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.