Background Information:

What are the other Names for the Procedure?

• Scintiogram of Lymphatic System

What is Lymphoscintigraphy radiology procedure? (General Explanation)

• Lymphoscintigraphy is a branch of nuclear medicine imaging. It is a non-invasive procedure that provides imaging of the lymphatic system, which circulates the lymphatic fluid and cells of the immune system
• Commonly the procedure is used for conditions such as lymphedema, skin cancer, and breast cancer
• Nuclear medicine uses very small amounts of radioactive material (radiotracer) to diagnose and treat various kinds of diseases/disorders such as heart disease, cancers, and conditions affecting the endocrine, gastrointestinal, and neurological systems
• A radiotracer can be sent to the organ via different ways. It can be injected, swallowed, or inhaled as a gas, and it eventually goes to the target organ. Special imaging devices detect the emission and produce pictures

What part of the Body does the Procedure involve?

The Lymphoscintigraphy procedure may be performed on several parts of the body. It depends upon the particular lymphatic system that is affected by the disease process. It may include the arms and legs, skin, or the breast.

Why is the Lymphoscintigraphy radiology procedure Performed?

The Lymphoscintigraphy procedure is performed for following reasons:

• To identify sentinel lymph node: Sentinel lymph nodes are the first nodes to receive lymphatic drainage from a tumor
• To identify spread of cancer and to plan a biopsy or surgery accordingly
• Also, to identify blockages in the lymphatic system that leads to a condition called lymphedema, which results in swelling of the extremities

What is the Equipment used? (Description of Equipment)

The following equipment is used for the Lymphoscintigraphy procedure:

• The procedure can use positron emission tomography (PET), single photon emission computed tomography (SPECT), or a gamma camera
• The gamma camera detects radiation and takes pictures from different angles
• A gamma camera is used in SPECT as well; it rotates around the body to produce 3D images of the body
• A computer uses the data from the camera and produces images

What are the Recent Advances in the Procedure?

There have been no recent advances to the Lymphoscintigraphy procedure.

What is the Cost of performing the Lymphoscintigraphy radiology procedure?

The cost of Lymphoscintigraphy procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding Lymphoscintigraphy procedure and what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
• Also, if the procedure involves multiple steps or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

http://www.ncbi.nlm.nih.gov/pubmed/25525889 (accessed on 07/20/2015)

http://www.ncbi.nlm.nih.gov/pubmed/25521776 (accessed on 07/20/2015)

http://www.ncbi.nlm.nih.gov/pubmed/25517573 (accessed on 07/20/2015)

Prior to Lymphoscintigraphy radiology procedure:

How does the Lymphoscintigraphy radiology procedure work?

• Patients are given radioactive material that accumulates in the target organ
• After the radioactive material has accumulated, a gamma camera, SPECT, or PET scan detects the radioactivity and obtains the necessary pictures

How is the Lymphoscintigraphy radiology procedure Performed?

The Lymphoscintigraphy procedure is performed in the following manner:

• The patient is positioned on the examination table and an IV line is inserted into the patient’s arm vein
• A radiotracer is injected using a small needle
• The gamma camera takes a series of images after the radiotracer injection

The radiotracer injection site and imaging is determined by the study being performed:

• Lymphedema (swelling of arms of legs):
  • A radiotracer is injected between the first and second toes or fingers
  • Both sides of the extremity are imaged for comparison and to determine the obstruction in the lymphatic system           
• Melanoma cancer (skin cancer):
  • A radiotracer is injected at the site of the melanoma
  • Imaging is taken of the area involved      
• Breast cancer:
  • The radiotracer is injected at the site of tumor and surrounding tissues, including the area around the nipple (areola)             

Patients may be asked to do several exercises for certain specific studies, such as:

• They may be asked to walk for leg exams, or perform handgrip exercise for an arm exam
• Additional images are taken after the exercises are completed

Where is the Procedure Performed?

Lymphoscintigraphy is performed as an outpatient procedure, at a hospital.

Who Performs the Procedure?

A radiology technologist performs the Lymphoscintigraphy procedure under the guidance of a radiologist.

How long will the Procedure take?

The length of Lymphoscintigraphy procedure depends upon the kind of study being performed:

• Lymphedema studies takes about 30 minutes to several hours
• Melanoma studies may take an hour or up to 3-4 hours
• Breast cancer studies may take 30 minutes to several hours

Who interprets the Result?

A radiologist interprets the results of the procedure.

What Preparations are needed, prior to the Procedure?

The following preparations may be needed prior to a Lymphoscintigraphy procedure:

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient, including information related to the medications that are currently being taken
• Do inform the medical professional if you have a history of any medical conditions, such as a heart disease, asthma, diabetes, or kidney disease
• Do inform the medical professional about any allergies, especially related to barium or iodinated contrast material, which may be used in the procedure
• It is advisable to wear comfortable and loose clothes. Avoid wearing any metal objects or jewelry, as it may interfere with the x-ray
• Women should notify the physician if they are pregnant or breastfeeding their child; as many such procedures may not be performed on pregnant women
• Depending on the procedure adopted, the patient may be asked for certain bowel or bladder preparations before the preparation sessions
• The patient may be asked to avoid eating or drinking several hours before the test
• It is recommended to notify the physician about any implants or metal objects in the body, such as a pacemaker, nerve simulators, surgical staples, or artificial heart valves, braces, or dyed tattoos, as they may interfere with the imaging, in some cases
• Patients may be asked to do certain exercises during the exam, so they are advised to inform their physician, if they have asthma, chronic lung conditions, or any other knee or hip problems
• The patients are given specific instructions depending upon the study being performed

What is the Consent Process before the Procedure?

