Lymphatic Metastases from Pelvic Tumors: Anatomic Classification, Characterization, and Staging

Abstract

The spread of pelvic tumors to lymph nodes is an important means of tumor dissemination. Nodal metastases have important management and prognostic impact. Pelvic tumors usually metastasize first to regional lymph nodes, which are specific groups of nodes for each tumor, and are classified according to the TNM system as N-stage disease. If a pelvic tumor spreads to a lymph node outside of the defined regional nodes, this is considered M-stage disease, which usually results in upstaging of the disease to overall stage IV cancer and may potentially affect the patient's treatment options. Knowledge of the regional nodal spread of each tumor is essential in formulating effective search strategies for cross-sectional imaging studies performed for staging. Also important is correct description of the nomenclature of nodal metastases to facilitate proper staging. In this review, the patterns of regional nodal spread and N-stage classification are presented for carcinomas of the anus, bladder, cervix, endometrium, ovary, penis, prostate, rectum, testis, vagina, and vulva. Pelvic lymph node anatomy and nomenclature are reviewed with schematic illustrations and clinical examples from patients with pelvic tumors.

Ovarian involvement in endometrioid adenocarcinoma of uterus

“…The presence (yes/no) of enlarged or suspicious paraaortic and pelvic nodal disease as well as adnexal involvement by this CT imaging was recorded. Paraaortic nodes were considered enlarged if greater than 10 mm and pelvic nodes are considered enlarged if greater than 8 mm in short axis dimension by convention [10]. Record was made if additional suspicious features, round contour or obvious necrosis, if present within these nodes as well.…”

Clinical analysis of vulvar cancer

“…CT should determine the presence or absence of lymph node metastasis, to be based on the number of lymph nodes and the size of the lymph node. 11 Information found metastasis more overlap between lymph node size, but the difference was statistically significant (P = 0. 019).…”

Local behavior and lymph node metastases of Wilms' tumor: accuracy of computed tomography

“…The imaging evaluation of abdominal lymph nodes is commonly performed in cases of other diseases. Parameters such as size, shape, attenuation and presence of calcifications or necrosis are utilized (13) . Size is most commonly utilized, but such a parameter is limited because of the great variability in sizes of normal lymph nodes, superimposing on values for affected lymph nodes.…”