Equivocal lymphogram and lymph node aspiration: importance in staging carcinoma of the prostate

Lymphography is often used in staging clinically localized carcinoma of the prostate, but has been criticized for lack of specificity and sensitivity. Strict criteria for metastases eliminate some false positives but increase the number of false negatives. In 50 cases, liberal criteria were used for an equivocal interpretation, and these nodal defects as well as positive defects were biopsied percutaneously with thin-needle aspiration and cytologic evaluation. Of 37 equivocal lymphograms, 18 (49%) had a positive biopsy establishing stage D disease without pelvic lymphadenectomy. The equivocal lymphogram is a important diagnostic category when it can be further evaluated by aspiration biopsy.