[Lymphography for prostatic carcinoma. 1. Results of leg lymphography].
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Aged↗
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[The unilateral re-lymphography on the first day of accumulation. A contribution to the capacity of accumulation of the lymph-node following lymphography (author's transl)].
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Contrast Media↗
Lymphography of the breast as an accessory in the early diagnosis and detection of carcinoma of the breast: lymphography as a prognostic tool.
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Breast Neoplasms↗
Is it wise to eliminate lymphography from the staging of Hodgkin's disease?
We believe that lymphography and CT are complementary rather than mutually exclusive techniques for the diagnosis and staging of HD. Unfortunately, it seems that many radiologists and clinicians disregard the ability of lymphography to provide qualitative information on lymph node architecture, which is not available by CT. The use of lymphography is declining in several teaching centers throughout the world. This makes it difficult for young radiologists to acquire the skills needed to perform and interpret lymphographies successfully. In turn, radiologists who have little experience with lymphography are less likely to use the technique. Because most of the treatment-related morbidity in HD is dose-related, and because lymphography helps to avoid over- and undertreatment, we believe that high-quality lymphography continues to have a significant role in the staging of selected HD patients. Moreover. lymphography may reduce both the cost of management and the morbidity rate in many HD patients. One solution would be to continue to use lymphography in a small number of institutions specialized in the management of HD.
Hodgkin Disease↗
Lymphography as a guide to prognosis in malignant testicular tumours.
Lymphography was performed in 130 patients with malignant neoplasm of the testes. The patients were treated by irradiation, supplemented by chemotherapy when lymph node metastases were present. The survival rates of the various pathologic subdivisions were analyzed according to the lymphography. The following 5-year survival rates were observed: seminoma: normal lymphography 94%, pathologic lymphography 69%; teratocarcinoma: normal lymphography 86%, pathologic lymphography 14%; embryonal carcinoma: normal lymphography 64%, pathologic lymphography 33%.
Adolescent↗
Lymphography and abdominal computed tomography in staging Hodgkin's disease.
Lymphography and abdominal CT were performed in 78 patients staged for Hodgkin's disease. In 82% of all patients, both examinations agreed on the presence or absence of lymph node involvement. In the group of 39 patients undergoing lymphography prior to CT, the agreement was 90%. In the group of 39 patients with lymphography following CT, the agreement was 74%. In 50% of the patients with discrepant findings, lymphography revealed abnormal nodes compared with CT. Lymphography was abnormal in 26% of patients with a normal CT scan as the first examination, and in 9% of patients with a normal CT scan as the second examination. It is concluded that lymphography is more reliable than CT in the examination of the abdomen. CT performed after a normal or an abnormal lymphogram adds little additional information. When CT is preferred as the initial investigation in staging Hodgkin's disease, lymphography only adds significant information if the CT scan is normal or equivocal.
Adolescent↗
Lymphography prior to laparoscopic Palomo varicocelectomy to prevent postoperative hydrocele.
BACKGROUND: We report our experience with preoperative lymphography to identify and perioperatively preserve the ligature of the lymphatic vessels to reduce the incidence of postoperative testicular hydrocele in patients undergoing laparoscopic Palomo varicocelectomy for adolescent varicocele. MATERIALS AND METHODS: Twenty-seven consecutive patients with varicocele had preoperative lymphography. The mean age was 13.5 years (range, 8-18 years) and the mean grade of varicocele was III. We performed lymphography with intrascrotal isosulfan blue. The laparoscopic Palomo procedure was successfully carried out in all patients. RESULTS: In 17 patients (63%) we were able to identify and conserve the lymphatic vessels by lymphography. Mean follow-up was 9.5 months (range, 6-24 months). None of the 27 patients had a recurrence. None of the 17 patients with positive lymphography had a testicular hydrocele. One of the 10 remaining patients developed a sizable hydrocele. CONCLUSION: Preoperative lymphography prior to laparoscopic Palomo varicocelectomy is a simple and feasible method for preventing testicular hydrocele. However, the method should be standardized to identify the exact site, the correct level of injection of blue dye, and to determine the optimal time to perform lymphography prior to the procedure.
Adolescent↗
[Reliability and value of diagnostic lymphography in carcinoma of the sigmoid, rectum and anus (author's transl)].
