Early demonstration of spontaneous perinodal lymphangiogenesis by lymphoscintigraphy after vascularized lymph node transplantation - a pilot study

Despite the lymphatic system being so important and extensive, the field of lymphatic diseases, research is still very young. Lymphedema is a progressively debilitating condition with no known "cure." Specific pathologies that could benefit from improved lymphatic drainage by advanced super surgical techniques or engineered tissue transfer are being sought. Microsurgical techniques like lympho venous bypass and anastomosis have spurred interest as they tend to physiologically restore the damaged lymphatic channels and may be a key to permanent cure. The latest in the field is vascularized lymph node transfer (VLNT), indicated in post mastectomy or other post operative settings producing disruption of regional lymphatic channels and draining lymph nodes. Autologous healthy lymph nodes are transferred along with surrounding fat and vascular pedicle to the affected limb in a bid to promote lymphangiogenesis. Lymphoscintigraphy (LS) is a simple, noninvasive nuclear technique used in identifying upper or lower limb lymphatic dysfunction and obstruction with a high degree of sensitivity. Quantitative LS is extremely useful in follow-up assessment of lymphedema post manual lymphatic drainage (MLD) or other forms of medical management. We hypothesize that LS can document perinodal lymphangiogenesis post VLNT. Three cases of acquired lymphedema (suspected filariasis and post mastectomy conditions) who underwent VLNT in our institute were prospectively studied with LS. The imaging findings highlight the subtle lymphatic regeneration along with the vascularized graft in all three patients during the early post-operative period. This is the first (pilot) study documenting early spontaneous perinodal lymphangiogenesis after VLNT in human subjects. ^99mTc Nanocolloid LS has been found to be incremental in demonstrating early lymphangiogenesis. (author)