泌尿生殖器系悪性腫瘍に対するリンパ系造影の再検討

Abstract

Lymph node dissection was applied to 25 cases of malignant neoplasm of urogenital Organs and 517 lymph nodes dissected were studied in comparison with pre-operative lymphangiogram and the results were statistically analysed. From the results obtained, the clinical value of lymphangiography was reevaluated. 1. According to the predetermined diagnostic standard, the specimen was lymphangiographically examined. (a) Out of various abnormalities in lymph nodes, the lymph node enlargement was seen in more than 96% of all, and enlargement alone was most in number in the various types of abnormal changes of lymph nodes. (b) The case indicating metastasis in the lymph node having no enlargement was only one out of 517. Whereas, no metastasis was observed histologically in the lymph node indicating no abnormal findings other than enlargement. In other words, enlargement of lymph node is a fairly important indispensable condition indicating the existence of metastasis, but it is not the sufficient condition. (c) Lymph nodes judged to be abnormal but indicating no metastasis histologically (false positive) counted 122 or 23.6%. Whereas the case which was judged to be normal but indicated metastasis (false negative) was only one or 0.2%. (d) As to the cases which were judged to have abnormality at lymphatic channels, 60% of the lymph nodes of such cases indicated metastasis. In order to increase the diagnostic value of lymphangiography, it is therefore extremely important to take into account not only the findings of lymph node but also the findings of lymphangiogram. 2. Filling defects of lymph node was observed in 75% of the cases of metastasis while it was 2.2% in the nonmetastasis group. Foamy appearance of the nodes was seen in 16.7% of the metastasis group and 4.4% of the non-metastasis group. Practically no correlation was observed between filling defects and foamy appearance of the nodes. 3. Based on the above findings, a new diagnostic standard of malignant neoplasm viewed from lymphangiogram was proposed. 4. Foot lymphangiography alone has limitations in the angiographic range for lymphangiography of malignant neoplasm of urogenital organs. In some cases, it is necessary to apply specific lymphangiography in combination with foot lymphangiography.