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[Indications for lymphography in uterine cancer].

The analysis of the clinicoroentgenological findings in 98 patients with corpus uteri cancer has shown the frequency and volume of lymphogenic metastasis depending on the histological structure and degree of tumor local dissemination. Predominant metastatic sites have been defined:external and general iliac lymph nodes. Indications to lymphography depending on primary tumor spreading have been worked out. The authors managed to show the value of x-ray observation over time and repeated lymphography in the evaluation of the therapeutic efficacy and metastasis detection.

Adenocarcinoma↗

[The value of lymphography in testicular, bladder and kidney tumors].

On the basis of 143 lymphographical findings of testicular tumours, 95 of vesical tumours and 55 of renal tumours, this method of examination for urological tumours is evaluated. Lymphography has great diagnostic value for testicular tumours. It is very accurate, and the examination is essential for staging, the planning and checking of therapy and for prognosis. If possible it should always be carried out in combination with computerized tomography. With vesical and renal tumours the value of this examination is often limited by the low lymphogenic rate of metastasis, the low accuracy with vesical tumours and often by therapeutic procedures which are independent of lymph node findings. Nevertheless, even with these two types of tumour lymphography is justified by the information it gives on further course, possible inoperability and the help it gives in field delimitation and checking of therapy. Its use in connection with vesical and testicular tumours will depend on the therapeutic preference of the particular clinician.

Diagnosis, Differential↗

Indirect lymphography of the breast with iotasul: a vanishing hope?

Using a new aqueous nonionic contrast medium (Iotasul, Schering) we attempted visualization of axillary lymph nodes in patients with breast carcinoma. Intradermal infusion into the areola consistently opacified the subareolar plexus and latero-cranial lymphatic trunk. Axillary nodes were visualized in 78.6% of patients, but only 5.7% of surgically excised nodes were partially or totally opacified. Eleven patients underwent axillary lymph node dissection and histology confirmed metastases in 4, of which only two were detected by lymphography. Breast lymphography is inadequate for routine clinical application, and radical axillary dissection remains the mainstay for documentation of nodal metastases.

Breast Neoplasms↗

[Functional effects of micro-oil embolization following lymphography].

Lymphography, if performed correctly, has few clinically relevant complications. Nevertheless, the passage of oily contrast medium into the pulmonary vascular bed along physiological pathways can usually be verified radiographically and functionally. Since that part of the contrast medium filtered in the lungs is of no diagnostic value we think that a total amount of 14--16 ml Lipiodol Ultrafluid should normally suffice for outlining the retroperitoneal lymph passageways from the legs. With smaller amounts one may misinterpret an incomplete filling of the cranial paraaortic lymph nodes as filling defects. We agree with most authors that in patients with abnormal lung function, especially those with restrictive disorders, and in patients with pre-existing right heart strain lymphography should only be considered when truly indicated and only after testing of pulmonary function.

Contrast Media↗

Value of computed tomography and lymphography in staging carcinoma of the uterine cervix.

CT scanning was performed on 68 consecutive patients with newly diagnosed, untreated carcinoma of the uterine cervix (FIGO stage IB-IVA). Lymphography was performed in 61 cases. Surgical pathological correlation was obtained in 16 patients. CT and clinical stage accorded only in 68%, mainly because of CT errors in the determination of parametrial involvement. CT detected enlarged lymph nodes in 60.5%, compared to 39.5% of cases with lymphographically demonstrated nodal metastases; this discrepancy resulted mainly from the inability of CT to discriminate benign nodal changes. Our data suggest lymphography as radiological staging procedure in early stage (IB, IIA) carcinoma and the routine use of CT in advanced stage (IIB-IV) disease.

Adult↗

Differential diagnosis of lymphedema after indirect lymphography with Iotasul.

Indirect lymphography with Iotasul (interdigital, intradermal infusion) was performed in 32 patients with lymphedema. No side effects were observed. Opacification of the peripheral lymph vessels reveals two distinct patterns: 1. No, few, or only very small-calibre lymph vessels ("hypoplasia"): 17 patients (primary lymphedema in 14 cases, secondary in 3). 2. Many large-calibre (dilated) lymph vessels ("hyperplasia"): 15 patients (primary lymphedema in 2 cases, secondary in 13). An occasional finding in "hypoplasia" is drainage of the contrast material in the region of the adventitia of vessels, and a network of extremely fine lymph vessels apparently corresponding to the dermal plexus is sometimes observed. Because it leads to the opacification of barely perceptible lymph vessels in the extreme periphery which were previously inaccessible to radiology, indirect lymphography offers a genuine gain in information and improves the differential diagnosis. When administered correctly, Iotasul invariably enhances the peripheral lymph vessels without making any great demands of the patient or investigator.

Adolescent↗

[Value and limits of echography and abdominal lymphography in malignant lymphomas].

