Prognostic Value of Lymphography in Cervical Cancer

Abstract

This work is based on a review of 341 lymphographies carried out as a part of the initial diagnostic work-up performed on the same number of patients referred to our Institute for treatment from January 1961 to December 1976. As regards the distribution by clinical stage of the cases under consideration, there were 152 cases in Stage I (44.6%), 100 in Stage II (29.3%) and 89 in Stages III plus IV (26.1%). The positive lymphography incidence at the 2 extremes (Stage I a and Stages III plus IV) was 3.5 % and 46.0 %, respectively. The histologic type on its own did not seem to influence the incidence of lymph node metastases detectable by lymphography. For the negative cases, with all the stages mixed together, a 68.8 % 5-year survival rate free of disease was recorded, as compared with the 32.0 % found for the positive cases (P < 0.0001). A similar difference was recorded stage by stage. Our observations support the opinion that lymphography is valid in clinical practice to distinguish the minimum or nil lymph node invasion cases (negative) with favorable prognosis, from the cases having lymph node invasion of a certain importance or even at a maximum (positive), with a poor fate, independently of the initial clinical stage. Furthermore they suggest the advisability of reviewing the basic concepts of the clinical classification in cervical cancer, to be cautious in considering clinical reviews that do not report information of this importance, and to put under discussion different therapeutic approaches for cases presenting a lymphographic abnormality.