Skip to main content
SpringerLink
Log in

Bildgebende Diagnostik von Lymphknoten bei Verdacht auf Tumorbefall

Radiologic evaluation of lymph nodes in cancer patients

  • Leitthema
  • Published:
Die Chirurgie Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Bei soliden Tumoren ist die Detektion lokoregionärer Lymphknoten(LK)-Filiae für die Prognose aber v. a. auch für die Wahl der richtigen Therapie von entscheidender Bedeutung. Dafür stehen verschiedene nichtinvasive Bildgebungsverfahren oder – klassischerweise – die LK-Dissektion zur Verfügung.

Ziel der Arbeit/Fragestellung

Die vorliegende Arbeit stellt allgemeine Prinzipien der nichtinvasiven Lymphknotendiagnostik dar und diskutiert den Stellenwert der klinisch verfügbaren Bildgebungsmodalitäten (Ultraschall [US], Computertomographie [CT], Magnetresonanztomographie [MRT], Positronenemissionstomographie [PET]). Zudem werden technische Weiterentwicklungen der einzelnen Modalitäten aufgezeigt.

Material und Methoden

Literaturrecherche und Zusammenfassung der klinischen und wissenschaftlichen Erfahrung der Autoren.

Ergebnisse

Die verfügbaren Bildgebungsverfahren werden unterteilt in (1) morphologische (US, CT, MRT) und (2) funktionelle Modalitäten (PET, spezielle MRT). Erstere erfassen strukturelle LK-Parameter wie Größe und Form, letztere Eigenschaften, die über die Morphologie hinausgehen (z. B. den Glukosestoffwechsel). Die für zukünftige Therapiealgorithmen erforderliche hohe diagnostische Genauigkeit wird eine Kombination beider Aspekte erforderlich machen.

Diskussion/Schlussfolgerung

Derzeit weist keine der verfügbaren Modalitäten ausreichende Genauigkeit auf, um in allen onkologischen Szenarien die LK-Dissektion zu ersetzen. Eine der großen Herausforderungen an die interdisziplinäre onkologische Forschung ist es, das optimale Zusammenspiel von Bildgebung und LK-Dissektion für die verschiedenen Malignome und Tumorstadien zu definieren.

Abstract

Background

In solid tumors, the detection of locoregional lymph node metastases is of decisive importance not only for the prognosis but also for selecting the correct treatment. Various noninvasive imaging methods or, classically, lymph node dissection are available for this purpose.

Objective

This article presents the general principles of noninvasive lymph node diagnostics and discusses the value of the clinically available imaging modalities, ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET). In addition, recent new technical developments of each modality are highlighted.

Material and methods

Literature search and summary of the clinical and scientific experience of the authors.

Results

The available imaging procedures are divided into (1) morphological (US, CT, MRI) and (2) functional modalities (PET, special MRI). The former capture structural lymph node parameters, such as size and shape, while the latter address properties that go beyond morphology (e.g. glucose metabolism). The high diagnostic accuracy required for future treatment algorithms will require a combination of both aspects.

Discussion/conclusion

Currently, none of the available modalities have sufficient accuracy to replace lymph node dissection in all oncological scenarios. One of the major challenges for interdisciplinary oncological research is to define the optimal interaction between imaging and lymph node dissection for different malignancies and tumor stages.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5

Literatur

  1. von Below C, Daouacher G, Wassberg C et al (2016) Validation of 3 T MRI including diffusion-weighted imaging for nodal staging of newly diagnosed intermediate- and high-risk prostate cancer. Clin Radiol 71:328–334. https://doi.org/10.1016/j.crad.2015.12.001

    Article  Google Scholar 

  2. Buerke B, Puesken M, Müter S et al (2010) Measurement accuracy and reproducibility of semiautomated metric and volumetric lymph node analysis in MDCT. AJR Am J Roentgenol 195:979–985. https://doi.org/10.2214/AJR.10.4010

    Article  Google Scholar 

  3. Choi JS, Kim J, Kwak JY et al (2009) Preoperative staging of papillary thyroid carcinoma: comparison of ultrasound imaging and CT. AJR Am J Roentgenol 193:871–878. https://doi.org/10.2214/AJR.09.2386

    Article  Google Scholar 

  4. Cui X‑W, Jenssen C, Saftoiu A et al (2013) New ultrasound techniques for lymph node evaluation. World J Gastroenterol 19:4850–4860. https://doi.org/10.3748/wjg.v19.i30.4850

    Article  Google Scholar 

  5. Gong Y, Wang Q, Dong L et al (2017) Different imaging techniques for the detection of pelvic lymph nodes metastasis from gynecological malignancies: a systematic review and meta-analysis. Oncotarget 8:14107–14125. https://doi.org/10.18632/oncotarget.12959