Diagnostic results obtained by echography and lymphography in the study of abdominal lymphoglandular involvement in patients with lymphomas are compared. The data indicate that while lymphography is more revealing, the two examinations should be used together in staging. Echography, on the other hand, should be used for long-term surveillance, once the lymphographic contrast medium has been absorbed.

Female↗

[Lymphography as an investigation method for bladder cancer in adults].

The use of lymphography as an investigational method in bladder cancer is a controversial subject. Results of a personal series of 90 cases, including 50 that were histologically confirmed, are compared with those reported in the published literature. Results were fairly different from those previously described, as though there was a lower sensitivity (43 as against 85 p. cent in the literature), specificity was much higher (100 as against 94 p. cent) as well as positive predictive value (100 as against 69 p. cent). This improvement was mainly due to the use of Piver and Wallace's assessment criteria, and results should be improved still further in the future by more frequent use of needle puncture cytology. Even with the increasing employ of the scanner, lymphography still remains a precise method for investigating bladder cancer.

Adult↗

[Lymphography in staging prostatic cancer: correlations between the histo-pathological, anatomic and radiologic results in 30 patients. The role of transcutaneous lymph node biopsy].

Between September 1, 1978 and March 1, 1981, 35 patients with prostatic carcinoma, apparently localized (T0-3) and histologically proved, underwent pedal lymphography. 30 out of 35 underwent cytologic and/or histopathologic examination of pelvic lymph nodes, either by transcutaneous thin needle biopsy and/or pelvic lymphadenectomy. Prospective analysis demonstrated an overall lymphographic sensitivity of 84.2%, specificity of 73.7%, positive accuracy of 68.7% and negative accuracy of 78.5%. The authors herein underline the usefulness of lymphography and lymph node biopsy which, if cytologic positiveness occurs, allows to avoid pelvic lymphadenectomy.

Adenocarcinoma↗

[The value of pretherapeutic lymphography in testicular teratoma and carcinoma of the bladder (author's transl)].

According to the results of our investigations pretherapeutic lymphography is of high clinical value in cases of testicular teratoma and carcinoma of the bladder. The exstirpation and subsequent histological evaluation of all retroperitoneal lymph nodes in 50 patients with testicular teratoma and carcinoma of the bladder revealed a diagnostic accuracy of 80% (n = 50). Thus, lymphography proves to be of major benefit for the planning of future treatment and the preoperative determination of the state of the disease.

Humans↗

[Exploration and surveillance of the retroperitoneal space by lymphography and ultrasonography in patients with non-Hodgkin's lymphomas (author's transl)].

The authors propose to conduct, in a systematic manner, lymphography and ultrasonography examinations before treatment of 75 cases of non-Hodgkin's lymphoma. The latter investigation enables examination of the upper part of the retroperitoneal space, and the detection of coeliomesenteric adenopathies, or possible lesions in the liver, spleen, and kidneys. The surveillance of most patients during treatment is possible with ultrasonography, if marked lipiodol resorption has occurred. Though this procedure is easy to conduct in all radiological departments, it does not have the same sensitivity as lymphography associated with computed tomography.

Humans↗

[Clinical value of lymphography in cervical cancer (author's transl)].

From January 1961 to June 1978, 417 patients with cervical cancer were submitted to lymphangiography as part of the initial diagnostic work-up. As regards the distribution by clinical stage of the cases under consideration, there were 187 cases in Stage Ib (44.8%) 99 in Stage II (23.7%) and 131 in Stage III plus IV (31.5%). For the early stages preference was given to a radical surgery plus pre- or postoperative radiotherapy combination (154/417 patients, or 36.9%). On the contrary, the cases which were more developed locally or which presented contra-indications to surgery received radiological treatment alone (263/417 cases, or 63.1%). The overall incidence of positive examinations was 29.9% (10.7% in Stage Ib; 28.3% in Stage II; 58.7% in Stage III and 60.0% in Stage IV). The histologic type on its own did not seem to influence the incidence of lymph node metastases detectable by lymphography. In the 145 patients who had surgical exploration, the overall diagnostic accuracy of lymphography was 82.8% with 3 false positive and 22 false negative reports. The para-aortic chains were involved in 28/417 patients (6.7%). For the negative cases, with all the stages mixed together, a 74.7% 5-year survival rate free of disease was recorded, as compared with the 34.5% found for the positive cases (P less than 0.0001). Similar differences was recorded stage by stage.

Female↗

[Diagnosis of extension of cervical cancer by combined methods of 67Ga-computer scintigraphy, I.V.P. and lymphography (author's transl)].

