vessels using X-ray or MRI. This procedure is particularly valuable in oncology, especially for locating sentinel lymph nodes in breast cancer and assessing the status of lymph nodes prior to potential removal. The lymphatic system plays a crucial role in the immune response by transporting lymph—a fluid that helps filter out bacteria, viruses, and cancer cells through approximately six hundred nodes.
During the procedure, the dye is typically infused near the groin, allowing it to travel through the lymphatic channels while the patient remains still for optimal imaging. Lymphangiography can help determine if cancer has spread to the lymph nodes, thereby aiding in cancer staging and treatment decisions. Minimal patient preparation is required, but some side effects, such as a burning sensation during dye infusion or a bluish tint to urine afterward, may occur. The primary risks include allergic reactions to the dye and potential infections at the infusion site. Overall, lymphangiography is a vital tool in cancer care that assists in surgical planning and monitoring treatment progress.
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Lymphangiography
DEFINITION: Lymphangiography is the injection of a dye (lipoidal) or radioactive material into the lymphatic system so that the location and condition of lymph nodes and lymph vessels can be determined using X-ray or magnetic resonance imaging (MRI). If an MRI is used, the procedure is called MR lymphangiography.
Cancers diagnosed: Most often used to determine the location of sentinel lymph nodes in breast cancer or to determine the condition of lymph nodes prior to or removal; sometimes used to diagnose lymphomas, Hodgkin lymphoma, and Non-Hodgkin lymphoma.
Why performed: The lymphatic system is part of the immune system. It consists of a network of channels that carries lymph, a clear, yellowish fluid, and about six hundred nodes, or enlarged spaces. The lymph nodes trap bacteria, viruses, and cancer cells so that they can be destroyed by white blood cells stored in the nodes. Lymph nodes are one of the first places to which cancer spreads, so knowing if there are cancer cells in the nodes is important in staging and treating all cancers.
Lymphangiography helps the surgeon know if the disease has spread, show the progress of treatments, or determine where to biopsy or which lymph nodes to remove. The sentinel nodes are the first nodes through which lymph flows after it passes the primary tumor. In some women with breast cancer, the sentinel node is located using lymphangiography and then removed. If no cancer is found, no additional nodes need to be removed, thus reducing the amount of surgery the patient needs.
Patient preparation: Minimal preparations are needed for lymphangiography. The patient may be asked not to drink for several hours before the test since the lymphangiography takes up to seven hours and requires that the patient remain still.
Steps of the procedure: A dye is most often infused near the groin but sometimes into the hand or foot. The dye enters the lymph system and highlights the lymph channels and nodes. The dye may cause a mild burning feeling. It enters the body very slowly, and the patient must remain still. An X-ray or MRI machine images the patient's lymphatic system as the dye circulates. Sometimes, images are retaken the following day.
After the procedure: The site where the dye was infused is cleaned and closed. The patient’s urine may be bluish for several days. The dye can remain in the body for up to two years.
Risks: Allergic reactions to the dye and infection at the infusion site are the main risks.
Results: From this test, the physician can tell if the lymph nodes are swollen or clogged, a condition that may indicate cancer. The surgeon can also determine which nodes are sentinel nodes.
Bibliography
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Lu, Qing, et al. "Imaging Lymphatic System in Breast Cancer Patients with Magnetic Resonance Lymphangiography." PLoS ONE, vol. 8, no. 7, 2013. DOI:10.1371/journal.pone.0069701.
"Lymphangiography and Lymphatic Embolization." The Children’s Hospital of Philadelphia, www.chop.edu/treatments/lymphangiography-and-lymphatic-duct-embolization. Accessed 20 june 2024.
"Lymphangiography." Cleveland Clinic, my.clevelandclinic.org/health/diagnostics/22991-lymphangiography. Accessed 20 june 2024.
"Lymphangiogram." MedlinePlus, 2022, medlineplus.gov/ency/article/003798.htm. Accessed 20 June 2024.
Schwartz, Fides R., et al. “Lymphatic Imaging: Current Noninvasive and Invasive Techniques.” Seminars in Interventional Radiology, vol. 37, no. 3, 2020, pp. 237-249. doi:10.1055/s-0040-1713441.