Lymph drainage from the vulva.

Fifty-four patients with cervical cancer stage Ib were injected preoperatively with 99mTc-colloid in different areas of the vulva and three controls in the axilla. The radioactivity in the groins and the pelvis was measured with a scintillation camera and in the removed pelvic lymph nodes with a well counter. A low activity could be measured in the removed pelvic nodes of the controls indicating the radioactivity which had reached the pelvic nodes via the bloodstream. Clitoris and perineum had a bilateral lymph flow. In all the other patients the vast majority of the radioactivity was found in the ipsilateral lymph nodes. A significant, but small amount of activity was recorded in the contralateral nodes in 67% of the patients and in all patients injected in the anterior part of the labium minus. The medial external iliac lymph chain had an uptake of 73% of the total activity measured in the removed pelvic nodes. Only in 13% of the patients was the activity higher in the lateral than in the medial external iliac chain. Direct lymphatic pathway from the clitoris to the pelvic lymph nodes was not found. Anastomoses exist probably in 13 out of 42 patients between the presacral and/or common iliac nodes on both sides.