Atlas of Lymphoscintigraphy and Sentinel Node Mapping: A Pictorial Case-Based Approach

Description

Although lymphoscintigraphy was originally introduced into clinical routine for identification of the cause of peripheral edema, more recently it has been widely applied for radioguided biopsy of the sentinel lymph node in patients with solid cancers. The procedure is now considered crucial for adequate planning of oncologic surgery in a growing number of cancers. This atlas presents a collection of richly illustrated teaching cases that demonstrate the clinical relevance and impact of lymphoscintigraphy in different pathologic conditions. After introductory chapters on the anatomy, physiology, and pathophysiology of lymphatic circulation, the role of lymphoscintigraphy in differential diagnosis of peripheral edema and characterization of intracavitary lymph effusions is addressed. The principal focus of the book, however, is on the use of lymphoscintigraphic mapping for radioguided sentinel node biopsy in cutaneous melanoma and cancers at a range of anatomic sites. The most commonly observed lymphoscintigraphic patterns are depicted, and anatomic variants and technical pitfalls of the procedure receive careful attention. The role of tomographic multimodality imaging is also considered. The atlas will be an excellent learning tool for residents in nuclear medicine and other specialists with an interest in the field. Title Page Copyright Page Foreword Foreword Preface Table of Contents Contributors 1 The Anatomy and Physiology of Lymphatic Circulation 1.1 Introduction 1.2 The Physiology of Lymph Flow 1.3 Anatomy of the Lymphatic System 1.3.1 Lymphatics of the Breast 1.3.2 Lymphatics of the Skin 1.4 Lymphatic Visualization Techniques References 2 The Pathophysiology of Lymphatic Circulation in Different Disease Conditions 2.1 Introduction 2.2 Lymphatic Circulation and LipidAbsorption 2.3 Pathophysiology of Lymph DrainageFailure 2.4 Edema 2.5 Lymphedema 2.6 Lymphatic Malignancies 2.7 Acute Lymphangitis 2.8 Lymphatic Circulation in Obesity and Cardiovascular Disease 2.9 Intracavitary Lymphedema References 3 Methodological Aspects of Lymphoscintigraphy: Radiopharmaceuticals and Instrumentation 3.1 Radiopharmaceuticals 3.1.1 Introduction 3.1.2 Injected Volume and Activity 3.1.3 Factors Affecting Radiocolloid Uptake 3.2 Instrumentation 3.2.1 Introduction 3.2.2 Intraoperative Probes 3.2.3 Portable Gamma Cameras References 4 Methodological Aspects of Lymphoscintigraphy: Bicompartmental Versus Monocompartmental Radiocolloid Administration 4.1 Introduction 4.2 Methodology 4.3 Imaging 4.4 Qualitative Visual Interpretation 4.5 Lymphoscintigraphy with Stress Test 4.6 Quantitative Lymphoscintigraphy 4.6.1 Transport Index 4.6.2 Transport Time 4.6.3 Tracer Appearance Time 4.6.4 Transport Capacity 4.6.5 Removal Rate Constant 4.6.6 Depot Activity Transported to Inguinal Lymph Nodes 4.6.7 Uptake Index of the Left Inguinal to theRight Inguinal Lymph Nodes 4.6.8 Washout Rate Constant and Depot Half-Life 4.6.9 Liver to Nodal Ratio References 5 Lymphoscintigraphy for the Differential Diagnosis of Peripheral Edema and Intracavitary Lymph Effusion 5.1 Introduction 5.2 Differential Diagnosis 5.3 Diagnostic Characterization 5.4 Management of Lymphedema 5.5 Lymphoscintigraphy in the Management