Are lymphangiograms necessary before placing patients with nonseminomatous testicular tumors on surveillance?

Lymphangiographic findings in 174 patients with early stage nonseminomatous testicular tumors were evaluated retrospectively to determine the need to perform the procedure before patients are placed on surveillance. When physical examination, chest x-ray, computerized tomographic scans and serum tumor marker levels were normal, lymphangiography detected unsuspected metastasis in only 4 per cent of the patients, while providing misinformation in another 4 per cent. Plain radiographs of 99 patients on surveillance taken at 2-month intervals resulted in only 1 instance when the x-rays became positive and were the first evidence of metastasis. These findings indicate that routine lymphangiography is not necessary to assess the retroperitoneum when computerized tomography and the serum tumor markers are unequivocally normal.