technetium-tc-99m-sulfur-colloid and Esophageal-Neoplasms

The principal radionuclide procedures involved in the evaluation of esophageal disorders that are amenable to surgery are illustrated and briefly described. The role of the radionuclide esophagogram (RE) in the diagnosis and management of achalasia, oculopharyngeal muscular dystrophy and its complications, tracheoesophageal fistulae, pharyngeal and esophageal diverticulae, gastric transposition, and fundoplication is discussed. Detection of columnar-lined esophagus by Tc-99m pertechnetate imaging and of esophageal carcinoma by Ga-67 citrate and Tc-99m glucoheptonate studies also is presented.

Topics: Barrett Esophagus; Deglutition Disorders; Diverticulum, Esophageal; Esophageal Achalasia; Esophageal Diseases; Esophageal Neoplasms; Esophagus; Gallium Radioisotopes; Gastroesophageal Reflux; Humans; Muscular Dystrophies; Organotechnetium Compounds; Radionuclide Imaging; Rhenium; Sodium Pertechnetate Tc 99m; Stomach; Sugar Acids; Technetium; Technetium Tc 99m Sulfur Colloid; Tracheoesophageal Fistula

Aim of the study was to observe the impact of bone marrow damage induced by local irradiation on leukopenia.. For the human study, five cancer patients received local radiation therapy. Bone marrow aspiration was conducted to measure nucleated cell count and 99mTc-Sc sulfur colloid ECT imaging was carried out to examine bone marrow function. For the animal study, fifty New Zealand white rabbits were divided into 3 groups: non-irradiated control group (N.=10), abdomen irradiation group (irradiation area did not cover bone marrow) (N.=20), chest irradiation group (irradiation area covered bone marrow) (N.=20). Nucleated cell counts were taken after confirming onset of leukopenia.. Bone marrow of five patients proliferated normally. ECT imaging showed no abnormality in the pattern of red bone marrow distribution. Hematopoietic function was mildly active.. Suppressed myeloproliferative function does not fully account for irradiation-induced leukopenia.

Topics: Animals; Bone Marrow; Bone Marrow Cells; Cell Proliferation; Esophageal Neoplasms; Female; Hodgkin Disease; Humans; Leukocytes; Leukopenia; Lung Neoplasms; Male; Nasopharyngeal Neoplasms; Rabbits; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

This study was undertaken to assess the feasibility of lymphoscintigraphy of the gastric cardia and to identify the incidence of paraesophageal lymphatic drainage, precluding total gastrectomy with esophagojejunostomy as a potentially curative therapy for gastric cardia cancer.. Ten patients scheduled for esophagectomy with high-grade dysplasia or with esophageal cancer at least 3 cm above the esophagogastric junction were enrolled in this study. Preoperatively, 111 MBq of(99m)Tc-labeled nanocolloid (n = 5) or sulfur colloid (n = 5) were injected into the submucosa of the tumor-free cardia. Subsequently, lymphoscintigraphy in combination with CT was obtained. Locoregional lymph node stations were measured for radioactivity by a gamma-probe intraoperatively and ex vivo in the resection specimen.. In each patient, at least 1 radioactive lymph node station was detected. In total, 42 radioactive lymph node stations were detected by gamma-probe. Of those 42 areas, 38 (90%) were visible at preoperative lymphoscintigraphy. In the group of 5 patients in whom nanocolloid was used, a median of 2 (range, 1-4) node stations per patient was identified, whereas when sulfur colloid was administered a median of 6 (range, 4-8) active lymph node stations per patient could be detected (P < 0.002). Paraesophageal drainage was identified in 1 patient.. Lymphoscintigraphy of the gastric cardia is feasible and can accurately determine the location of radioactive lymph nodes. Early paraesophageal lymphatic drainage is rare.