of Lymphedema Clinical Cases Case 5.1 Upper Limb Monocompartmental Lymphoscintigraphy in Stage III Primary Lymphedema of the Upper Left Arm Without Lymphadenomegaly Background Clinical Case Lymphoscintigraphy Case 5.2 Upper Limb Monocompartmental Lymphoscintigraphy in Non-Pitting Edema of the Upper Left Limb in Patient with Rheumatoid Arthritis Background Clinical Case Lymphoscintigraphy Case 5.3 Axillary Reverse Mapping Lymphoscintigraphy in Breast Cancer Patient with Positive Sentinel Lymph Node Before Lymphadenectomy Background Clinical Case Lymphoscintigraphy Case 5.4 Axillary Reverse Mapping Lymphoscintigraphy in Breast Cancer Patient with Infiltrative Lobular Carcinoma and Positive Sentinel Lymph Node Before Lymphadenectomy Background Clinical Case Lymphoscintigraphy Case 5.5 Lower Limb Monocompartmental Lymphoscintigraphy in Patient with Bilateral Swelling and Non-Pitting Edema of the Lower Limbs Background Clinical Case Lymphoscintigraphy Case 5.6 Lower Limb Bicompartmental Lymphoscintigraphy in Patient with Edema of the Left Lower Limb Background Clinical Case Lymphoscintigraphy Case 5.7 Lower Limb Monocompartmental Lymphoscintigraphy in Patient with Bilateral Lower Limb Lymphedema Background Clinical Case Lymphoscintigraphy Case 5.8 Lower Limb Monocompartmental Lymphoscintigraphy in Patient Previously Submitted to Left Saphenectomy Background Clinical Case Lymphoscintigraphy Case 5.9 Lower Limb Monocompartmental Lymphoscintigraphy in Patient with History of Lymphadenectomy of the Groin Basin for Melanoma Background Clinical Case Lymphoscintigraphy Case 5.10 Post-Exercise Lower Limb Monocompartmental Lymphoscintigraphy in Patient with Bilateral Leg Edema Background Clinical Case Lymphoscintigraphy Case 5.11 Lower Limb Monocompartmental Lymphoscintigraphy at Rest and Post-Exercise with Semiquantitative Evaluation of the Tracer Appearance Time in Patient with Lymphedema of the Left Lower Limb Post Left Groin Lymphadenectomy Background Clinical Case Lymphoscintigraphy Case 5.12 Lower Limb Monocompartmental Lymphoscintigraphy at Rest and Post-Exercise with Semiquantitative Evaluation of the Tracer Appearance Time in Patient with Right Lower Limb Primary Lymphedema, Clinical Stage 3 According to Foeldi Background Clinical Case Lymphoscintigraphy Case 5.13 Lower Limb Monocompartmental Lymphoscintigraphy at Rest and Post-Exercise with Semiquantitative Evaluation of the Tracer Appearance Time in Patient with Post-Lymph Nodal Dissection Lymphedema of the Lower Limbs Background Clinical Case Lymphoscintigraphy Case 5.14 Post-Exercise Lower Limb Monocompartmental Lymphoscintigraphy in Patient with Acute Edema of the Left Lower Limb and Painful Left Inguinal Lymphadenomegaly Background Clinical Case Lymphoscintigraphy Case 5.15 Lower Limb Monocompartmental Lymphoscintigraphy at Rest and Post-Exercise with Semiquantitative Evaluation of the Tracer Appearance Time in Patient with Secondary Lymphedema of the Right Lower Limb Background Clinical Case Lymphoscintigraphy Case 5.16 Lower Limb Monocompartmental Lymphoscintigraphy in Patient with Secondary Bilateral Non-Pitting Edema of the Lower Extremities, More Evident on the Left, and Left Ureteral Obstruction Due to Lymphocele Background Clinical Case Lymphoscintigraphy Case 5.17 Lower Limb Bicompartimental