Quantitative Assessment of Lymphoscintigraphy: Optimizing Diagnostic Accuracy in Peripheral Oedema Evaluation

Document Type : Original Paper, Diagnostic NM

Authors

1 Department of Nuclear Medicine and Clinical Oncology, Faculty of Medicine ,Cairo University.

2 Department of Nuclear Medicine and Clinical Oncology, Faculty of Medicine, Cairo University

Abstract

Objectives: To assess the prevalence of equivocal cases in interpretation of routine lymphoscintigraphy at an Egyptian nuclear medicine medical centre (NMROCK) and to investigate the enhanced diagnostic precision provided by quantitative analysis of lymphoscintigraphy in the diagnosis of peripheral lymphedema
Patients and methods: Fifty patients (100 limbs), presenting with lymphedema in either upper or lower limbs underwent lymphoscintigraphy following a standardized protocol. Both qualitative and quantitative analyses were conducted. For quantitative analysis, a region of interest (ROI) was delineated around the injection site and regional lymph nodes for each limb on the 1.5-hour static images. The count of each ROI was recorded, and the regional lymph node uptake percentage for each limb was calculated.
Results: The occurrence of equivocal cases was determined to be 8.0%. Employing the non-parametric Mann-Whitney test, a significant discrepancy was observed in the percentage of lymph node uptake between normal limbs (mean=36.54%) and abnormal limbs (mean=14.56%). The Receiver Operator Characteristic (ROC) curve analysis revealed a cut-off value of 6.87, which provided the optimal balance between sensitivity (60.3%) and specificity (81%) (P < 0.001)
Conclusion: Combining qualitative and quantitative lymphoscintigraphy methods has potential value for optimizing diagnostic accuracy of lymphedema, particularly in cases where equivocal results are obtained through qualitative indices which will eventually result in better patient management.

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