A physician will request your consent for Lymphoscintigraphy procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent. 

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What are the Benefits versus Risks, for this Procedure?

Following are the benefits of the Lymphoscintigraphy procedure:

• It is noninvasive and less expensive procedure that provides a lot of detailed information
• The procedure provides details about both the structure and function of the target area, which is usually unobtainable with other imaging techniques

Following are the risks of the Lymphoscintigraphy procedure:

• Some patients may develop an allergic reaction to the radioactive material used in the procedure; though, it is very rare
• Some procedures may not be performed on women who are pregnant or breast feeding
• There is a very small risk of radiation from the radioactive material used in the procedure. However, the amount of radioactive material used is very small and so the risk from radiation is very minimal compared to other procedures

What are the Limitations of the Lymphoscintigraphy radiology procedure?

Following are the limitations of the Lymphoscintigraphy procedure:

• Nuclear medicine scans do not provide resolution of structures as high as that compared to other imaging techniques
• The procedure may take a long time, as the radioactive material takes time to accumulate in the target organ or structure

What are some Questions for your Physician?

Some of the basic questions that you might ask your healthcare provider or physician are as follows:

• What is a Lymphoscintigraphy procedure?
• Why is this procedure necessary? How will it help?
• How soon should I get it done? Is it an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed?
• What are the risks while performing the procedure?
• What are the complications that might take place during recovery?
• What are the possible side effects from the procedure? How can I minimize these side effects?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any lifestyle restrictions or modifications required after the procedure is performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required after the procedure?
• Is there any medication that needs to be taken for life after the procedure?
• What are the costs involved?

During the Lymphoscintigraphy radiology procedure:

What is to be expected during the Lymphoscintigraphy radiology procedure?

The following may be expected during the Lymphoscintigraphy procedure:

• The entire procedure is mostly painless, except for a slight pin prick associated with IV line insertion
• The patient may feel a cold sensation when the radiotracer is being injected through the IV line
• Patients may be asked to perform some exercises depending upon the study being performed
• Some patients may feel a slight discomfort, as they may be asked to stay still during the imaging process to avoid any image blurriness
• Patients may resume their normal activities after the procedure, unless otherwise suggested by the physician
• Patients are advised to drink plenty of water for the first few hours after the procedure, in order to eliminate the small amount of radioactive material left in the body

What kind of Anesthesia is given, during the Procedure?

No anesthesia is used during the Lymphoscintigraphy procedure, unless the procedure is performed in an operation room.

How much Blood will you lose, during the Procedure?

Since the procedure is a minimally invasive one, the blood loss involved during the procedure is minimal.

What are the possible Risks and Complications during the Lymphoscintigraphy radiology procedure?

• Radiotracers used during the procedure may cause allergic reactions in some patient populations
• Rarely, skin infections may develop at the site of needle insertion

What Post-Operative Care is needed at the Healthcare Facility after the Lymphoscintigraphy radiology procedure?

Patients are advised to drink plenty of water for the first few hours after the procedure, to get rid of the little radioactive material that is still left in the body.

After the Lymphoscintigraphy radiology procedure:

What is to be expected after the Lymphoscintigraphy radiology procedure?

• Unless informed otherwise, patients may resume their normal activities after the Lymphoscintigraphy procedure
• The patients are asked to take plenty of water for a few hours immediately following the procedure, so as to get rid of any radioactive material that is still left in the body

When do you need to call your Physician?

If the patient is experiencing an allergic reaction from the radiotracer material, then do contact the physician immediately.

What Post-Operative Care is needed at Home after the Lymphoscintigraphy radiology procedure?

Drinking plenty of water after the procedure may help in eliminating any radioactive material, which is still left in the body.

How long does it normally take to fully recover, from the Procedure?

Generally, patients may resume their normal activities once the procedure is completed, unless the healthcare provider suggests otherwise.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

• Lymphoscintigraphy procedure may involve the removal of tissue depending upon the procedure undertaken
• If a tissue sample is removed, it is send to the pathology laboratory for further study

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

• The pathologist may take anywhere from a few days to weeks depending upon the tissue removed and the complexity of the case
• The tissue may be sent out to different hospital for further study by a specialist in the pathology lab, which may take further time

Who will you receive a Bill from, after the Lymphoscintigraphy radiology procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers. 

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The hospital, where the procedure is performed
• Healthcare providers, physicians, and radiologists, who are involved in the process

The patient is advised to inquire and confirm the type of billing, before the Lymphoscintigraphy procedure is performed.