What is Lymphoscintigraphy?

What to expect when undergoing this test

Female breast with internal anatomy including lymph nodes, alveoli, lobules ducts and muscle tissue
Getty Images/Science Picture Co

A lymphoscintigraphy, also known as sentinel lymph node mapping, is an imaging procedure that determines lymph drainage and the number of sentinel nodes. If a node is in an unusual location, the lymphoscintigraphy will identify that location for a biopsy. A simple and painless tool, a lymphoscintigraphy can be extremely helpful in breast cancer treatment planning.

Purpose of Test

Lymphoscintigraphy is increasingly being used to manage early breast cancer as more studies show that it is very effective. While it used to be used to identify other conditions, it has been proven to be particularly useful in breast cancer.

In the case of metastatic breast cancer, the sentinel nodes are the first to show evidence of metastatic deposits. Lymphoscintigraphy can identify these irregular nodes and detect which nodes are free from metastases. This is significant: If the axillary lymph node is cancer-free, it means you won't need axillary clearance surgery.

Physicians perform lymphoscintigraphies to plan a biopsy or surgery and develop a comprehensive treatment plan.

Risks and Contraindications

The risks associated with lymphoscintigraphy are considered small, especially compared to the benefits.

This is a nuclear medicine procedure, which means you'll be exposed to a very small amount of radiation. However, that amount is less than with a standard X-ray. Tests like this have been used for more than 50 years and doctors have seen no long-term side effects from this kind of low exposure.

Allergic reactions to the radiotracer that will be injected are rare. If they do occur, they are usually mild. Still, make sure you let your doctor and the technician know if you've ever had an allergic reaction or other problem with a similar test.

The injection may cause redness and slight pain, which should go away quickly.

Lymphoscintigraphy isn't recommended for everyone with breast cancer. Contraindications include:

  • Pregnancy and breastfeeding
  • Clinically positive (N1) axilla
  • Previous biopsy, especially excisional biopsy
  • Previous breast and axillary surgery
  • Advanced disease
  • Neoadjuvant chemotherapy
  • Multicentric and multifocal disease
  • Ductal carcinoma in situ (DCIS)
  • High body mass index
  • Old age (higher failure rates may be due to changes in lymphatic flow)

Make sure your doctor knows all medications you're taking, including any herbal supplements or vitamins.

Before the Test

Be sure to arrive early enough to check in before your appointment time. It's a good idea to use the bathroom first, too.

Timing

The length of the test varies from about 30 minutes to two hours or longer based on a number of factors. Be sure to ask ahead of time how long yours is expected to take.

Location

You probably will undergo a lymphoscintigraphy in an outpatient or clinic setting, but some hospitals offer it as well. 

What to Wear

Depending on where you are going for this test, you may either be asked to wear a medical gown or just remain in your own clothes. It's suggested that you wear comfortable clothing without metal snaps or buttons. Before the procedure, remove any jewelry or accessories that have any metal.

Food and Drink

You shouldn't have to restrict food and drink before or after lymphoscintigraphy.

Cost and Health Insurance

If you have health insurance, check with your carrier to see whether lymphoscintigraphy will be covered and how much you'll need to pay yourself. Also, check on whether the facility where it will be performed is covered.

Your doctor's office and the facility should be able to provide cost information for you.

What to Bring

Be sure you have your insurance card and any paperwork your doctor may have given you.

During the Test

Once you're called back, you'll be given time to change into a gown (if necessary). You may be asked to confirm information such as your name, date of birth, and the test you're scheduled for. A nurse will get you prepared and then a doctor or technologist will perform the procedure.

Pre-Test

You will be asked to lie down on an examination table. Your nurse may insert an IV into your arm, depending on your needs. The necessary radioactive material will be given, potentially through multiple injections around the tumor or areola.

Beyond the needle or IV placement, the lymphoscintigraphy is completely painless. After the injection, you may experience a cooling sensation, but it should not be uncomfortable.

Throughout the Test

A specialized camera that "sees" the radiotracer(s) will take images of your breast. Depending on the clinic, you may be asked to change your position in order to get images of different areas.

The most difficult part of the screening is that you must remain still while the images are being taken. The better you follow the instructions about when not to move, the quicker the process will go.

Post-Test

Once the test is done, you may be asked to wait while the images are reviewed to make sure everything came out clear enough. If not, you may need to re-do some of them. Otherwise, you can get dressed and leave.

After the Test

You shouldn't have any lingering side effects to manage and can usually return to your normal routine right away. In rare cases, your doctor may recommend rest afterward. This will be communicated to you before you leave.

It is suggested that you drink more water than usual to help your body flush out the radioactive materials.

Interpreting Results

A radiologist or doctor specializing in nuclear medicine will look at the images and send a report to your oncologist. Your doctor's office should contact you about the results and whether any follow-up is necessary.

Follow-Up

The information from the lymphoscintigraphy will help your doctor determine how extensive your surgery needs to be. Make sure you understand the results and what they mean for you. Ask questions if anything isn't clear.

A Word From Verywell

Because this test carries a minimal risk for most people and can prevent a procedure you may not need, it's a common recommendation. You may be getting tired of medical tests and scans, but know that the information gained through lymphoscintigraphy often can't be obtained in any other way—and it could save you unnecessary surgery and the pain of recovery.

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