The role of lymphangiography in vulvar carcinoma

BACKGROUND The aim of this multicenter study was to investigate the feasibility and negative predictive value of sentinel lymph node detection with blue dye in vulvar carcinoma patients. METHODS In patients with squamous cell carcinoma of the vulva without suspicious groin lymph nodes, patent blue V was injected intradermally shortly before surgery. Routine groin lymph node dissection and radical vulvectomy were performed. During the surgery, blue lymph vessels and lymph nodes were identified, and the blue lymph nodes were sent separately for histologic examination. The negative predictive value of the blue lymph nodes for the absence of metastases was assessed by histologic examination of the groin lymph node specimens. RESULTS Fifty‐one patients in whom 93 groin lymph node dissections were performed were entered. One or more blue lymph nodes were detected in only 52 groins (56%). Nine (17%) of these were tumor positive, and 6 blue lymph nodes were the only tumor positive lymph nodes in the specimen in which they were found. There were two false‐negative blue lymph nodes. The negative predictive value was 0.953. CONCLUSIONS It was shown in this multicenter study that sentinel lymph node detection in vulvar carcinoma patients with blue dye only is not feasible because its negative predictive value is too low. Further studies involving the use of a combination of radioactive labeled technetium and blue dye are warranted. Cancer 1999;86:652–6. © 1999 American Cancer Society.

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“…No satisfactory method to achieve this has been identified. Neither palpation of the groin nor lymphography is reliable 6, 7…”

mentioning

confidence: 99%

Identification of sentinel lymph nodes in vulvar carcinoma patients with the aid of a patent blue V injection

Ansink

Sie-Go

Velden

et al. 1999

Cancer

120

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“…Lymphography was performed for lymphatic metastasis in 295 patients with endometrial carcinoma and the results revealed that lymphography was positive in 8.9% of patients at Stage I, 28.6% at Stage II, 57.1% at Stage III, and 66.6% at Stage IV, with the coincidence rate with pathology reaching 86.3% [3]. In 1986, a retrospective study on 32 patients with urogenital tumors showed that the accuracy rate of LG was the highest, with a specificity of 83% in judging pelvic lymphatic metastasis [4]. Lang compared preoperative LG and retroperitoneal lymph node dissection in 30 cases of ovarian cancer, and found that the correlation between lymphography and histological examinations was 83.3% [2].…”

Section: Clinical Significancementioning

confidence: 94%

Application progress of lymphography in oncology

Liu

Yin

2009

Front. Med. China

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Lymphography is often used for the diagnosis of lymphatic metastasis in oncology. Determination of lymphatic metastasis is extremely important for accurate cancer staging, which may directly guide the clinical therapeutic scheme. In recent years, the technology of lymphography has developed rapidly on the basis of traditional lymphography, with the appearance of computed tomography (CT) lymphography, nuclear magnetic resonance (MR) lymphography, contrast-enhanced lymphosonography, and so on; the diagnostic accuracy has also been improved. The imaging principles and methods of these various technologies of lymphography are reviewed in this paper, and their applications and significance in oncology are also discussed in detail.

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“…In 1985, Von Eschenbach et al concluded that gross lymph node metastases could be detected with a high degree of accuracy in selected genitourinary tumors using direct lymphangiography (20). A retrospective study in 1986 evaluated 32 patients diagnosed with genitourinary cancers (21). Accuracy rates were highest for pelvic nodes, 16 out of 21 being correctly diagnosed with a specificity of 83%, but overall it was concluded that a negative scan was more likely to be predictive of node status than a positive scan.…”

Section: Intra-lymphatic Imagingmentioning

confidence: 99%

Imaging of the lymphatic system: new horizons

Barrett

Choyke

Kobayashi

2006

Contrast Media Mol Imaging

133

125

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The lymphatic system is a complex network of lymph vessels, lymphatic organs and lymph nodes. Traditionally, imaging of the lymphatic system has been based on conventional imaging methods like computed tomography (CT) and magnetic resonance imaging (MRI), whereby enlargement of lymph nodes is considered the primary diagnostic criterion for disease. This is particularly true in oncology, where nodal enlargement can be indicative of nodal metastases or lymphoma. CT and MRI on their own are, however, anatomical imaging methods. Newer imaging methods such as positron emission tomography (PET), dynamic contrast-enhanced MRI (DCE-MRI) and color Doppler ultrasound (CDUS) provide a functional assessment of node status. None of these techniques is capable of detecting flow within the lymphatics and, thus, several intra-lymphatic imaging methods have been developed. Direct lymphangiography is an all-but-extinct method of visualizing the lymphatic drainage from an extremity using oil-based iodine contrast agents. More recently, interstitially injected intra-lymphatic imaging, such as lymphoscintigraphy, has been used for lymphedema assessment and sentinel node detection. Nevertheless, radionuclide-based imaging has the disadvantage of poor resolution. This has lead to the development of novel systemic and interstitial imaging techniques which are minimally invasive and have the potential to provide both structural and functional information; this is a particular advantage for cancer imaging, where anatomical depiction alone often provides insufficient information. At present the respective role each modality plays remains to be determined. Indeed, multi-modal imaging may be more appropriate for certain lymphatic disorders. The field of lymphatic imaging is ever evolving, and technological advances, combined with the development of new contrast agents, continue to improve diagnostic accuracy.

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The role of lymphangiography in vulvar carcinoma

Cited by 8 publications

References 3 publications

Identification of sentinel lymph nodes in vulvar carcinoma patients with the aid of a patent blue V injection

Identification of sentinel lymph nodes in vulvar carcinoma patients with the aid of a patent blue V injection

Application progress of lymphography in oncology

Imaging of the lymphatic system: new horizons

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