The role of lymphangiography in vulvar carcinoma

The records of all patients with vulvar carcinoma seen at Washington University School of Medicine between 1970 and 1983 were reviewed to determine the role of lymphangiography in the management of patients with vulvar malignancy. Forty-three patients were identified who had a preoperative lymphangiogram followed by radical vulvectomy and lymph node dissection. Thirty-two films were available for review. Seventy-seven sets of lymph nodes were obtained from the 32 patients. Overall diagnostic accuracy was 42 of 77 (54.5%), with a sensitivity of three of 19 (15.7%) and a specificity of 39 of 59 (66.1%). Corresponding values for inguinal nodes were 26 of 57 (45.6%), two of 16 (12.5%), and 24 of 41 (58.5%), respectively. Accuracy rates for pelvic nodes were 16 of 21 (76.2%) with a sensitivity rate of one of three (33%) and a specificity of 15 of 18 (83%). Negative scans were more likely to be accurate than positive scans, 88.6% versus 30%. While a negative lymphangiogram may be helpful in predicting the absence of metastases, its poor specificity limits its widespread usefulness.