RETROPERITONEAL LYMPH-NODE STAGING OF TESTICULAR-TUMORS

A prospective multicentre study was carried out to determine the effic iency of various diagnostic methods in the assessment of the retroperi toneal space. The diagnostic findings were confirmed histologically af ter retroperitoneal lymph node dissection (RLND). The sensitivity was 71% for bipedal lymphography, 41% for computed tomography (CT), 31% fo r abdominal ultrasound and 37% for alpha-fetoprotein/human chorionic g onadotrophin (AFP/HCG). Specificity was 60, 94,87 and 93% respectively . When all diagnostic methods were combined, sensitivity was 88% and s pecificity 48%. The value of all methods depends on the metastatic enl argement of the lymph nodes. The predictive value of a negative diagno sis was 73% for lymphography, 67% for CT, 6 1% for ultrasound and 65% for AFP/HCG; the predictive value of a positive diagnosis was 58, 85, 69 and 81% respectively. Despite these results, lymphography is indica ted only when a surveillance strategy is planned, since it detected 58 % of the lymph node metastases that were overlooked by CT and tumour m arkers. Despite this, 17% of patients with clinical stage I tumours ha d metastases. False positive rates are detrimental to primary chemothe rapy: between 24% (at least 2 methods positive) and 46% (1 or more met hods positive) of patients with clinical stage II A/B tumours had a pa thological stage I and for these patients primary chemotherapy meant o vertreatment.