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The value of lymphography in the tumour diagnostic--the comparison lymphography with computerized tomography.

The main indications for lymphography by oncological patients are primary or secondary lymph node tumours. CT also became very useful in these cases. In this study the results of lymphography and computed tomography were compared in 100 patients with lymph node tumours. An absolute concurrence of both methods was found in only one half of the material. In 18% lymphography was clearly positive and CT negative. In 6% CT was positive while lymphography was negative. In 25% CT yielded important extra useful information. Lymphography and CT complement each other. Both methods are about equal in terms of sensitivity and reliability. CT is the basic method to be performed invariably prior to lymphography.

Adolescent

[Ultrasonic diagnosis, computed tomography and lymphography of retroperitoneal lymphomas--re-evaluation of lymphography].

Regarding the present results and the review of literature, we are of the opinion that negative attitude towards lymphography is not justified. In diagnostic procedure, priority is given to sonography and computed tomography because of their non-invasiveness. Lymphography is indispensable in all cases where sonography or computed tomography show negative findings and where the therapy planning depends on evidence or exclusion of retroperitoneal lymphomas. In general the combination of both computed tomography and lymphography is the most sensitive and consequently, the safest method in the diagnosis of retroperitoneal lymphomas.

Evaluation Studies as Topic

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

[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

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

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

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

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

[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

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

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

[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