Current status of lymphography in patients with cancer

In the early 1960's lymphography was received enthusiastically. Expectations were high that a very accurate diagnostic method for the detection of metastases had been found. This enthusiasm subsided after it became apparent that small lesions could not be discerned and that the images demonstrated were frequently nonspecific. Better correlation was achieved with advanced stages of cancer but because the presence of metastases was usually already known, it was questionable if the lymphogram contributed much to the management of the patient. In recent years, after the examination was placed in its proper prospective, the value and status of lymphography in patients with cancer were reassessed. The radiographic findings were divided into direct, or actual demonstration of metastastases, and indirect changes--those changes resulting from replacement of lymph nodes or blockage of the vessels by metastases. Lymphography proved particularly valuable in the diagnosis and staging of patients with pelvic cancer arising from such organs as cervix, uterus, vulva, ovary, and from tumors arising from the prostate, testicles, and penis. It also proved valuable in the assessment of extension of disease in melanomas of the extremities. The value of the positive lymphogram is easy to assess. However, when one encounters a "normal" lymphogram, one must realize that this does not exclude the presence of metastatic disease; it merely demonstrates that the the time of the study no lesions were recognized in visualized lymph nodes. Therefore, the negative lymphogram should not result in any modification of treatment which would have been prescribed under the same clinical circumstances if one did not have the lymphogram at hand.