Percutaneous Transperitoneal Fluoroscopy-Guided Fine-Needle Biopsy of Lymph Nodes

Abstract

After lymphography from the foot, with uncertain findings, fine-needle biopsy during fluoroscopy was performed in 107 patients. In 69 patients with possible metastases, involvement was demonstrated in 46, confirmed in 43 at operation. Lymph node involvement by general lymphatic disease was suggested in 38 patients, with biopsy confirmation in 12. In metastatic disease non-representative material was obtained in only 2 patients, in general lymphatic disease in 10. No significant complications occurred, and the side effects were small.

Accuracy of Transcutaneous Aspiration Biopsy in the Definitive Assessment of Nodal Involvement in Prostatic Carcinoma

“…Routine clinical, laboratory and pathological studies and lymphangiography have been shown to be of limited value in predicting the presence or absence of positive lymph nodes. Transcutaneous fluoroscopy-guided fine needle aspiration biopsy of pelvic lymph nodes is an innocuous and highly reliable technique for determining nodal metastasis in patients with prostatic cancer and it enhances Accepted for publication 18 August 1982. and extends the usefulness of lymphangiography (Wallace et al, 1977;Gothlin, 1979;Macintosh et al, 1979;Prando et al, 1979;Correa et al, 1981).…”

The Value and Role of Percutaneous Pelvic Lymph Node Aspiration Biopsy in Definitive Staging of Prostatic and Bladder Carcinoma

“…Pelvic lymphadenectomy has replaced bipedal lymph angiography as the definitive means of diagnosing lymph node metastasis of prostatic cancer. The removal of pel vic nodes has a morbidity in 20-30% of the patients and the mortality rate may be 1 % [2,8,9,14], In the manage ment of bladder cancer, pelvic lymphadenectomy is not a current staging procedure and it has recently been sug gested that the operation does not increase the morbidity associated with cystectomy, and that it has a therapeutic effect in the control of local and regional disease [6,26,27], In patients with prostatic carcinoma the percuta neous fine-needle aspiration biopsy has been proposed as a noninvasive, innocuous, diagnostic method, alternative to surgical staging [4,5,7,12,13,17,18,24,28,[30][31][32], On the other hand we were unable to find any specific reference to the value and accuracy of biopsy aspiration in the management of bladder carcinoma. In the present series of 26 patients with prostatic carcinoma, the high overall accuracy [96.15%) and specificity (100%) of fineneedle biopsy aspiration demonstrate the reported value of this procedure as definite diagnostic means in deter mining tumor stage.…”

“…The right external iliac chain was aspirated in 23 patients, the left external iliac chain in 22 patients, the right common iliac chain in 7 patients, the left common iliac chain in 2 patients, the right internal iliac chain in 6 patients, the left internal iliac chain in 7 patients, the right obturator group in 14 patients and the left obturator group in 7 patients. The aspiration procedure has been previously described [12,31,32], According to our previous report, a modified needle was developed in order to obtain a larger quantity of cytological material [17], A maximum of three aspirations per node provided sufficient material for cytologic evaluation in all cases. The correct needle pla cements in the depth of the node were always confirmed when the motion of the needle produced notable synchronous movements of the entire nodal chain ( fig.…”

“…In the reported series of pelvic node aspiration biopsies in patients with urological neoplasms [4,5,7,12,21,24,30], a control pelvic lymphadenectomy was rarely performed. It is evident that the effectiveness of aspiration biopsy should be assessed by histologic control [17].…”

“…The per cutaneous fluoroscopy-guided aspiration biopsy of pelvic nodes has been proposed as a noninvasive, alternative procedure to surgical staging in determining or excluding the nodal involvement of prostatic carcinoma [4,5,7,12,13,17,18,21,24,[29][30][31], In patients with prostatic carci noma a positive cytology from the aspirate is always consid ered diagnostic of stage D disease [5,7,30]. The negative cytologic findings do not completely exclude the nodal extension of the tumor, since not all nodes are opacified by the lymphangiography and therefore cannot be aspirated [5,7,30].…”