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Metastatic lymph nodes in urogenital cancers: contribution of imaging findings

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Abstract

The presence of nodal metastasis in patients with urogenital malignancies is an important factor for prognosis, and radiologic identification of enlarged nodes greatly affects treatment choices. Radiologic evaluation for nodal metastases is usually performed with computed tomography, but magnetic resonance imaging is also useful in evaluating primary and nodal metastases in pelvic tumors. On these cross-sectional modalities, nodal metastases are usually suspected according to location and size criteria. Although there has been no general consensus on the criteria, a short axis diameter of 8 to 10 mm is generally applied. However, radiologic evaluation does not always provide sufficient accuracy for nodal staging because of an inability to diagnose smaller metastatic lymph nodes. The clinical significance of a radiologic recognition of enlarged nodes also differs by cancer type in relation to differences in staging systems and treatment. The presence of regional lymphadenopathy in patients with renal cell carcinoma often alters surgical methods, whereas the presence of regional lymphadenopathy is an indication of systemic chemotherapy in patients with cancers of the urinary tract, prostate, and testicles. In this report, preferential sites and staging of nodal metastasis and contributions of radiologic imaging are reviewed for each urogenital cancer.

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References

  1. Mickisch G, Carballido J, Hellsten S, et al. Guidelines on renal cell cancer. Eur Urol 2001;40:252–255

    Article  PubMed  CAS  Google Scholar 

  2. Choyke PL, Amis ES, Bigongiari LR, et al. Renal cell carcinoma staging. American College of Radiology. ACR appropriateness criteria. Radiology 2000;215(suppl):721–725

    PubMed  Google Scholar 

  3. Oosterlinck W, Solsona E, Van der Meijden APM, et al. EAU guidelines on diagnosis and treatment of upper urinary tract transitional cell carcinoma. Eur Urol 2004;46:147–154

    Article  PubMed  CAS  Google Scholar 

  4. Oosterlinck W, Lobel B, Jaske G, et al. Guidelines on bladder cancer. Eur Urol 2002;41:105–112

    Article  PubMed  Google Scholar 

  5. Laguna MP, Pizzocaro G, Klepp O, et al. EAU guidelines on testicular cancer. Eur Urol 2001;40:102–110

    Article  PubMed  CAS  Google Scholar 

  6. Schmoll HJ, Souchon R, Krege S, et al. European consensus on diagnosis and treatment of germ cell cancer: a report of the European Germ Cell Cancer Consensus Group (EGCCCG). Ann Oncol 2004;15:1377–1399

    Article  PubMed  CAS  Google Scholar 

  7. Scherr D, Swindle PW, Scardino PT. National comprehensive cancer network guidelines for the management of prostate cancer. Urology 2003;61(suppl 2A):14–24

    Article  PubMed  Google Scholar 

  8. Harisinghani MG, Dixon WT, Saksena MA, et al. MR lymphangiography: imaging strategies to optimize the imaging of lymph nodes with ferumoxtran-10. Radiographics 2004;24:867–878

    PubMed  Google Scholar 

  9. Hofer C, Kübler H, Hartung R, et al. Diagnosis and monitoring of urological tumors using positron emission tomography. Eur Urol 2001;40:481–487

    Article  PubMed  CAS  Google Scholar 

  10. Schöder H, Larson SM. Positron emission tomography for prostate, bladder, and renal cancer. Semin Nucl Med 2004;34:274–292

    Article  PubMed  Google Scholar 

  11. Grubnic S, Vinnicombe SJ, Norman AR, et al. MR evaluation of normal retroperitoneal and pelvic lymph nodes. Clin Radiol 2002;57:193–200

    Article  PubMed  Google Scholar 

  12. Kim SH, Kim SC, Choi BI, et al. Uterine cervical carcinoma: evaluation of pelvic lymph node metastasis with MR imaging. Radiology 1994;190:807–811

    PubMed  CAS  Google Scholar 

  13. Van den Brekel MWM, Stel HV, Castelijns JA, et al. Cervical lymph node metastasis: assessment of radiologic criteria. Radiology 1990;177:379–384