Lymphoscintigraphy in Patient with Post-Traumatic Edema of the Left Leg Associated with Disability Grade 3 According to Ricci Scale, at Baseline and After 5 Years of Multiple Surgeries and Cycles of Therapy Background Clinical Case Lymphoscintigraphy Lower Limbs Case 5.18 Upper and Lower Limb Bicompartmental Lymphoscintigraphy in Patient with Bilateral Feet and Ankle Edema, More Prevalent in Left Side Background Clinical Case Lymphoscintigraphy Upper Limbs Lower Limbs Case 5.19 Upper and Lower Limb Bicompartmental Lymphoscintigraphy in Patient with Right Pelvic Para-Vesical and Inguinal Swelling Background Clinical Case Lymphoscintigraphy Upper Limbs Lower Limbs Case 5.20 Lower Limb Bicompartmental Lymphoscintigraphy in Patient with Edema of the Scrotum Background Clinical Case Lymphoscintigraphy Case 5.21 Lower Limb Monocompartmental Lymphoscintigraphy in Patient with Post-Surgical Chylopericardium (Ductus Arteriosus), Treated with Thoracentesis Background Clinical Case Lymphoscintigraphy Lower Limbs References 6 The Sentinel Lymph Node Concept in Oncologic Surgery 6.1 History 6.2 Concept and Definition 6.3 Concluding Remarks References 7 General Concepts on Radioguided Sentinel Lymph Node Biopsy: Preoperative Imaging, Intraoperative Gamma-Probe Guidance, Intraoperative Imaging, and Multimodality Imaging 7.1 Introduction 7.2 Preoperative Imaging 7.3 Intraoperative Gamma-probe Guidance 7.4 Intraoperative and Multimodality Imaging References 8 SPECT/CT Image Generation and Criteria for Sentinel Node Mapping 8.1 Introduction 8.2 The Clinical Problem 8.3 Image Generation with SPECT/CT 8.4 General Indications and Contraindications for SPECT/CT 8.5 Comprehensive Interpretation of Preoperative Imaging of Sentinel Lymph Nodes 8.6 SPECT/CT as a Roadmap for Intraoperative Detection of Sentinel Lymph Nodes References 9 Preoperative and Intraoperative Lymphatic Mapping for Radioguided Sentinel Node Biopsy in Breast Cancer 9.1 Introduction 9.2 The Clinical Problem 9.3 Lymphatic Drainage of the Breast 9.4 Lymphoscintigraphy 9.4.1 Radiopharmaceuticals 9.4.2 Modalities of Radiocolloid Injection 9.4.3 Preoperative Imaging 9.5 Contribution of SPECT/CT 9.6 Intraoperative Detection 9.6.1 Combining Existing Technologies with New Modalities 9.7 Internal Mammary Chain 9.7.1 Lymphatic Drainage to the Internal Mammary Chain 9.7.2 Internal Mammary Node Positivity Rates 9.8 Accuracy of Radioguided Sentinel Lymph Node Biopsy 9.9 Long-term Outcome of Sentinel Lymph Node Biopsy 9.10 Indications and Contraindications for Sentinel Lymph Node Biopsy 9.11 Controversial Indications 9.12 Certification for Sentinel Lymph Node Biopsy in Patients with Breast Cancer Clinical Cases Case 9.1 Sentinel Node Mapping in Breast Cancer: Drainage to Axillary Nodes After Periareolar Injection (Planar Imaging) Background Clinical Case Lymphoscintigraphy Case 9.2 Sentinel Node Mapping in Breast Cancer: Drainage to Multiple Axillary Nodes After Intradermal Injection (Planar Imaging) Background Clinical Case Lymphoscintigraphy Case 9.3 Sentinel Node Mapping in Breast Cancer: Drainage to Single Axillary Node After Intra- Peritumoral Injection (Planar Imaging) Background Clinical Case Lymphoscintigraphy Case 9.4 Sentinel Node Mapping in Breast Cancer: Drainage to Axillary Nodes After Intradermal Injection (Planar and SPECT/CT