Lymphangiography. Its practical value in surgically staged patients with Hodgkin's disease

Since the introduction of "staging laparotomy" (to determine the disease's stage) in assessing Hodgkin's disease, some observers have argued that lymphangiography could be safely omitted in the initial diagnostic evaluation. To test these opinions a series of 75 patients with Hodgkin's disease who had a staging laparotomy and histological correlation with lymphangiograms was reviewed. Of 16 examinations with positive results, one proved to be a false positive. Of the 14 examinations with equivocal results, one proved histologically positive. In the remaining 45 lymphangiograms, five were falsely negative. In all five of these patients abdominal lymph nodes were involved, but in areas that do not routinely opacify on lower extremity lymphangiography. The overall accuracy was 90 percent.Therapeutically, the lymphangiogram permits accurate planning for treatment by radiation therapy so that all known disease is treated and yet bone marrow is not excessively irradiated. Changes in lymph node architecture after therapy provide valuable information as to regression of the disease or signs of its early recurrence.