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PubMed1989

The role of lymphography in the management of carcinoma of the endometrium.

In order to assess the role of lymphography in the postoperative management of carcinoma of the endometrium, 57 consecutive cases were analysed retrospectively. Forty-eight patients had undergone definitive surgery and bipedal lymphography was performed in 41 cases (85%). Unilateral pelvic lymphadenopathy was detected in three cases (7%); two stage I, one stage II. In no case did the result of lymphography alter management, based on histological criteria, with either intracavitary radiotherapy alone or in combination with external beam therapy to the pelvis. In a short median follow-up of 11 months (range 2-19 months), four cases have relapsed but all had normal lymphography at initial postoperative staging. Bipedal lymphography has no role in the routine management of carcinoma of the endometrium.

Adult↗
PubMed1990

Investigation of the swollen limb with isotope lymphography.

The usefulness of isotope lymphography was evaluated in patients with chronic lower leg swelling. Forty patients (15 male, 25 female, age range 5 months-67 years) were assigned one of six clinical diagnoses based on clinical assessments, venography and lymphography. All the patients and seven normal controls were examined with bilateral isotope lymphography involving subcutaneous injection of 0.15 ml 99mTc-antimony sulphide colloid into the first web space of each foot. The percentage uptake of isotope-colloid in the inguinal lymph nodes at 1 and 2 h was equated with lymphatic function. Highly significant (P = 0.0001) differences existed between the different clinical groups and isotope lymphography discriminated well between oedema of lymphatic and non-lymphatic origin. Isotope lymphography appears to be a safe and useful test of lymphatic function.

Adolescent↗
PubMed1983

Comparison of computed tomography, lymphography, and phlebography in 200 consecutive patients with regard to retroperitoneal metastases from testicular tumor.

Two hundred patients with testicular tumor were examined by computed tomography (CT), lymphography, and phlebography of the inferior vena cava and left renal and testicular veins. Metastases were demonstrated in 71. CT was positive in 66, lymphography in 60, phlebography in 53, and a combination of lymphography and phlebography in 65. CT was particularly helpful in studying the upper retroperitoneal space and defining the extent of tumor. Lymphography was preferable for demonstrating metastases in non-enlarged, contrast-filled nodes. Phlebography was never the only positive examination and is not recommended as a routine procedure, though it may be helpful in planning surgery. The authors suggest that CT be performed first, followed by lymphography in negative or equivocal cases.

Adolescent↗
PubMed1989

Pelvic cancers: staging of 139 cases with lymphography and fine-needle aspiration biopsy.

One hundred thirty-nine patients with pelvic cancers (101 bladder carcinomas, 27 prostatic carcinomas, and 11 testicular tumors) considered for radical surgery were studied with lymphography and percutaneous fine-needle aspiration (FNA) biopsy, and the results were correlated with lymphadenectomy. Adequate material for FNA was obtained in 97%, 88%, and 100% of the bladder, prostatic, and testicular tumors, respectively. For bladder carcinoma, the global accuracy was 58% for lymphography and 93% for FNA; the high false-negative rate for lymphography (48%) was lowered to 25% with FNA, providing that the obturator nodes were punctured. For prostatic carcinomas, it was not possible to evaluate the true-positive rate because the patients with positive FNA results did not under-go surgery. For testicular tumors, lymphography and FNA had almost the same global accuracy (73% and 75%), but FNA had a better specificity (100%) than lymphography (86%). FNA had no false-positive results, which means that positive biopsy results obviate radical surgery; when FNA results are negative a lymphadenectomy should be performed. With its mild morbidity, FNA has a role in the preoperative staging of pelvic carcinomas.

Aged↗
PubMedDate not supplied

[Study of the retroperitoneal lymphatic spread of müllerian ovarian carcinoma, using lymphography].

From January 1973 to May 1974, 117 patients with ovarian carcinomas were evaluated with lymphography. The tumors were staged and classified histopathologically according to FIGO (1971). Considering all cases, lymphography showed nodal metastases in 44 patients (38%). Lymphography was positive in 36% of serous cystoadenocarcinomas, in 26% of mucinous cystoadenocarcinomas, in 15% of endometrioid carcinomas and in 36% of unclassified carcinomas. Of the 10 cases not identified by cell type, lymphography was positive in 40% of cases. In 68% of cases bilateral involvement was found. The site of metastatic nodes was in 32% of cases only in the iliac chains were both involved. Considering the single node chains we found 36% of para-aortic, 27% of common iliac, 35% of external iliac and 2% of inguinal involvement. Metastases were observed, regardless of histological type, in 25% of cases in stage III, 62% iin stage IV, 54% in recurrences and only in 5% of cases in stage I. Therefore the lymphatic spread seems to occur in more advanced stages and in recurrences. In 28 of 117 patients node biopsy was performed. Histological-lymphographic correlation was correct in 7/7 positive cases and in 19/21 negative cases (93%). These results show that lymphography is a reliable tool in the evaluation of ovarian cancer.

