Lymphography and CEA in the diagnosis of metastases in patients with stage IB cancer of the cervix.

Fifty-nine patients with Stage IB cancer of the cervix underwent lymphography and were screened for carcinoembryonic antigen (CEA) levels before radical hysterectomy with pelvic lymph node dissection. Very strict criteria were used in the evaluation of the lymphograms in order to avoid false positive results. CEA levels were determined in plasma with a modified CEA-Roche kit, and values over 5 micrograms/liter considered as positive. Lymphography: Approximately 20% of the pelvic lymph node metastases could be detected in films taken 24 hours after the injection of the contrast medium. In patients subjected to combined treatment with intracavitary radium followed by operation, control lymphograms were taken preoperatively, 6 weeks after the radium insertions. In these films the metastases detection rate was 55%, with no false positive lymphograms. CEA: Levels over 5 micrograms/liter were found in 13 patients. Pelvic lymph node metastases were found in 10 of them, giving a metastases detection rate of 42%. One patient with lung metastases and one patient with metastases in the ovaries also has elevated levels of CEA. There was one patient with "false positive" elevation of CEA. The combination of CEA determinations and lymphography 6 weeks after the radium treatment yielded a total pelvic lymph node metastasis rate of 85%.