Topics: Adenocarcinoma; Carcinoma, Squamous Cell; Cardia; Coloring Agents; Esophageal Neoplasms; Esophagectomy; Feasibility Studies; Humans; Lymph Nodes; Lymphoscintigraphy; Male; Middle Aged; Radiopharmaceuticals; Stomach Neoplasms; Technetium Tc 99m Aggregated Albumin; Technetium Tc 99m Sulfur Colloid

Because of surveillance strategies in patients with known Barrett's esophagus, more patients with high-grade dysplasia or early cancer in the distal esophagus and at the esophagogastric junction are identified. The need for and extent of lymphadenectomy in such patients are controversial. The technique of sentinel lymph node dissection (SLND) to diagnose early lymphatic spread is applied increasingly in tumors of the gastrointestinal tract. The poorly defined lymphatic drainage of the esophagogastric junction has so far prevented many investigators from performing SLND in tumors of this anatomic region. We report the first results of SLND in Barrett's and cardia cancer. The preliminary experience indicates that the method is, even in this anatomical area, feasible and yields good results in early tumors. In advanced tumors, the method lacks sensitivity. Mapping should be done with blue dye and a radiocolloid. The concept of sentinel lymph node mapping and detection thus may open the door to individualized therapy for patients with high-grade dysplasia in a Barrett's esophagus or with early Barrett's and cardia cancer.

Topics: Adenocarcinoma; Algorithms; Barrett Esophagus; Cardia; Coloring Agents; Esophageal Neoplasms; Esophagectomy; Esophagogastric Junction; Humans; Lymph Nodes; Lymphatic Metastasis; Radionuclide Imaging; Radiopharmaceuticals; Rosaniline Dyes; Sensitivity and Specificity; Sentinel Lymph Node Biopsy; Stomach Neoplasms; Technetium Tc 99m Sulfur Colloid

The authors present their experience with the radionuclide esophagogram. Cases illustrating achalasia, diffuse esophageal spasm, nutcracker esophagus, oculopharyngeal muscular dystrophy, reflux esophagitis, gastroesophageal reflux, Barrett's esophagus, hiatal hernias, pharyngoesophageal diverticulum, and malignant tumors of the esophagus are included. The radionuclide esophagogram proved to be a useful procedure in the diagnosis and follow-up of many esophageal diseases.

Topics: Adenocarcinoma; Adult; Aged; Barrett Esophagus; Deglutition Disorders; Diverticulum, Esophageal; Esophageal Achalasia; Esophageal Diseases; Esophageal Neoplasms; Esophagitis, Peptic; Female; Gastroesophageal Reflux; Hernia, Hiatal; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Radionuclide Imaging; Reference Values; Spasm; Stomach Neoplasms; Technetium Tc 99m Sulfur Colloid

A tracheo-esophageal fistula, developed following radiotherapy for an esophageal carcinoma, was vividly demonstrated by radionuclide imaging. The abnormality was later confirmed by a barium esophagram and endoscopic examinations. The scintigraphic procedure, making use of a Tc-99m sulfur colloid swallow, appears to be a simple alternative method that may be clinically useful for the diagnosis of such a condition.

Topics: Barium Sulfate; Carcinoma, Squamous Cell; Esophageal Neoplasms; Humans; Male; Middle Aged; Radiography; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Tracheoesophageal Fistula

Lymphoscintigraphies of esophageal carcinoma in nine patients were studied with the aid of 99mTc-labeled rhenium sulfur colloid (99mTc-Re). 99mTc-Re was injected into the submucosal layer of the esophagus (just above the oral side of the tumor) using an esophagoscope, 1 or 2 days before operation. Lymphoscintigraphies at intervals of 1, 3 and 20 h after the injection were performed. After that, the region and the number of the visualized (hot) nodes were assessed. After the operation the lymph nodes were dissected and the hot nodes were determined by scintiphotography. The dissected nodes were then studied histologically. A total of 106 nodes were removed from the mediastinum of nine patients. Histologically, metastases were found in 12 of 106 nodes. Twenty six of 106 (24.5%) could be observed visually on the scintigram and 80 (75.5%) could not. Among the visualized (hot) nodes, 34.6% were positive for metastasis. On the other hand, among the nonvisualized, so-called cold, nodes, only 3.8% were positive for metastasis. Hot nodes of the esophagus indicate a high percentage probability of metastatic nodes.

Topics: Aged; Endoscopy; Esophageal Neoplasms; Evaluation Studies as Topic; Humans; Lymph Node Excision; Lymph Nodes; Lymphatic Metastasis; Male; Mediastinum; Radionuclide Imaging; Rhenium; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid