ROLE OF LYMPHOGRAPHY FOR RADIOTHERAPY

Abstract

Between August 1970 and July 1973, 307 lymphographies with various diseases were performed at Department of Radiology, School of Medicine, Gunma University. This paper reports our experience of lymphographic interpretation, and techniques and complications of lymphography with literature review. Main study population consists of patients with various malignant neoplasm; 94 of the patients with carcinoma of the uterine cervix, 80 with malignant lymphoma, 31 with bladder tumor, 21 with ovarian tumor and 16 with testicular tumor. The effort was made to decrease “false positive” and equivocal diagnosis of metastasis from lymphogram. For this purpose, final diagnosis was often made after consideration of previous history, local skin condition, typical metastatic pathway and growth characteristics of primary tumor, and other factors which may affect lymph node change in lymphogram.
Pedal lymphogram was interpreted showing metastasis in one to all nodes in 60.4% of all cases : 81.3% of the patients with carcinoma of the uterine cervix showed metastasis, 51.3% of malignant lymphoma, 74.2% of bladder tumor, 30.0% of ovarian tumor, 18.8% of testicular tumor and 58.5% of the remainder.
Initial clinical stage of the disease was reclassified to advanced stage after lymphographic interpretation in 53.1% of the patients with carcinoma of the uterine cervix and 35.9% malignant lymphoma. This reassured us the value of lymphography for correct staging of the disease prior to the initiation of therapy.
Supraclavicular lymph nodes were opacified in 50.2% of the study without preference of diseases. opacification alone did not indicate metastases as long as architecture was normal. We attempted to correlate supraclavicular lymph nodes opacification to prognosis resulting in good prognosis in these patients. There should be further study evaluating the good prognosis in patients with supraclavicular lymph nodes opacification, of which mechanism may be explained partially by human body defence mechanism.
We did not make direct comparison between radiographic and histologic findings of the same nodes in many cases. However, we obtained high accuracy of lymphographic interpretation with operated bladder tumor.
We observed only minor complications; allergic dermatitis in the area of dye injection and mild degree of fever in the day of examination. None of severe complications, such as respiratory distress, neurological complication or cardiovascular disturbance was experienced. Pedal lymphography can be performed easily in any clinical center without much equipment and with minimal technical training. It can provide a valuable information to radiotherapist and oncologist.