From 1963 to 1973, 253 patients with cancer of the sigmoid, rectum and anus underwent diagnostic lymphography at the Istituto Nazionale Tumori of Milan. In 218 patients lymphography was performed as part of the intial diagnostic work-up, while in 35 it was done during the follow up period, after surgery. The accuracy of radio-histological correlation was 95%. This confirms the reliability of diagnostic lymphography and its clinical usefulness. In view of these results, this diagnostic tool is essential in the initial evaluation in patients with carcinoma of the anus, because lymphography was superior (28%) to the clinical inspection (6%) in the evaluation of the inguino-iliac lymph nodes. Lymphography is also useful in rectal cancer since it permits, in case of nodal metastases, selection of a group of patients in whom the therapeutic program should be revised. The exam is useless in cancer of the sigmoid. In the small group of patients who had lymphography in the follow up period, this technique was the only to show, in symptomatic patients, the presence of pelvic and/or para-aortic nodal metastases. Lymphography is also useful in these patients for the evaluation of the results of the radio/chemotherapy on involved nodes.
Anus Neoplasms↗
Lymphography and abdominal computed tomography in the staging of non-Hodgkin lymphoma. With an analysis of discrepancies.
Ninety-one patients with non-Hodgkin lymphoma (NHL) were subjected to computed tomography (CT) and lymphography. Both examinations agreed in 74 patients (81%) with regard to the infradiaphragmatic lymph nodes. In patients undergoing CT prior to lymphography, the concordance amounted to 75 per cent. When lymphography was the initial examination, the concordance amounted to 86 per cent. Lymphography was abnormal in 30 per cent of the patients with a normal CT scan and in 93 per cent of those with an abnormal CT scan as the first examination. CT was abnormal in 4 per cent of patients with a normal lymphogram and in 84 per cent of those with an abnormal lymphogram as the first examination. CT did not detect mesenteric or retrocrural lymph node enlargement in the absence of retroperitoneal lymph node involvement. Eleven patients had extranodal manifestations of the disease (excluding liver and spleen), and 3 were detected primarily with CT. Lymphography is the most complete examination for the infradiaphragmatic lymph nodes for staging purposes. Although CT outlined the disease better, it changed the lymphographic diagnosis in only 2 per cent of the patients. Lymphography modified the CT stage in 15 per cent of the patients. When abdominal CT is performed first, in staging patients with NHL, lymphography will only yield additional information when CT is normal or equivocal.
Adolescent↗
Unilateral pedal lymphography in patients with filarial chyluria.
OBJECTIVE: To evaluate the usefulness of unilateral pedal lymphography in patients with filarial chyluria. PATIENTS AND METHODS: Of 114 patients with filarial chyluria, all underwent lymphography (unilateral pedal in 106) and 55 underwent selective ureteric sampling for chyle. RESULTS: Unilateral pedal lymphography in the 106 patients detected lymphaticorenal fistulae (LRF) in 104 (98%). Lymphatic crossover was seen in all 106 patients, from the second sacral segment to the first lumbar segment. The most frequent crossover site was at the L5 level (87%). There was complete correlation between the side of LRF and the side of chyluria as assessed by selective ureteric sampling. CONCLUSION: Unilateral pedal lymphography can detect LRF via lymphatic crossover even when it is on the opposite side from that injected with contrast agent. The advantages of unilateral lymphography over bilateral procedures are that it is easy to identify crossover channels, and the discomfort for the patient is reduced because there are fewer incisions and it is quicker. Unilateral lymphography is recommended as the initial method when lymphography is indicated in filarial chyluria.
Adult↗
CT lymphography-navigated sentinel lymph node biopsy in patients with superficial esophageal cancer.
BACKGROUND: To evaluate experimentally and clinically the feasibility of a newly developed technique of endoscopic computed tomography (CT) lymphography with endoscopic submucosal injection of iopamidol for esophageal sentinel lymph node (SLN) mapping and biopsy examination. METHODS: Nine anesthetized dogs underwent CT after endoscopic submucosal injection of 2 mL iopamidol; 1.25-mm thick CT images were obtained before and at 1, 3, 5, 7, and 10 minutes after contrast injection. Clinically, 12 patients with superficial esophageal cancer (preoperative imaging stage: cT1, cN0) underwent CT lymphography in a similar fashion at 1, 5, and 10 minutes after peritumoral injection, followed by radical esophagectomy and regional lymph node dissection under CT lymphography guidance. RESULTS: CT lymphography visualized the draining lymphatic vessels and SLNs within 5 minutes after contrast injection. All 14 SLNs in dogs (average, 1.5 nodes per animal; range, 1-2) and 28 SLNs in patients (average, 2.3 nodes per patient; range, 1-4) were found intraoperatively at the correct location under CT lymphography guidance. Lymph node metastasis could be detected with excellent sensitivity and accuracy in this small number of patients with no false-negative findings; metastasis was positive only in the preoperatively identified SLNs in 4 patients and in both SLNs and distant nodes in 1 patient, and was negative in all resected nodes in the remaining 7 patients. CONCLUSIONS: Endoscopic CT lymphography appears to allow accurate identification of direction and locations of lymph flow and SLNs, and has the potential clinical applicability for esophageal SLN mapping and biopsy examination, but will require a large study to determine its accuracy and usefulness.