Adenocarcinoma↗
PubMed1994

Is there still a role for lymphography in the management of early stage carcinoma of the cervix?

The value of lymphography in the management of carcinoma of the cervix is controversial and in many institutions has ceased to be used as part of routine staging. We present the results of 103 patients with carcinoma of the cervix treated by radical radiotherapy alone at the Royal Marsden Hospital between 1984 and 1990 all of whom had a staging lymphogram and computed tomography (CT) of the abdomen and pelvis as part of their routine staging prior to therapy. Our results show that 72 patients (70%) had no involved nodes detected on either CT or lymphography (LG--ve/CT--ve) while 16 patients (15.5%) were thought to have involved lymph nodes on lymphography alone but not on CT (LG+ve/CT-ve). The remaining 15 cases (14.5%) had involved lymph nodes on both CT and lymphography (LG+ve/CT+ve). There were no patients shown to have involved lymph nodes on CT with a negative lymphogram. Survival analysis on these three groups showed that patients in the LG+ve/CT+ve group did worse than the other two groups with only a 28% 5 year survival compared with 60% (LG-ve/CT-ve group) and 64% (LG+ve/CT-ve group) (p < 0.1). This effect of lymph node involvement disappeared in a multivariate analysis using Cox regression when stage came out as the strongest factor affecting survival. After controlling for stage, a further analysis of patients with only stage I and II disease has shown that patients who were LG+ve/CT+ve still did significantly (p < 0.05) worse (30% 5 year survival) than the other two groups: LG-ve/CT-ve group altered clinical management in 5/6 patients with stage I or IIA disease who avoided radical surgery and who were given a parametrial boost to the site of lymph node involvement. The possible benefit of this additional treatment to explain the higher survival rate of patients in the LG+ve/CT-ve group is discussed further. We conclude that lymphography still has a limited role to play in patients with early stage disease (I or IIA) who do not appear to have involved lymph nodes on CT scanning.

Adult↗
PubMed1976

Role of lymphography in management of filarial chyluria.

1. One hundred patients with chyluria were studied with lymphography and 80 cases were followed up for a period varying between six months to two and one half years. 2. There was preponderance of left sided lesions. The site of fistulations were mostly in the region of pelvis and calyces of the kidney. 3. It was observed that lymphography was very useful in treatment of chyluria. Thirty-eight patients (48%) with chyluria were completely free from symptoms and after lymphography, 23 (28%) of them had relief and 19 (24%) of the patients did not have any beneficial effect after lymphography. This procedure was of great help in demonstrating the site of fistulations which could be surgically corrected, in certain situations. 4. Lymphographic appearances of thoracic duct was helpful in deciding the operation of thoracic duct jugular vein anastomosis in some cases. 5. Lymphatico venous anastomosis was done in 3 patients at the root of the scrotum in whom retrograde flow of contrast material occurred into the testicular lymphatics on lymphography.

Chyle↗
PubMed1989

The clinical value of lymphography in cervical cancer, FIGO-stage Ib-IIa.

We report the limited value of lymphography in detecting lymphnode-metastases in 54 patients with operable cervical cancer, FIGO-stage Ib-IIa. A low predictive value of the positive lymphogram and low sensitivity of lymphography were found. This was not affected by the use of strict criteria in assessing the lymphograms. Analysis of the sensitivity of lymphography showed poor ability of the radiologist in localising a metastasis in a patient. High accuracy of lymphography and high specificity were found relatively easy to achieve. They are of minor clinical importance. Only 29 percent of patients with proved lymphnode-metastases had lymphographical evidence at the site of these metastases. It was decided not to continue the routine use of lymphography in this group of patients.

Adenocarcinoma↗
PubMed1977

[The value of lymphography as supplemental examination in thoracic diseases (author's transl)].

A literature review about the significance and incidence of lymphography in intrathoracic diseases (lymphogranulomatosis, reticulum cell sarcoma, lymphosarcoma, chronic lymphatic leukemia, giant follicular lymphoma, pulmonary sarcoidosis) is given. Intrathoracic manifestations of malignant lymphomas are absolute indications for lymphography. With the proof of retroperitoneal lymph node involvement alterations in staging of the disease and therapeutical consequences are emerging. In benign lymph node diseases, such as pulmonary sarcoidosis, lymphography will be also helpful for staging, but therapeutic consequences do not ensue, an absolute indication for lymphography is not validated. Lymphography is valuable for the diagnosis of diseases and injuries of the thoracic duct. The existing methods of lymphographic visualization of intrathoracic lymph nodes are not yet satisfying and need further research.

