Comparative Study of Lymphography and Aspiration Cytology in the Staging of Prostatic Carcinoma

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Abstract
Accurate staging of prostatic carcinoma is essential in determining the prognosis and establishing the most adequate therapy of the disease. Lymphography is the most widely used method in staging prostatic carcinoma but shows false-positive rates varying up to 58% and false-negative rates varying from 11-66%. Aspiration biopsy was proposed to enhance the reliability of lymphography. Transcutaneuous aspiration biopsy of the pelvic nodal chains was performed in 35 patients with clinically localized prostatic carcinoma using a long-beveled side-holed modified Chiba needle. A total of 124 nodal chains were punctured and malignant cells were found in 26 aspiration biospies of 15 patients. In determining the true stage of the disease, aspiration cytology and lymphography showed accuracy of 91% vs. 57%; sensitivity of 83% vs. 67% and specificity of 100% vs. 47%, respectively. Positive cytologic findings are conclusive for stage D disease, while negative cytology may be accepted as definitive only when the neoplasm is well differentiated or the Gleason sum is 2-3-4. Combined use of lymphography and aspiration cytology permits surgical staging to be limited to those patients with indifferentiated neoplasm, intermediate or high Gleason sum (5-10) and negative cytology.