Imaging) Background Clinical Case Lymphoscintigraphy Case 9.5 Sentinel Node Mapping in Breast Cancer: Drainage to Axillary Nodes After Subareolar Injection (Planar and SPECT/CT Imaging) Background Clinical Case Lymphoscintigraphy Case 9.6 Sentinel Node Mapping in Breast Cancer: Failure of Lymphatic Drainage (Due to Metastatic Axillary Nodes) After Intratumoral and Subdermal Injection (Planar and SPECT/CT Imaging) Background Clinical Case Lymphoscintigraphy Case 9.7 Sentinel Node Mapping in Breast Cancer: Failure of Lymphatic Drainage After Intratumoral and Subdermal Injection; Subsequent Visualization of Axillary Nodes After Periareolar Injection (Planar Imaging) Background Clinical Case Lymphoscintigraphy Case 9.8 Sentinel Node Mapping in Breast Cancer: Prior Axillary Lymph Node Dissection with Controlateral Axillary Migration After Subdermal Injection (Planar Imaging) Background Clinical Case Lymphoscintigraphy Case 9.9 Sentinel Node Mapping in Breast Cancer: Drainage to a Single Node of the Inner Mammary Chain After Peritumoral Injection (Planar Imaging) Background Clinical Case Lymphoscintigraphy Case 9.10 Sentinel Node Mapping in Breast Cancer: Drainage to Multiple Axillary and Inner Mammary Chain Nodes After Subareolar Injection (Planar and SPECT/CT Imaging) Background Clinical Case Lymphoscintigraphy Case 9.11 Sentinel Node Mapping in Breast Cancer: Drainage to Multiple Axillary and Inner Mammary Chain Nodes After Subareolar Injection (Planar and SPECT/CT Imaging) Background Clinical Case Lymphoscintigraphy Case 9.12 Sentinel Node Mapping in Breast Cancer: Drainage to Multiple Intramammary and Axillary Nodes After Subareolar and Intradermal Injection (Planar and SPECT/CT Imaging) Background Clinical Case Lymphoscintigraphy Case 9.13 Sentinel Node Mapping in Breast Cancer: Drainage to Multiple Intramammary and Axillary Nodes After Subareolar and Intradermal Injection (Planar and SPECT/CT Imaging) Background Clinical Case Lymphoscintigraphy References 10 Preoperative and Intraoperative Lymphatic Mapping for Radioguided Sentinel Node Biopsy in Cutaneous Melanoma 10.1 Introduction 10.2 The Clinical Problem 10.3 Lymphatic Drainage of the Skin and Nodal Groups 10.4 Indications and Contraindications for Sentinel Lymph Node Biopsy 10.4.1 Clinical Indications for Sentinel Lymph Node Biopsy in Melanoma 10.4.2 Clinical Contraindications for Sentinel Lymph Node Biopsy in Melanoma 10.5 Radiocolloid Injection 10.6 Preoperative Imaging of Sentinel Lymph Nodes 10.7 Contribution of SPECT/CT 10.8 Intraoperative Imaging 10.9 Common and Rare Variants 10.10 Technical Pitfalls in Lymphatic Mapping Clinical Cases Case 10.1 Sentinel Node Mapping in Melanoma of the Head and Neck: Drainage to “in Transit” Nodes in the Occipital Region (Planar Imaging) Background Clinical Case Lymphoscintigraphy Case 10.2 Sentinel Node Mapping in Melanoma of the Abdomen: Drainage to Axillary and Parasternal Nodes (Planar Imaging) Background Clinical Case Lymphoscintigraphy Case 10.3 Sentinel Node Mapping in Melanoma of the Back: Drainage to “in Transit” Paravertebral Nodes (Planar Imaging) Background Clinical Case Lymphoscintigraphy Case 10.4 Sentinel Node Mapping in Melanoma of the Back: Bilateral Drainage to Left “in Transit” Subscapular and Left Axillary Nodes (Planar Imaging) Background Clinical