Diagnosis of extension of cervical cancer still depends mostly on subjective inspection and palpation and there is only a few objective methods to know the extent of invasion and metastasis of the cancer and the difficulty of surgical operation. To develop a new method, a combination of 67Ga-computer scintigraphy, I.V.P. and lymphography was evaluated in the diagnosis of parametrial infiltration and lymph metastasis in 84 cases of cervical cancer at the stage one to four. 67Ga-citrate is now the most efficient of oncotropic radioisotopes with a short half life. It was revealed that this isotope bounds to the protein with a molecular weight of about 70,000 daltons or more in the 105,000g supernatant of the cytoplasm of tumor cells. The 67Ga accumulation on scintigram was classified into five types according to the shape, extent and concentration, and in each type tissue specimens obtained by surgical operation were examined histologically. I.V.P. with reference to renogram was also used to know the extent of parametrial invasions of cancer in which cases the ureter was extremely distended. Lymphography was done by Kinmonth method. The extent of parametrial invasion was judged from findings of both 67Ga-scintigram and I.V.P., and metastasis was estimated by abnormal features of both 67Ga-scintigram and lymphogram. As a result of the above study on the combination of the three methods, the rate of correct diagnosis for parametrial infiltration was increased to 70.8% by combining the findings of I.V.P. to scintigram, and the rate for lymph metastasis was improved to 89.6% by combining lymphogram to scintigram. At the same time the rate of false negative diagnosis for each extension of the cancer could also be decreased. It might be concluded that this combined method has a large diagnostic significance.

Computers↗

Iotasul, a water-soluble (non-oily) contrast medium for direct and indirect lymphography: radiological and morphological investigations in dogs.

Radiological, light microscopic and electron microscopic findings after direct and indirect lymphography with Iotasul, a new non-ionic water-soluble (not oily) contrast medium, are reported. The results of the studies in 18 dogs clearly show that the roentgenological demonstration of the lymph system following intralymphatic administration of Iotasul in the dog is not inferior to that following the use of conventional oily con contrast medium passes quickly to the lymphatic system and the lymph nodes and is eliminated within 24 hours. The complications and tissue reactions known from oily contrast media are not observed following use of the new water-soluble contrast medium. Furthermore, studies of the fine structures show unequivocally that no morphologically detectable changes attributable to the contrast medium occur either in the region of the injection or in the lymph vessels, lymph nodes and organs such as kidney, liver, lung, spleen and myocardium. Preliminary studies indicate that the new contrast medium offers the possibility of indirect demonstration of lymph vessel regions and groups of lymph nodes (indirect lymphography) which have largely escaped detection by the previous routine lymphographic examination.

Animals↗

[Accuracy and general relevance of preoperative lymphography in gynaecology (author's transl)].

Lymphographic findings obtained from 304 patients were compared with results obtained from histological testing of extirpated lymph nodes, with the view to making an assessment of accuracy of presurgical lymphography. Agreement was recordable in 82.3 per cent of all cases, while 3.3 per cent of the findings were falsely negative and 4.9 per cent falsely positive. The relevance of preoperative lymphography to diagnosis and planning of therapy for various gynaecological carcinomas is discussed.

Diagnostic Errors↗

[Role of lymphography in determining a lymph flow blockage and the level of lympholymphatic shunting in edema of the extremities].

Different lymphographic methods were used for determining the disturbances of the lymph flow and the levels of the lympho-lymphatic shunts in 139 patients having edema of the upper (70) and lower (69) extremities. A conclusion is made that the generally accepted method of lymphography by means of the administration of a contrast substance into the vessels of one collector in some cases can not reveal the first symptoms of partial block of the lymph flow in clinical manifestation of edema. The successive lymphography of several collectors is necessary. With its aid the author has found that under normal conditions and in mild edemas they fulfil drainage separately, and in the expanded zone of edema they compensate the activity of one another.

Adolescent↗

[The value of contrast lymphography in the planning of abdominal surgery].

Contrast lymphography is a significant diagnostic method for metastatic changes discovery in lymph nodes of pelvic and abdominoretroperitoneal area. Preoperatively it enables surgeon to plan the surgical treatment, and postoperatively it is indispensable for the successful treatment and radiotherapy planning. From 1965-1977. yrs. 325 contrast lymphographies were accomplished. The patients with urinary bladder and rectum carcinomas were examined. The ones with pelvic and long bones tumors were presented too, because of the congruent lymph supply and insufficient reviews in literature. Lymphographically visible metastases were pathologically proved in more than 80% of cases. For better visibility of lymph nodes during the surgical treatment, in 100 cases, chromolymphography was applied. There were no complications before or after the performance of the method. In less visible changes, supplementary researches should be accomplished to make the changes interpretation more reliable.

Abdominal Neoplasms↗

[Indirect lymphography in the preoperative diagnosis of thyroid and parathyroid diseases].

The authors come to a conclusion that indirect lymphography is an effective method for the diagnosis of alterations in the thyroid gland (thyroiditis, malignant tumor, diffuse and nodular goiter). It can be also used in order to establish the state of its regional lymph nodes more exactly. The thyroid gland lymphography added by contrasting the esophagus is a simple and effective method for topical preoperative diagnosis and determination of localization of the altered parathyroid gland.

Adolescent↗