Pelvic lymph node metastases in cervical cancer: comparison of lymphography, inspection, radiography, and histologic examination of lymph nodes.

Lymphangiography is commonly performed in the pretreatment evaluation of patients with cervical carcinoma, but its value is controversial. The purpose of this report is to determine the reliability of lymphography in the indication of metastatic pelvic lymph nodes by comparing data from preoperative lymphangiography, inspection of lymph nodes during laparotomy, radiography of surgically removed lymph nodes, and postoperative histologic report. Twenty-one patients (mean age 51.1 years, SD 14.5) with cervical cancer FIGO stages I b to II b were enrolled in this study. They all underwent Wertheim's radical hysterectomy with pelvic lymphadenectomy. With reference to histologic report this series included 8 squamous carcinomas (38%), 10 adenocarcinomas (48%) and 3 sarcomas (14%). Seven patients (33%) had a positive preoperative lymphangiography, in 9 patients (43%) lymph nodes were considered positive at the inspection during laparotomy, postoperative radiography of the lymph nodes was considered probably positive in 7 patients (33%) and positive in 2 patients (10%), histologic report was positive for lymphonodal metastases in 4 patients (19%). A total of 335 lymph nodes were studied, and with reference to the evaluated methods (lymphangiography, inspection, radiography, histology), 1 positive method was found in 40 lymph nodes (12%), 2 positive methods in 6 lymph nodes (2%), 3 or 4 positive methods in none of the lymph, nodes, and 4 negative methods in 289 lymph nodes (86%). Histologic report was positive in 4 lymph nodes (1%). Lymphangiography in the pretreatment evaluation in cases of cervical carcinoma is not reliable in indicating possible metastatic lymph nodes. It remains a useful exam fixation to be routinely performed.