[Value of lymphography in the preoperative diagnosis of gynecologic cancers]

In advanced tumors, the imaging techniques such as ultrasound, computer tomography or magnetic resonance imaging are at the forefront. In order to plan surgical procedure, lymphography is indicated as a supplementary diagnostic measure mainly in tumors of the corpus and the cervix uteri, especially in the early and middle stages. In tumors of the ovary, the vagina and the vulva, diagnostic assistance in deciding on therapy is to be expected only in occasional cases. The indication for lymphography should not only be established in relation to the tumor stage, but also tumor grading, since a very much higher local regional metastatic spreading is to be reckoned with in increasing grading, so that the choice of therapeutic procedure is crucially affected. In using preoperative diagnostic measures, the postoperative morphological follow-up should be considered: Examinability of the removed lymph nodes, especially in preoperative suspicion of metastases. Behavior of the lymph nodes in the post-therapeutic phase with consideration of recurrence diagnostics. Planning of radiotherapeutic target volume considering collateral circulations and atypical lymphatics.