Hodgkin Disease↗
PubMed1987

[Lymphography in Hodgkin's lymphoma. Diagnostic value based on the current status of experience and knowledge].

Lymphography was carried out at least once in 355 patients with Hodgkin's lymphoma (HL). In 229 patients, there was a histological subclassification: 26 LP, 63 NS, 122 NC and 18 LD cases. The lymphographic manifestations could be subdivided empirically into two superordinate groups: 1. lymph nodes closely linked together in chains (LC) with dense structures as well as LC destructions, LC debris and 2. LC of varying size with pathological internal structure. Apart from in the NS type, a correlation between the lymphological appearance and the histological subtype could not be discerned in any other histological subgroup. After lymphography, 61.6% of stages I and II were assigned to stage III. The staging of the lymphography was: stage I 24.5%, stage II 47.3%, stage III 10% and stage IV 9%, and after lymphography: stage I 9.9%, stage II 17.7%, stage III 63.1% and stage IV 9.3%. From a qualitative point of view, lymphography is superior to all other methods in the diagnosis of malignant lymphomas and should hence be carried out obligatorily in suspicion of a malignant lymphoma.

Adolescent↗
PubMed1985

[Malignant lymphoma of Waldeyer's ring: is lymphography always necessary?].

The role of lymphography for patients with malignant lymphomas involving Waldeyer's ring was retrospectively reviewed. The materials were 97 patients who were treated at Kyushu University Hospital from January, 1966 to December 1982. Lymphography was performed in 72 patients. Abnormal retroperitoneal nodes were detected only in 13 of them (18%). Six of the 7 patients (86%) with gastrointestinal involvement as well as Waldeyer's ring had positive lymphography, whereas only 6 of the 51 patients (12%) without gastrointestinal involvement had such findings. Although there was a significant difference in survival by cervical and inguinal lymph node status, no such discrepancy was seen between 41 stage II patients staged after lymphography and 16 stage II patients staged clinically. All these results suggest that lymphography is not always essential for patients with malignant lymphomas involving Waldeyer's ring.

Adolescent↗
PubMed1983

[Lymphography and lymph node excision in bladder cancer. Apropos of a series].

The authors reviewed a series of 100 consecutive total cystectomies for carcinoma of the bladder, 78 with bilateral pelvic lymph node dissection and 43 with preoperative lymphography, attempting to determine the reliability of lymphography, to quantify the risk of lymphadenectomy and to assess the usefulness of lymphadenectomy when the nodes are involved. Routine reading of lymphography was associated with a level of accuracy of 68.7% an error rate of 10.8% and a level of uncertainty of 20.5%. Evaluating the results by number of patients rather than by the number of sides opacified by lymphography, the score was even lower: accuracy 60.5%, error 13.2%, doubt 26.3%. Strictly reviewing those cases where all necessary information was present in the record, initial routine reading of lymphographies gave 58% accuracy, 14% error, and 28% doubtful. Retrospective reading by one radiologist only gave much better results, but these did not correspond with the results obtained in everyday routine work. The number of complications related to lymphadenectomy appeared slight: amongst 78 operations, one lymphocoele, two cases of prolonged lymphatic discharge and three cases of oedema of the lower limbs. Of 14 patients with involved nodes, only three are living without recurrence and with follow-up periods which are as yet too short. All patients with involvement extending above the common iliac bifurcation died within a short time, as did all those with prostatic involvement. Comparing the data from their own series and the literature, the authors came to the following conclusions.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1993

[Is lymphography still relevant in seminoma?].

In the radiotherapist's point of view lymphography and computed tomography scan compete for staging and therapy planning of testicular seminoma. We investigated whether lymphogram can be replaced by computed tomography scan. 114 patients with histologically confirmed seminoma of the testis were treated by radiotherapy at the Nürnberg Community Hospital (n = 65) and the University of Erlangen (n = 49) from 1978 through 1991. Radiological staging included both computed tomography scan and lymphography in all cases. The results of both methods were similar in 79%. Computed tomography scan led to an upstaging in 4% while lymphography was negative. 17% of the patients showed negative results considering computed tomography scan while lymphogram was positive. In accordance with these data treatment portals or doses were altered in 21%. Using the M.D. Anderson Hospital clinical staging system a stage IIa (micrometastasis < 2 cm) is not safely identified by computed tomography scan. Just lymphography can safely identify a stage IIa patient. On the other hand, lymphography shows a very high amount of false positive interpretations. However, two conclusions are made: 1. Using a conventional technic (radiation of para-aortal and ipsilateral iliac region, dose about 30 Gy HD) lymphogram can be superseded by computed tomography scan. 2. In the case of reducing treatment volume and/or dose lymphogram should be added to computed tomography scan.

Dysgerminoma↗
PubMed1977

[Vulvar neoplasms and preoperative lymphography].

