Pathways of lymphatic spread in male urogenital pelvic malignancies.
Regional lymph node involvement in urogenital malignancies (category N in the TNM classification system) is a significant radiologic finding, with important implications for treatment and prognosis. Male urogenital pelvic cancers commonly spread to iliopelvic or retroperitoneal lymph nodes by following pathways of normal lymphatic drainage from the pelvic organs. The most likely pathway of nodal spread (superficial inguinal, pelvic, or paraaortic) depends on the tumor location in the prostate, penis, testis, or bladder and whether surgery or other therapy has disrupted normal lymphatic drainage from the tumor site; knowledge of both factors is needed for accurate disease staging. At present, lymph node status is most often assessed with standard anatomic imaging techniques such as multidetector computed tomography or magnetic resonance (MR) imaging. However, the detection of nodal disease with these techniques is reliant on lymph node size and morphologic characteristics, criteria that provide limited diagnostic specificity. Functional imaging techniques, such as diffusion-weighted MR imaging performed with or without a lymphotropic contrast agent and positron emission tomography, may allow a more accurate nodal assessment based on molecular or physiologic activity.
Center for Diagnostic Imaging, Hospital Clínic de Barcelona, Villarroel 170, 08036 Barcelona, Spain. blancapbrufau@hotmail.com
Blanca
B
Paño
Carmen
C
Sebastià
Laura
L
Buñesch
Judit
J
Mestres
Rafael
R
Salvador
Napoleón G
NG
Macías
Carlos
C
Nicolau
D006119:Groin; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging; D008297:Male; D010388:Pelvis; D014057:Tomography, X-Ray Computed; D014565:Urogenital Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*