Case Lymphoscintigraphy Case 10.5 Sentinel Node Mapping in Melanoma of the Head and Neck: Drainage to Ipsilateral Cervical Nodes (Planar and SPECT/CT Imaging) Background Clinical Case Lymphoscintigraphy Case 10.6 Sentinel Node Mapping in Melanoma of the Right Scapular Region: Drainage to IpsilateralCervical Nodes (Planar and SPECT/CT Imaging) Background Clinical Case Lymphoscintigraphy Case 10.7 Sentinel Node Mapping in Melanoma of the Back: Drainage to Bilateral Supraclavicular Nodes and Ipsilateral Cervical and Axillary Nodes (Planar and SPECT/CT Imaging) Background Clinical Case Lymphoscintigraphy Case 10.8 Sentinel Node Mapping in Melanoma of the Back: Drainage to Groin Nodes (Planar and SPECT/CT Imaging) Background Clinical Case Lymphoscintigraphy References 11 Preoperative and Intraoperative Lymphatic Mapping for Radioguided Sentinel Node Biopsy in Head and Neck Cancers 11.1 Introduction 11.2 The Clinical Problem 11.3 Indications and Contraindications for Sentinel Lymph Node Biopsy 11.4 Radiocolloid and Modalities of Injection 11.5 Preoperative Imaging of Sentinel Lymph Nodes 11.6 Lymphatic Drainage and Lymph Node Groups of the Neck 11.7 Intraoperative Detection of Sentinel Lymph Nodes 11.8 Contribution of SPECT/CT 11.9 Intraoperative Imaging 11.10 Common and Rare Variants 11.11 Technical Pitfalls 11.12 Accuracy of Radioguided Sentinel Lymph Node Biopsy Clinical Cases Case 11.1 Sentinel Node Mapping in Carcinoma of the Hard Palate: Drainage to Bilateral Submandibolar Nodes After Submucosal Peritumoral Injection (Planar Imaging) Background Clinical Case Lymphoscintigraphy Case 11.2 Sentinel Node Mapping in Oral Cavity Carcinoma: Drainage to Ipsilateral Submandibolar Nodes After Submucosal Peritumoral Injection (Planar Imaging) Background Clinical Case Lymphoscintigraphy Case 11.3 Sentinel Node Mapping in Carcinoma of the Tongue: Drainage to Bilateral Cervical Nodes After Submucosal Peritumoral Injection (Planar Imaging) Background Clinical Case Lymphoscintigraphy Case 11.4 Sentinel Node Mapping in Carcinoma of the Tongue: Drainage to Ipsilateral Cervical Nodes After Submucosal Peritumoral Injection (Planar Imaging) Background Clinical Case Lymphoscintigraphy Case 11.5 Sentinel Node Mapping in Thyroid Carcinoma: Drainage to Ipsilateral Cervical Node After Intratumoral Injection (Planar and SPECT/CT Imaging) Background Clinical Case Lymphoscintigraphy Case 11.6 Sentinel Node Mapping in Thyroid Carcinoma: Drainage to Bilateral Cervical Nodes After Intratumoral Injection (SPECT/CT Imaging) Background Clinical Case Lymphoscintigraphy Case 11.7 Sentinel Node Mapping in Thyroid Carcinoma: Drainage to Multiple Ipsilateral Cervical Nodes After Intratumoral Injection (Planar and SPECT/CT Imaging) Background Clinical Case Lymphoscintigraphy Case 11.8 Sentinel Node Mapping in Carcinoma of the Tongue: Drainage to Ipsilateral Cervical Nodes After Intratumoral Injection (Planar and SPECT/CT Imaging) Background Clinical Case Lymphoscintigraphy References 12 Preoperative and Intraoperative Lymphatic Mapping for Radioguided Sentinel Node Biopsy in Non-Small-Cell Lung Cancer 12.1 Introduction 12.2 The Clinical Problem 12.3 Indications for Sentinel Lymph Node Biopsy 12.4 Sentinel Lymph Node Biopsy Techniques in Non-Small-Cell Lung Cancer 12.4.1 Nonradionuclide Methods 12.4.2 