Important role of iodized oil based post-lymphangiography CT for treatment planning of specific lymphatic second-line interventions in patients with postoperative therapy-refractory lymphatic fistula.

Zielsetzung To explore post-lymphangiography computed tomography (post-LAG CT) as an alternative imaging modality to conventional lymphangiography (con-LAG) for dedicated treatment planning of specific lymphatic second-line interventions in patients with postoperative therapy-refractory lymphatic fistula (LF) in different locations.

Material und Methoden A systematic literature search from 1999.5.13 to 2019.5.13 was performed based on con-LAG in order to define potential targets for specific lymphatic second-line interventions to treat postoperative therapy-refractory LF. Additionally, a systematic review of the institutional prospective database was performed between 2004.4.1 to 2018.9.30. All patients undergoing con-LAG with immediate post-LAG CT in the management of postoperative therapy-refractory LF were involved. Morphological signs of LF and potential targets for specific lymphatic second-line interventions to treat LF were compared 1:1 between con-LAG and post-LAG CT. McNemar tests and the evaluation of the Kappa value were performed.

Ergebnisse Potential targets for specific lymphatic second-line interventions to treat LF included extravasation/pooling of iodized oil, afferent lymph ducts, and afferent lymph nodes. Post-LAG CT showed excellent agreement but significantly higher sensitivity regarding the detection of the pathological signs of LF compared with con-LAG (Kappa value = 0.82; p = 0.008). In addition, post-LAG CT showed excellent agreement of identifying extravasation/pooling of iodized oil, afferent lymph ducts, and afferent lymph nodes compared with con-LAG (Kappa value = 0.956, 0.853 and 0.867, respectively), but with better capability regarding the identification of afferent lymph ducts and lymph nodes (p = 0.016; P = 0.031).

Schlußfolgerungen Post-LAG CT is a potentially better imaging modality as con-LAG for the dedicated treatment planning of specific lymphatic second-line interventions (such as interstitial embolization via afferent lymph nodes) in patients with postoperative therapy-refractory LF.