Diagnostic and Prognostic Value of Lymphography in Patients with Cancer of the Endometrium

Abstract

The results of foot lymphography in 161 patients with endometrial carcinoma, observed from 1968 to 1977 at the Istituto Nazionale Tumori of Milan are reported. Ninety-three were new cases, 40 were recurrences, and 28 were patients who underwent restaging diagnostic procedures without clinical evidence of disease. The majority of the cases were adenocarcinomas (146/161, or 91%), 10 were mixed adenosquamous carcinomas (6%) and 5 (3%) were adenoacanthomas. The overall incidence of pathologic lymphograms was 30% (46/161 patients). The incidence of the lymphatic spread was related to the clinical stage and to the extent of recurrent disease. In fact, in the 93 new cases, lymphography was positive in 11% of patients at stage I, 39% at stage II, 57% at stage III and 67% at stage IV disease. In the 40 pretreated patients, lymph node involvement was 33% in vaginal recurrences, 52% in pelvic abdominal recurrences and 73% in widespread diffusion. Finally, in 28 pretreated patients with no evidence of disease, the incidence of lymph node involvement was 7%. Metastases were found only in the pelvic nodes in 59% of the patients and only in the para-aortic nodes in 10%; in 31%, both chains were simultaneously involved; bilateral involvement was found in 45% of the patients with radiologically proven metastases. The 5-yr survival rate for patients at stage I-II and III disease with positive lymphography was 47.6% as compared with 83.5% for negative cases. In patients at stage I and II, the difference of survival was equal to 23.4%. The reliability of the results is confirmed by the concordance with the data of the literature on histologic involvement, by the first radiologic-anatomic comparison, and by the clinical course of the positive cases. Lymphography is of unquestionable value for an appropriate staging and for a correct treatment. The prognostic significance of the procedure is evident and such as to justify a major therapeutic aggressiveness in positive cases.