20 patients with histologically verified carcinoma of the vulva fulfilled the following conditions: general operability, preoperative lymphography, radical vulvectomy with inguinal lymph node resection and histological examination of all lymph nodes. It was studied how far the preoperative lymphography plays a role for the strategy of operative treatment of carcinoma of the vulva and eventually in the limitation of risks of operative treatment. A survey of the lymphatic drainage of the vulva underlines the importance of the knowledge of the lymphatic pathways for the operation and for the lymphography as performed in this hospital since 1972. The results suggest that lymphography shows an unacceptable high number of false-negative results in cases of metastatic involvement of the inguinal nodes (7 out of 10 cases), whereas it is reliable for the judgment of the iliac and paraaortal nodes. For this reason the resection of the inguinal nodes remains a necessary part of radical vulvectomy. The additional removal of intrapelvic lymph nodes has been restricted to patients with lymphographic signs of positive nodes. In our opinion preoperative lymphography is of considerable value to minimize the operative risk for patients with carcinoma of the vulva by means of a more precise preoperative diagnosis, stage-oriented therapy and postoperative control.

Aged↗
PubMed1976

[The importance of the results of pretreatment pelvic lymphographies in the prognosis of carcinomas of the uterine cervix. A critical evaluation of the proposal to classify these tumors according to the TNM system (author's transl)].

Between 1966 and 1969, 494 patients with carcinoma of the uterine cervix stages I a to IV were admitted in our hospital for primary treatment. In 420 of these patients with carcinoma of the cervix stage I b to IV, complete results of bilateral pretreatment pelvic lymphography are available. The correlation between the results of the lymphographies, the choice of the operative treatment and the cure rates in these 420 cases are reported. All the correlations between the results of the pretreatment lymphography and the prognosis are described. A positive lymphography was in our series of high prognostic value. A plea is therefore made to include the results of the pretreatment lymphography into the classification of carcinoma of the cervix. Classification of the carcinoma of the cervix into the TNM categories is desirable. Our series is reported in these TNM categories. The advantages of such classification are described. The morbid entity of carcinoma of the cervix becomes more transparent to the observer and the choice of operative therapy becomes easier. The prognosis is more clearly established. The proposals of the TNM committee of the UICC for the classification of carcinoma of the cervix according to the TNM categories and the staging according to these categories are discussed critically.

Female↗
PubMed1983

Lymphography and computed tomography in staging nonseminomatous testicular cancer: limited detection of early stage metastatic disease.

The efficacy of lymphography and computed tomography (CT) in staging nonseminomatous testicular cancer was analyzed in 41 patients. Retroperitoneal lymphadenectomy in 30 patients with early tumor stage revealed 56% sensitivity, 90% specificity, and 80% overall accuracy for lymphography; CT was less accurate (44% sensitivity, 81% specificity, 70% overall accuracy). The presence of advanced disease in 11 patients was depicted equally by lymphography and CT, but CT better demonstrated the anatomic extent of the metastases. CT is valuable for discriminating between advanced and early tumor stages; the similar inaccuracy of lymphography in early disease militates against its routine and complementary use; retroperitoneal lymphadenectomy then remains the only accurate staging modality.

Adolescent↗
PubMed1980

Lymphography in the evaluation of urinary bladder carcinoma.

Lymphography was performed in 41 patients with bladder carcinoma. The lymphographic findings were correlated to the clinical and histological staging and the pre-operative grading. Twenty-seven patients were operated upon. The findings of lymphography were compared with the findings at operation, and the pathological examination of the removed lymph nodes. The lymphographic diagnosis was proved to be correct in 77.7% of the patients. There were two false positive lymphographies, and one false negative. Lymphography in groups T3 or T4 yielded a high diagnostic accuracy.

Aged↗
PubMed1986

Influence of computed tomography scanning and lymphography on the management of testicular germ-cell tumours.

Seventy-eight patients with seminoma and 66 patients with teratoma had computed tomography (CT) of the thorax and abdomen performed as part of initial staging following orchidectomy. Four of 65 (6%) seminoma and 13 of 66 (20%) teratoma patients were upstaged by the addition of CT scanning. No seminoma patients with Stage I disease according to abdominal CT and lymphography had an abnormal thoracic CT scan. Seven of 52 (13%) seminoma and 4 of 21 (19%) teratoma patients who were Stage I according to the CT scan had their staging altered by lymphography. CT was of particular value for defining the exact extent and bulk of metastatic disease prior to and following chemotherapy and radiotherapy, prior to surgical excision of residual disease following chemotherapy, and for investigating potential sites of disease relapse. For all patients with teratoma, we recommend CT of the thorax and abdomen, with bipedal lymphography for those with normal CT scans. For seminoma patients, we suggest lymphography followed by abdominal CT and if either is abnormal, thoracic CT.

Dysgerminoma↗