Endobronchial lymphoscintigraphy (EBLS). New diagnostic modality.

A safe, simple method of visualizing deep intrathoracic lymph nodes and determining regional tracheobronchial lymphatic drainage with colloidal radionuclides has been developed. The tracer is injected submucosally via a bronchoscope and lymph node scanning is performed at least 2 hours later. The technique was developed and tested in seven canine experiments. Endobronchial lymphoscintigraphy (EBLS) has been performed in 43 patients undergoing routine bronchoscopic examination. 99mTc phytate, 198Au colloid, and 99mTc antimony sulfide have been used; the last appears to have been the most satisfactory. The primary lymphatic drainage from selected sites of the tracheobronchial tree could be determined. Up to five lymph nodes have been visualized, with an average of 2.1 lymph nodes seen in those patients with lymph node visualization. Four patterns of lymphatic drainage were seen; ipsilateral ascending, contralateral ascending, descending, and no spread of injected colloid. In some cases cervical and celiac lymph nodes were seen. In combination with conventional diagnostic methods, EBLS in many cases clarified the extent and nature of underlying disease.