Comparative study of lymphography and aspiration cytology in the staging of prostatic carcinoma. Report of 35 cases with histological control and review of the literature.

Accurate staging of prostatic carcinoma is essential in determining the prognosis and establishing the most adequate therapy of the disease. Lymphography is the most widely used method in staging prostatic carcinoma but shows false-positive rates varying up to 58% and false-negative rates varying from 11 to 66%. Aspiration biopsy was proposed to enhance the reliability of lymphography. In our study we performed transcutaneous aspiration biopsy of the pelvic nodal chains in 35 patients with clinically localized prostatic carcinoma using a long-beveled side-holed modified Chiba needle. 124 nodal chains were punctured and malignant cells were found in 26 aspiration biopsies of 15 patients. In determining the true stage of the disease, aspiration cytology and lymphography showed accuracy of 91 versus 57%; sensitivity of 83 versus 67% and specificity of 100 versus 47%, respectively. Positive cytologic findings are conclusive for stage D disease, while negative cytology may be accepted as definitive only when the neoplasm is well differentiated or the Gleason sum is 2-3-4. Combined use of lymphography and aspiration cytology permits surgical staging to be limited to those patients with undifferentiated neoplasm, intermediate or high Gleason sum (5-10) and negative cytology.