1984 Volume 26 Issue 12 Pages 2388-2394_1
In the recent progress of roentogenologic and endoscopic techniques, detection of digestive tract malignancies has not been a difficult problem. However, diagnosis of metastatic lymph nodes in patients with these conditions can only be achieved on pathological assesments at the time of operation or autopsy. The authors have been able to demonstrate the pen-gastric lymphatics on X-ray in gastric cancer patients with our newly developed Endoscopic Lymphography (ELG). The procedure is the indirect method by use of endoscopy in which the contrast medium is given by the injector under endoscopic visualization into the sub-mucosa or muscle layer of the surrounding area of gastric lesion. The regional lymphatic vessels, the fine and afferant ducts, were clearly observed on X-ray immediately after the injection. The nodes were also seen on X-ray after an interval, between a few hours and twenty-four hours later. The pen-gastric lymphatics were detected on ELG in 2 of 4 cases with early gastric cancer and in 8 of 10 cases with advanced cancer. In comparison of pathological diagnosis, nonmetastatic lymph nodes revealed were less than 5 mm in size, and these usually showed fine nodular patterns. On the other hand, metastatic ones demonstrated filling defects, swelling, marginal irregularity and other abnormalities. The ELG could be a good indicator for the local treatment of early gastric cancer and the complete regional lymph node dissection at the operation. However, a further improvement in the techniques, X-ray demonstration and contrast medium is necessary for constant visualization of the lymphatics.
