Computed tomography in early stages of testicular carcinoma. Size of normal retroperitoneal lymph nodes and lymph nodes in patients with metastases in stage II A. A SWENOTECA study: Swedish-Norwegian Testicular Cancer Project.

From the SWENOTECA Project, the CT findings in 156 patients treated by bilateral retroperitoneal lymphadenectomy were reviewed. Of these, 112 were in stage I (no metastases) and 44 in stage II A (metastases in normal-sized lymph nodes and in nodes with a maximum diameter in the transverse plane of less than or equal to 20 mm). The normal size of lymph nodes in young Scandinavian men was found to be less than 10 mm X 8 mm above the bifurcation, except in the area below the left renal vein to the left of the aortic midline where the normal size was found to be maximally 14 mm X 10 mm. The addition of a lymphangiographic contrast medium did not change the size of the lymph nodes significantly above the bifurcation, while changes of importance were noticed in the pelvic area. Normal size without contrast medium was found to be at the most 15 mm X 10 mm and after addition of contrast medium to the nodes 28 mm X 12 mm. The results of the CT findings in the stage II A group were not impressive but changed somewhat for the better using the new limits concerning size of retroperitoneal lymph nodes. The impact of using different limits is discussed and it is concluded that metastases in normal-sized or almost normal-sized lymph nodes will continue to be a diagnostic problem, at least when using CT.