    Article  Google Scholar 

  6. Gould MK, Kuschner WG, Rydzak CE et al (2003) Test performance of positron emission tomography and computed tomography for mediastinal staging in patients with non-small-cell lung cancer: a meta-analysis. Ann Intern Med 139:879. https://doi.org/10.7326/0003-4819-139-11-200311180-00013

    Article  Google Scholar 

  7. Harisinghani MG, Barentsz J, Hahn PF et al (2003) Noninvasive detection of clinically occult lymph-node metastases in prostate cancer. N Engl J Med 348:2491–2499. https://doi.org/10.1056/NEJMoa022749

    Article  Google Scholar 

  8. Hofman MS, Lawrentschuk N, Francis RJ et al (2020) Prostate-specific membrane antigen PET-CT in patients with high-risk prostate cancer before curative-intent surgery or radiotherapy (proPSMA): a prospective, randomised, multicentre study. Lancet 395:1208–1216. https://doi.org/10.1016/S0140-6736(20)30314-7

    Article  CAS  Google Scholar 

  9. Houssami N, Ciatto S, Turner RM et al (2011) Preoperative ultrasound-guided needle biopsy of axillary nodes in invasive breast cancer: meta-analysis of its accuracy and utility in staging the axilla. Ann Surg 254:243–251. https://doi.org/10.1097/SLA.0b013e31821f1564

    Article  Google Scholar 

  10. Hövels AM, Heesakkers RAM, Adang EM et al (2008) The diagnostic accuracy of CT and MRI in the staging of pelvic lymph nodes in patients with prostate cancer: a meta-analysis. Clin Radiol 63:387–395. https://doi.org/10.1016/j.crad.2007.05.022

    Article  Google Scholar 

  11. Imani Moghaddam M, Davachi B, Mostaan LV et al (2011) Evaluation of the sonographic features of metastatic cervical lymph nodes in patients with head and neck malignancy. J Craniofacial Surg 22:2179–2184. https://doi.org/10.1097/SCS.0b013e3182324166

    Article  Google Scholar 

  12. Jansen BHE, Bodar YJL, Zwezerijnen GJC et al (2021) Pelvic lymph-node staging with 18F-DCFPyL PET/CT prior to extended pelvic lymph-node dissection in primary prostate cancer—the SALT trial. Eur J Nucl Med Mol Imaging 48:509–520. https://doi.org/10.1007/s00259-020-04974-w

    Article  CAS  Google Scholar 

  13. van Kalmthout LWM, van Melick HHE, Lavalaye J et al (2020) Prospective validation of gallium-68 prostate specific membrane antigen-positron emission tomography/computerized tomography for primary staging of prostate cancer. J Urol 203:537–545. https://doi.org/10.1097/JU.0000000000000531

    Article  Google Scholar 

  14. Kim EJ, Kim SH, Kang BJ et al (2014) Diagnostic value of breast MRI for predicting metastatic axillary lymph nodes in breast cancer patients: diffusion-weighted MRI and conventional MRI. Magn Reson Imaging 32:1230–1236. https://doi.org/10.1016/j.mri.2014.07.001

    Article  Google Scholar 

  15. Klingenberg S, Jochumsen MR, Ulhøi BP et al (2021) 68Ga-PSMA PET/CT for primary lymph node and distant metastasis NM staging of high-risk prostate cancer. J Nucl Med 62:214–220. https://doi.org/10.2967/jnumed.120.245605

    Article  CAS  Google Scholar 

  16. Lee M‑C, Tsai H‑Y, Chuang K‑S et al (2013) Prediction of nodal metastasis in head and neck cancer using a 3T MRI ADC map. AJNR Am J Neuroradiol 34:864–869. https://doi.org/10.3174/ajnr.A3281

    Article  Google Scholar 

  17. Mao Y, Hedgire S, Harisinghani M (2014) Radiologic assessment of lymph nodes in oncologic patients. Curr Radiol Rep 2:36. https://doi.org/10.1007/s40134-013-0036-6

    Article  Google Scholar 

  18. Mei M, Ye L, Quan J, Huang P (2018) Contrast-enhanced ultrasound for the differential diagnosis between benign and metastatic superficial lymph nodes: a meta-analysis. CMAR 10:4987–4997. https://doi.org/10.2147/CMAR.S174751

    Article  CAS  Google Scholar 

  19. Niu Z, Xiao M, Ma L et al (2022) The value of contrast-enhanced ultrasound enhancement patterns for the diagnosis of sentinel lymph node status in breast cancer: systematic review and meta-analysis. Quant Imaging Med Surg 12:936–948. https://doi.org/10.21037/qims-21-416

