A critical evaluation of foot lymphography in the demonstration of the regional lymph nodes of the uterine cervix

Clinical Results of Lymphography in Cancer of the Uterine Cervix. A Retrospective Study of 542 Consecutive, Unselected Patients

From 1961 to 1976, 542 patients were evaluated with foot lymphography for cancer of the cervix at the Istituto Nazionale Tumori of Milan. A group of 341 patients had lymphangiography as part of the initial diagnostic work-up. The overall incidence of positive examinations was 25% (9% stage I, 29% stage II, 46% stage III, 50% stage IV). In the 115 patients who had pelvic surgery the overall diagnostic accuracy of lymphography was 88%, with 2 false positive and 12 false negative reports. A second group of 90 patients was evaluated in the follow-up without clinical evidence of disease, and the incidence of metastases was 17%. Finally, a group of 111 patients was studied for recurrence, and in this group the incidence of metastases was 51%. As regards site of involvement, the external iliac chains were involved in 93 to 96% of the cases, the common iliac in 34 to 79%, and the para-aortic in 17 to 36% in the different clinical conditions. The highest incidence of para-aortic metastases was found in the clinically initial stages (I and II) and in the recurrences. The lymphographic involvement of the retroperitoneal nodes was usually limited to a single region (41%) or two regions (37%). Only in 22% of the positive cases was a diffuse involvement of the retroperitoneal node chains evident.

The management of vaginal melanoma

Between 1964 and 1987 ten patients with vaginal melanoma were treated at The University of Michigan Hospital. Five of the six patients who underwent radical surgery had adequate information concerning the first site of relapse, and in four of these five, pelvic sites or locoregional lymph nodes were the first sites of recurrent disease. One of these patients developed a 17-cm pelvic recurrence, which responded with a 75% reduction in size 3 months after completion of radiotherapy given in high individual fractions (400 cGy X 11). Three patients were managed with local resection, and all developed recurrent locoregional disease. One patient presented with metastatic disease. We conclude that locoregional control of vaginal melanoma is difficult to achieve with surgery alone. We hypothesize that preoperative radiotherapy to the pelvis (500 cGy X 6 given 3 days a week to the whole pelvis with subsequent consideration for a vaginal boost field) may improve the poor rate of locoregional control of vaginal melanoma that is seen when surgery alone is used.

The value of complete lymphadenectomy in radical treatment of cancer of the cervix, Stage IB

Two hundred ninety-three patients with Stage IB carcinoma of the uterine cervix were treated by intracavitary irradiation followed by radical hysterectomy and pelvic lymph node dissection in the 3-year period 1970 to 1972, inclusive. Preoperative lymphography was performed and intraoperative films were taken to obtain a lymphadenectomy that was as complete as possible. The number and location of remaining nodes were determined by postoperative films. No patients were lost to follow-up. The 5- and 10-year survival and recurrence rates were correlated to the number of remaining nodes. It is concluded that patients with four or more remaining nodes have a possible inferior prognosis compared with the rest of the patients. Meticulous and time-consuming search for a few remaining nodes was, however, not found to be justified.

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.