LYMPHANGIOGRAPHY: AN EVALUATION OF ITS APPLICATIONS

Testicular tumors: oncologic imaging and diagnosis

The extreme radiosensitivity of testicular seminomas plus recent advances in chemotherapy for nonseminomatous tumors and for advanced seminomas have made long term survival possible in the large majority of patients with testis cancer. Since choice of therapy is determined by tumor histology and extent of disease, accurate clinical staging is critical. Computed tomography (CT) of the abdomen and chest is the imaging procedure of choice for staging testis cancer. Clinical staging accuracy of 80 to 90% can be achieved using CT in combination with radioimmunoassays for beta-HCG and AFP. Ultrasonography (US), while less sensitive and specific than CT for determining nodal status, may be useful in thin patients with sparse retroperitoneal fat; in addition US may play an important role in detecting occult testicular neoplasms and in assessing primary tumor extent within the scrotum. Lymphangiography should be reserved for Stage I patients in whom elective treatment of the retroperitoneum is not planned. Follow-up should include serial radioimmunoassays for serum AFP and beta-HCG and periodic CT examinations of the abdomen and chest. Technical improvements in CT scanners and further experience with the use of tumor markers should help refine our ability to stage and manage patients with testicular tumors. In addition, nuclear magnetic resonance (NMR) imaging and radionuclide imaging following injection of radioactively labelled antibodies to AFP and beta-HCG are new techniques which offer great promise for the future.

The role of lymphangiography in the staging of prostatic cancer

Lymphangiography and staging lymphadenectomy were performed in 36 patients with carcinoma of the prostate. The accuracy of lymphangiography was 75% with a specificity of 79% and a sensitivity of 67%. The results of nodal metastases in relation to grade and stage of the tumor are compared with literature. Applications for lymphangiography in prostatic cancer are discussed.

Evaluation of pedal lymphangiography in staging non-seminomatous testicular carcinoma

An analysis is presented on 45 patients undergoing pedal lymphangiography followed by retroperitoneal lymphadenectomy for non-seminomatous testicular carcinoma. Retroperitoneal node metastases were predicted correctly with the lymphangiogram in 10 of 20 patients (50 per cent). The over-all predictive accuracy was 62 per cent.

Lymphangigraphic accuracy in the staging of testicular tumors

Since 1965, 103 patients with testicular neoplasms have been evaluated with lymphangiography for evidence of retroperitoneal disease. Thirty-five patients with testicular carcinomas had lymphadenectomies; corroboration of their initial lymphangiographic interpretaions with the surgical specimens was possible. There was an overall 79% (26 of 33) correlation. We feel that even with relatively inexperienced examiners, lymphangiography can be a useful means of evaluating the retroperitoneum.

Surgical applications of ethiodol with chlorophyll in lymphangiography: histopathologic, radiographic and clinical disadvantages in 36 cases

Images