Radiocolloids and Modalities of Injection 12.5 Preoperative Imaging of Sentinel Lymph Nodes 12.6 Intraoperative Detection of Sentinel Lymph Nodes 12.7 Accuracy and Perspectives of Radioguided Sentinel Lymph Node Biopsy References 13 Preoperative and Intraoperative Lymphatic Mapping for Radioguided Sentinel Node Biopsy in Cancers of the Gastrointestinal Tract 13.1 Introduction 13.2 Sentinel Lymph Node Mapping in Esophagogastric Cancer 13.2.1 Sentinel Lymph Node Mapping in Gastric Cancer 13.2.1.1 Preoperative Mapping with Radiocolloid 13.2.1.2 Intraoperative Sentinel Lymph Node Mapping by a Combination of Radiocolloid and Staining 13.2.2 Sentinel Lymph Node Mapping in Esophageal Cancer 13.2.2.1 Harvesting the Sentinel Lymph Node 13.3 Sentinel Lymph Node Mapping in Colon Cancer 13.3.1 Methods for Sentinel Lymph Node Mapping in Colorectal Cancer 13.3.1.1 Staining Method 13.3.1.2 Radioguided Method Clinical Cases Case 13.1 Sentinel Node Mapping in Rectal Cancer: Drainage to Hemorrhoidal Nodes After Submucosal Peritumoral Injection (Planar Imaging) Background Clinical Case Lymphoscintigraphy Case 13.2 Sentinel Node Mapping in Cancer of Ascending Colon: Drainage to Lumbo-Aortic Nodes After Submucosal Peritumoral Injection (SPECT/CT Imaging) Background Clinical Case Lymphoscintigraphy Case 13.3 Sentinel Node Mapping in Rectal Cancer: Drainage to Lumbo-Aortic Nodes After Submucosal Peritumoral Injection (Planar, SPECT/CT and Intraoperative Imaging) Background Clinical Case Technical Background Acquisition Case 13.4 Sentinel Node Mapping in Cancer of Ascending Colon: “Ex Vivo” Technique with Peritumoral Blue Dye and Radiocolloid Injection Background Clinical Case Technical Background Acquisition References 14 Preoperative and Intraoperative Lymphatic Mapping for Radioguided Sentinel Node Biopsy in Cancers of the Female Reproductive System 14.1 Introduction 14.2 The Clinical Problem 14.3 Lymphatic Drainage of Gynecological Tumors 14.3.1 Lymphatic Drainage from the Vulva 14.3.2 Lymphatic Drainage from the Cervix Uteri 14.3.3 Lymphatic Drainage from the Corpus Uteri 14.4 Indications and Contraindications for Sentinel Lymph Node Biopsy 14.4.1 Clinical Indications 14.4.1.1 Vulvar Cancer 14.4.1.2 Cervical Cancer 14.4.1.3 Endometrial Cancer 14.4.2 General Contraindications 14.5 Modalities of Radiocolloid Injection 14.5.1 Vulvar Cancer 14.5.2 Cervical Cancer 14.5.3 Endometrial Cancer 14.6 Preoperative Sentinel Lymph Node Imaging 14.6.1 Dynamic Study 14.6.2 Planar Study 14.7 Contribution of SPECT/CT 14.8 Intraoperative Detection of SentinelLymph Nodes 14.9 Intraoperative Imaging 14.10 Common and Rare Variants (with Possible Misinterpretation) 14.10.1 Vulvar Cancer 14.10.2 Cervical Cancer 14.10.3 Endometrial Cancer 14.11 Technical Pitfalls in Lymphatic Mapping Clinical Cases Case 14.1 Sentinel Node Mapping in Vulvar Carcinoma: Drainage to Bilateral Inguinal and Iliac Nodes After Intradermal Injection (Planar Imaging) Background Clinical Case Lymphoscintigraphy Case 14.2 Sentinel Node Mapping in Endometrial Carcinoma: Drainage to One-Sided Lumbo-Aortic Nodes After Submucosal Peritumoral Injection (Planar Imaging) Background Clinical Case Lymphoscintigraphy Case 14.3 Sentinel Node Mapping in Endometrial Carcinoma: Drainage to One-Sided Lumbo-Aortic Nodes After Intratumoral Injection (Planar and SPECT/CT Imaging) Background Clinical Case Lymphoscintigraphy Case 14.4 Sentinel Node Mapping in Cervical Carcinoma: Drainage to Bilateral Iliac Nodes After Submucosal Peritumoral Injection (Planar and SPECT/CT Imaging) Background Clinical Case Lymphoscintigraphy References 15 Preoperative and Intraoperative Lymphatic Mapping for Radioguided Sentinel Node Biopsy in Cancers of the Male Reproductive System 15.1 Introduction 15.1.1 Penile Cancer 15.1.2 Prostate Cancer 15.1.3 Testicular Cancer 15.2 The Clinical Problem 15.2.1 Penile Cancer 15.2.2 Prostate Cancer 15.2.3 Testicular Cancer 15.3 Indications and Contraindications for Sentinel Lymph Node Biopsy 15.3.1 Penile Cancer 15.3.2 Prostate Cancer 15.3.3 Testicular Cancer 15.4 Radiocolloid and Modalities of Injection 15.4.1 Penile Cancer 15.4.2 Prostate Cancer 15.4.3 Testicular Cancer 15.5 Preoperative Imaging of Sentinel Lymph Nodes 15.5.1 Penile Cancer 15.5.2 Prostate Cancer 15.5.3 Testicular Cancer 15.6 Lymphatic Drainage 15.6.1 Penile Cancer 15.6.2 Prostate Cancer 15.6.3 Testicular Cancer 15.7 Intraoperative Detection of Sentine lLymph Nodes 15.7.1 Penile Cancer 15.7.2 Prostate Cancer 15.7.3 Testicular Cancer 15.8 Contribution of SPECT/CT 15.8.1 Penile Cancer 15.8.2 Prostate Cancer 15.8.3 Testicular Cancer 15.9 Intraoperative Imaging 15.9.2 Open Surgery: Penile Cancer 15.9.3 Laparoscopic Surgery: Prostate Cancer and Testicular Cancer 15.10 Common and Rare Variants 15.10.1 Penile Cancer 15.10.2 Prostate Cancer 15.10.3 Testicular Cancer 15.11 Technical Pitfalls 15.11.1 Penile Cancer 15.11.2 Prostate Cancer 15.11.3 Testicular Cancer 15.12 Accuracy of Radioguided Sentinel Lymph Node Biopsy 15.12.1 Penile Cancer 15.12.2 Prostate Cancer 15.12.3 Testicular Cancer Clinical Cases Case 15.1 Sentinel Node Mapping in Prostate Carcinoma: Drainage to Bilateral Iliac Nodes After Peritumoral Injection (Planar Image) Background Clinical Case Lymphoscintigraphy Case 15.2 Sentinel Node Mapping in Penile Carcinoma: Drainage to Bilateral Groin Nodes After Peritumoral Injection (Planar Image) Background Clinical Case Lymphoscintigraphy Case 15.3 Sentinel Node Mapping in Testicle Cancer: Drainage to Lumbo-Aortic Nodes After Intratumoral Injection (Planar and SPECT/CT Imaging) Background Clinical Case Lymphoscintigraphy References 16 Preoperative and Intraoperative Lymphatic Mapping for Radioguided Sentinel Node Biopsy in Kidney and Bladder Cancers 16.1 Introduction 16.2 The Clinical Problem 16.3 Lymphatic Drainage and Nodal Groups in Renal Cancer 16.4 Lymphatic Drainage and Nodal Groups in Bladder Cancer 16.5 Radiocolloid Administration in Renal and Bladder Cancer 16.6 Preoperative Imaging of Sentinel Lymph Nodes in Renal and Bladder Cancer 16.7 Intraoperative Detection of Sentinel Lymph Nodes in Renal and Bladder Cancer 16.8 Contribution of SPECT/CT 16.9 Intraoperative Imaging 16.10 Accuracy of Radioguided Sentinel Lymph Node Biopsy in Renal Cancer Clinical Cases Case 16.1 Sentinel Node Mapping in Renal Cancer: Drainage to Two Lumbo-Aortic Nodes After Intratumoral Injection (SPECT/CT Imaging) Background Clinical Case Lymphoscintigraphy Case 16.2 Sentinel Node Mapping in Bladder Cancer: Drainage to Iliac Node After Peritumoral Injection (Planar and SPECT/CT Imaging) Background Clinical Case Lymphoscintigraphy References