Aged↗
Value of isotope lymphography in the diagnosis of lymphoedema of the leg.
BACKGROUND: Isotope lymphography has largely replaced contrast lymphography in the diagnosis of lymphoedema. Its accuracy has only been assessed in small studies and it is not known if it can identify patients with a proximal lymphatic obstruction who may be suitable for lymphatic bypass surgery. METHODS: Three hundred and ninety-five patients suspected to have lymphoedema were investigated by isotope lymphography between 1985 and 1995. Contrast lymphography was also carried out in 29 of these patients because the isotope results were thought to be misleading, or because lymphatic bypass surgery was being considered. RESULTS: In the 29 patients who had both investigations isotope lymphography detected 20 of 24 abnormal lymphatic systems. Four legs with obstructed groin lymphatics were reported as normal. Two legs with normal contrast lymphograms were erroneously diagnosed as having lymphoedema in the isotope study. Detectable groin nodes on the scintigrams were indicative of either normal lymphatics or proximal lymphatic obstruction. An increase in isotope uptake over 30-60 min of less than 50 per cent, or a total absence of isotope within groin nodes, was a sensitive indicator that patients were unsuitable for lymphatic bypass surgery. CONCLUSION: Isotope lymphography is a moderately sensitive test for lymphoedema, which will mistakenly classify some normal legs as lymphoedematous. It will usually correctly identify patients who are suitable for lymphatic bypass surgery.
Contrast Media↗
Lymphography: an old technique retains its usefulness.
Conventional lymphography has long been the method of choice for imaging the lymphatic system. However, the number of lymphographic studies performed in oncology centers has declined markedly since the introduction of cross-sectional imaging techniques, especially computed tomography (CT). Therefore, levels of expertise in both performing lymphography and interpreting lymphograms are falling. The unique ability of lymphography to demonstrate derangements of the internal architecture of normal-sized lymph nodes can be valuable and makes it more accurate than CT in evaluation of some lymphomas (especially Hodgkin disease) and genitourinary malignancies. In fact, lymphography and CT are complementary rather than mutually exclusive techniques for the staging of some lymphomas and genitourinary malignancies. In addition, lymphography opacifies the lymphatic channels and therefore may be a valuable tool for detection of lymphatic fistulas or lymphatic leakage. Finally, lymphography helps guide subsequent therapy in patients with lymphomas, genitourinary malignancies, or disorders of lymphatic flow.
Adolescent↗
Nodal involvement in cancer of the uterine cervix: value of lymphography and MRI.
In this study the preoperative staging of lymph node involvement in cervical cancer was analyzed retrospectively in 155 cases. All results were correlated with lymph node histology. One hundred and three patients underwent preoperative lymphography. Twelve of them were investigated by lymphography and MRI (magnetic resonance imaging). One patient was staged Ia, 10 patients were staged Ib and one patient was staged IIb. All patients underwent surgery; 18.5 lymph nodes were removed on average. Histologically lymph node involvement was found in 3 cases. Lymphography was able to detect lymph node involvement correctly in one case (33% sensitivity). We got two false positive results by lymphography (67% specificity). By MRI all cases were classified as nodal negative. MRI did not have advantage over bipedal lymphography in detecting lymph node involvement in our study, even though the results of lymphography were also poor.
Female↗
[Ultrasound and lymphography in malignant lymphoma. Comparison with consideration to staging].
The diagnostic value of abdominal ultrasound and lymphography was compared in the staging of 88 consecutive patients with malignant lymphoma, examined during the period March 1990 to April 1991. Lymphography was used as the reference method in the evaluation of the paraaortic and iliac lymphnodes. In 19% of the patients ultrasound examination could not be accomplished optimally, and these results were evaluated in a separate group. Lymphography demonstrated involvement of retroperitoneal lymphnodes in 27 patients, among these ultrasound was false negative in seven (= 26%). In ten patients ultrasound examination demonstrated lymphoma outside the lymphographic area. No false positive ultrasound examinations were found in the group with negative lymphography. Ultrasound cannot replace lymphography, but is an important supplement, and in those cases where ultrasound reveals lymphomas in the lymphographic area, lymphography can be omitted as ultrasound has a high predictive value.
Abdominal Neoplasms↗
Comparison of Gd [DTPA-bis (2-aminoethoxy) ethane] polymeric contrast agent with gadodiamide injection for interstitial MR lymphography: experimental study with rabbits.
