Lymphatic Drainage Routes of the Gastric Cardia Visualized by Lymphoscintigraphy
Huib A. Cense, MD1,
Gerrit W. Sloof, MD2,
Joost M. Klaase, MD1,
Jacques J. Bergman, MD3,
Formijn J. van Hemert2,
Paul Fockens, MD3 and
Jan J.B. van Lanschot, MD1
1 Department of Surgery, Academic Medical Center at the University of Amsterdam, Amsterdam, The Netherlands
2 Department of Nuclear Medicine, Academic Medical Center at the University of Amsterdam, Amsterdam, The Netherlands
3 Department of Gastroenterology, Academic Medical Center at the University of Amsterdam, Amsterdam, The Netherlands
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FIGURE 1. Radioactivity in paraesophageal lymph nodes (PE) as identified preoperatively by lymphoscintigraphy in combination with CT. Shown are CT scan (left), scintigram (middle), and a combination of CT scan and scintigram (right). This sagittal projection also shows the injection site (IS) at the gastric cardia and celiac trunk nodes (CTN). See also patient 9 in Table 1.
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FIGURE 2. Perioperative endoscopic injection of patent blue at the site (clip) where radioactive technetium was injected the previous day.
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FIGURE 3. In vivo and ex vivo lymphoscintigraphy of the same patient (patient 4). On the left is a lymphoscintigram of the patient immediately before surgery (i.e., 20 h after injection of technetium-labeled nanocolloid). On the right is a lymphoscintigram of the resected specimen immediately after surgery. The green lines indicate the contours of the resection specimen (esophagus–cardia) and an additional imaginary contour of the stomach. Lnn = lymph node.
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Copyright © 2004 by the Society of Nuclear Medicine.
