Lymphography: an old technique retains its usefulness.

Conventional lymphography has long been the method of choice for imaging the lymphatic system. However, the number of lymphographic studies performed in oncology centers has declined markedly since the introduction of cross-sectional imaging techniques, especially computed tomography (CT). Therefore, levels of expertise in both performing lymphography and interpreting lymphograms are falling. The unique ability of lymphography to demonstrate derangements of the internal architecture of normal-sized lymph nodes can be valuable and makes it more accurate than CT in evaluation of some lymphomas (especially Hodgkin disease) and genitourinary malignancies. In fact, lymphography and CT are complementary rather than mutually exclusive techniques for the staging of some lymphomas and genitourinary malignancies. In addition, lymphography opacifies the lymphatic channels and therefore may be a valuable tool for detection of lymphatic fistulas or lymphatic leakage. Finally, lymphography helps guide subsequent therapy in patients with lymphomas, genitourinary malignancies, or disorders of lymphatic flow.