Indirect lymphography of the breast with iotasul: a vanishing hope?

Using a new aqueous nonionic contrast medium (Iotasul, Schering) we attempted visualization of axillary lymph nodes in patients with breast carcinoma. Intradermal infusion into the areola consistently opacified the subareolar plexus and latero-cranial lymphatic trunk. Axillary nodes were visualized in 78.6% of patients, but only 5.7% of surgically excised nodes were partially or totally opacified. Eleven patients underwent axillary lymph node dissection and histology confirmed metastases in 4, of which only two were detected by lymphography. Breast lymphography is inadequate for routine clinical application, and radical axillary dissection remains the mainstay for documentation of nodal metastases.