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Lymphangiography in Hodgkin's Disease: Indications and Contraindications¹

Memorial Hospital for Cancer and Allied Diseases, New York, New York

Lymphangiography is an invaluable tool for the detection of retroperitoneal lymphoma, and helps determine prognosis, since prognosis varies with clinical extent of disease.

Patients with Stage I and IIA Hodgkin's disease should have a lymphangiogram in order to definitely determine whether disease exists below the diaphragm in the retroperitoneal space. If disease is found, current evidence indicates that it should be treated with radiation therapy. Lymphangiography is usually not indicated in patients with Stages IIB and III disease. Retroperitoneal disease almost invariably exists and the procedure should only be done for specific indications. The contraindications of this procedure should be kept in mind and carefully scrutinized in every patient who undergoes the procedure. The error in interpretation of lymphangiogram films is at least 10%, and may well be higher, especially in inexperienced hands. Errors are almost invariably falsely negative readings, not false positives.

The value of uncovering occult asymptomatic retroperitoneal Hodgkin's disease is still unknown. One would have to assume that, with our current therapeutic tools, the therapy of all apparent foci of disease is of value in patients with generalized Hodgkin's disease. We do not know that this is so. Although the lymphangiogram has given us a great deal of information about extent and patterns of disease in lymphoma, and has helped us with supportive management in symptomatic patients, we still do not know whether the therapy of asymptomatic nodes demonstrable on a lymphangiogram is of benefit to the patient.

¹ This program is supported in part by Research Grants CA-03215 and CA-05826 from the National Cancer Institute, USPHS, Bethesda, Maryland.