    Article  Google Scholar 

  20. Perera M, Papa N, Roberts M et al (2020) Gallium-68 prostate-specific membrane antigen positron emission tomography in advanced prostate cancer—Updated diagnostic utility, sensitivity, specificity, and distribution of prostate-specific membrane antigen-avid lesions: a systematic review and meta-analysis. Eur Urol 77:403–417. https://doi.org/10.1016/j.eururo.2019.01.049

    Article  Google Scholar 

  21. Saito T, Kurokawa Y, Takiguchi S et al (2015) Accuracy of multidetector-row CT in diagnosing lymph node metastasis in patients with gastric cancer. Eur Radiol 25:368–374. https://doi.org/10.1007/s00330-014-3373-9

    Article  Google Scholar 

  22. Saokar A, Islam T, Jantsch M et al (2010) Detection of lymph nodes in pelvic malignancies with computed tomography and magnetic resonance imaging. Clin Imaging 34:361–366. https://doi.org/10.1016/j.clinimag.2009.07.004

    Article  Google Scholar 

  23. Schicho A, Habicher W, Wendl C et al (2022) Clinical value of diffusion-weighted whole-body imaging with background body signal suppression (DWIBS) for staging of patients with suspected head and neck cancer. Tomography 8:2522–2532. https://doi.org/10.3390/tomography8050210

    Article  Google Scholar 

  24. Stabile A, Pellegrino A, Mazzone E et al (2022) Can negative prostate-specific membrane antigen positron emission tomography/computed tomography avoid the need for pelvic lymph node dissection in newly diagnosed prostate cancer patients? A systematic review and meta-analysis with backup histology as reference standard. Eur Urol Oncol 5:1–17. https://doi.org/10.1016/j.euo.2021.08.001

    Article  Google Scholar 

  25. Stijns RCH, Philips BWJ, Nagtegaal ID et al (2021) USPIO-enhanced MRI of lymph nodes in rectal cancer: A node-to-node comparison with histopathology. Eur J Radiol 138:109636. https://doi.org/10.1016/j.ejrad.2021.109636

    Article  Google Scholar 

  26. Wu L, Cao Y, Liao C et al (2011) Diagnostic performance of USPIO-enhanced MRI for lymph-node metastases in different body regions: A meta-analysis. Eur J Radiol 80:582–589. https://doi.org/10.1016/j.ejrad.2009.11.027

    Article  Google Scholar 

  27. Wu L‑M, Xu J‑R, Liu M‑J et al (2012) Value of magnetic resonance imaging for nodal staging in patients with head and neck squamous cell carcinoma: a meta-analysis. Acad Radiol 19:331–340. https://doi.org/10.1016/j.acra.2011.10.027

    Article  Google Scholar 

  28. Zhang L, Tian C, Wang P et al (2015) Comparative study of image quality between axial T2-weighted BLADE and turbo spin-echo MRI of the upper abdomen on 3.0 T. Jpn J Radiol 33:585–590. https://doi.org/10.1007/s11604-015-0463-9

    Article  CAS  Google Scholar 

  29. Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF) (2019) S3-Leitlinie Diagnostik und Therapie des Mundhöhlenkarzinoms, Langversion 3.01

    Google Scholar 

  30. Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF) (2022) Diagnostik und Therapie der Plattenepithelkarzinome und Adenokarzinome des Ösophagus; Langversion 3.1

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland

    Mark Härting, David Kaufmann, Timm Kleffel, Bertram Jehs, Thomas J. Kröncke & Florian Schwarz

  2. Klinik für Nuklearmedizin, Universitätsklinikum Augsburg, Augsburg, Deutschland

    Adriana Amerein

  3. Medizinische Fakultät, Ludwig-Maximilians-Universität München, München, Deutschland

    Florian Schwarz

Authors
  1. Mark Härting
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Adriana Amerein
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. David Kaufmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Timm Kleffel
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Bertram Jehs
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Thomas J. Kröncke
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Florian Schwarz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mark Härting.

Ethics declarations

Interessenkonflikt

M. Härting, A. Amerein, D. Kaufmann, T. Kleffel, B. Jehs, T.J. Kröncke und F. Schwarz geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Additional information

Redaktion

M. Anthuber, Augsburg

figure qr

QR-Code scannen & Beitrag online lesen

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Härting, M., Amerein, A., Kaufmann, D. et al. Bildgebende Diagnostik von Lymphknoten bei Verdacht auf Tumorbefall. Chirurgie 94, 105–113 (2023). https://doi.org/10.1007/s00104-022-01802-9

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00104-022-01802-9

Schlüsselwörter

Keywords

Search

Navigation