PURPOSE: To compare the differences between macromolecular and small molecular contrast agents in interstitial magnetic resonance (MR) lymphography. MATERIALS AND METHODS: In two groups of rabbits (N = 12 each), 0.5-mL volumes of 0.5 M and 0.1 M gadodiamide, respectively, were injected subcutaneously into the dorsal feet of both hind legs. After a 24-hour interval, 0.5 mL of Gd [DTPA-bis (2-aminoethoxy) ethane] polymeric contrast agent (Gd-poly-DTPA-EOEA) injection (0.1 M) was injected into the same sites in each rabbit. T1-weighted three-dimensional gradient-echo and maximum intensity projection (MIP) images were obtained before and after the administration of each agent. The nodal maximum short-axis diameter (MSAD) and signal-to-noise ratio (SNR) at each time point were measured. Postmortem measurements of nodal MSADs were also performed. The nodal MSAD measurements obtained by MR lymphography were compared with the postmortem measurements. As an additional control experiment, six rabbits received a subcutaneous injection of 0.5 mL of 0.1 M gadodiamide at the same sites as those described above. This procedure was repeated after a 24-hour interval to determine whether the first injected gadodiamide had any effect on the performance of the subsequently injected agent, by comparing the differences in nodal MSADs obtained by MR lymphography after each injection. RESULTS: Gd-poly-DTPA-EOEA showed a significantly longer enhancement plateau compared to gadodiamide. In comparison with postmortem measurements, nodal measurements by MR lymphography with Gd-poly-DTPA-EOEA at the peak-enhancement phase revealed no significantly different MSADs (P > 0.05), whereas nodal measurements by MR lymphography with gadodiamide showed significantly smaller MSADs (P < 0.05). A comparison of the nodal MSADs measured in two gadodiamide-enhanced MR examinations after the 24-hour interval showed no significant difference (P > 0.05). CONCLUSION: Interstitial MR lymphography with polymeric Gd-poly-DTPA-EOEA enhancer enables more sufficient and reliable visualization of lymph nodes compared to small molecular gadodiamide.
Animals↗
Are retroperitoneal lymph node metastases a major problem in endometrial adenocarcinoma? Diagnostic and prognostic assessment with lymphography.
The results of foot lymphography in 295 patients with endometrial carcinoma observed from 1968 to 1978 at two institutions are reported. One hundred and eighty-two were new cases, 61 were recurrences, and 52 were patients who underwent restaging diagnostic procedures without clinical evidence of disease. The incidence of lymphatic spread was correlated with the clinical stage, the pathologic stage, and the extent of recurrent disease. In fact, in the 182 new cases, at clinical stage, the pathologic stage, lymphography was positive in 8.9% of patients at Stage I, 28.6% at Stage II, 57.1% at Stage III, and 66.6% at Stage IV disease; at pathological stage, lymphography was positive in 8% of patients at Stage I, 14.8% at Stage II, 39.3% at Stage II, and 53.3% at Stage IV disease. There was lymph node involvement in 47.5% of the 61 pretreated patients. Finally, in 52 pretreated patients with no evidence of disease, the incidence of lymph node involvement was 7.7%. In new cases, metastases were found only in the pelvic nodes in 56.2% of the patients and only in the para-aortic nodes in 9.5%; in 34.3%, both chains were simultaneously involved. The five-year survival rate for patients at Stage I, II, and III disease with positive lymphography was 35% as compared with 73% for negative cases. In patients at Stage I and II, the difference of survival was equal to 24%. The reliability of the results is confirmed by the concordance with the data of the literature on histologic involvement, by the first radiologic-pathologic comparison, and by the clinical course of the positive cases. Lymphography is of unquestionable value for an appropriate staging and for a correct plan of treatment.
Adenocarcinoma↗
Computed tomography and lymphography in the presurgical staging of early carcinoma of the uterine cervix.
The value of bipedal lymphography and computed tomography (CT) in the presurgical staging of early carcinoma of the uterine cervix was analysed in 62 patients by histologic examination of pelvic lymph nodes and parametrial extension at the time of surgery. Macroscopic invasion of the lymph nodes was detected in 33% of the patients by CT and in 17% by lymphography. Microscopic invasion was suspected in 9% by CT scan and in 38% by lymphography. Physical examination with measurement of the tumor diameter was more predictive for regional extension of the disease as compared to lymphography and CT. CT may detect subclinical parametrial invasion but overestimation of the extent of the disease is common. Bipedal lymphography and CT add only limited information to the routine presurgical staging of cancer of the uterine cervix.
Adult↗