    PubMed  Google Scholar 

  14. Jager GJ, Barentz JO, Oosterhof GO, et al. Pelvic adenopathy in prostatic and urinary bladder carcinoma: MR imaging with a three-dimensional T1-weighted magnetization-prepared-rapid gradient-echo sequence. AJR 1996;167:1503–1507

    PubMed  CAS  Google Scholar 

  15. Harisinghani MG, Barentsz J, Hahn PF, et al. Noninvasive detection of clinically occult lymph-node metastases in prostate cancer. N Engl J Med 2003;348:2491–2499

    Article  PubMed  Google Scholar 

  16. Deserno WMLLG, Harisinghani MG, Taupitz M, et al. Urinary bladder cancer: preoperative nodal staging with ferumoxtran-10–enhanced MR imaging. Radiology 2004;233:449–456

    PubMed  Google Scholar 

  17. Dorfman RE, Alpern MB, Gross BH, et al. Upper abdominal lymph nodes: criteria for normal size determined with CT. Radiology 1991;180:319–322

    PubMed  CAS  Google Scholar 

  18. Vinnicombe SJ, Norman AR, Nicolson V, et al. Normal pelvic lymph nodes: evaluation with CT after bipedal lymphangiography. Radiology 1995;194:349–355

    PubMed  CAS  Google Scholar 

  19. Bellin MF, Lebleu L, Meric JB, et al. Evaluation of retroperitoneal and pelvic lymph node metastases with MRI and MR lymphangiography. Abdom Imaging 2003;28:155–163

    Article  PubMed  CAS  Google Scholar 

  20. Vassallo P, Wernecke K, Roos N, et al. Differentiation of benign from malignant superficial lymphadenopathy: the role of high-resolution US. Radiology 1992;183:215–220

    PubMed  CAS  Google Scholar 

  21. Som PM. Detection of metastasis in cervical lymph nodes: CT and MR criteria and differential diagnosis. AJR 1992;158:961–969

    PubMed  CAS  Google Scholar 

  22. Barentz JO, Jager GJ, Van Vierzen PBJ, et al. Staging urinary bladder cancer after transurethral biopsy: value of fast dynamic contrast-enhanced MR imaging. Radiology 1996;201:185–193

    Google Scholar 

  23. Anzai Y, Piccoli CW, Outwater EK, et al. Evaluation of neck and body metastases to nodes with ferumoxtran 10–enhanced MR imaging: phase III safety and efficacy study. Radiology 2003;228:777–788

    PubMed  Google Scholar 

  24. Motzer RJ, Bander NH, Nanus DM. Renal-cell carcinoma. N Engl J Med 1996;335:865–875

    Article  PubMed  CAS  Google Scholar 

  25. Lam JS, Shvarts OS, Leppert JT, et al. Renal cell carcinoma 2005: new frontiers in staging, prognostication and targeted molecular therapy. J Urol 2005;173:1853–1862

    Article  PubMed  Google Scholar 

  26. Hilton S. Imaging of renal cell carcinoma. Semin Oncol 2000;27:150–159

    PubMed  CAS  Google Scholar 

  27. Heidenreich A, Ravery V. Preoperative imaging in renal cell cancer. World J Urol 2004;22:307–315

    Article  PubMed  Google Scholar 

  28. Studer UE, Scherz S, Scheidegger J, et al. Enlargement of regional lymph nodes in renal cell carcinoma is often not due to metastases. J Urol 1990;144:243–245

    PubMed  CAS  Google Scholar 

  29. Johnson CD, Dunnick NR, Cohan RH, et al. Renal adenocarcinoma: CT staging of 100 tumors. AJR 1987;148:59–63

    PubMed  CAS  Google Scholar 

  30. Ozsahin M, Zouhair A, Villa S, et al. Prognostic factors in urothelial renal pelvis and ureter tumours: a multicentre Rare Cancer Network study. Eur J Cancer 1999;35:738–743

    Article  PubMed  CAS  Google Scholar 

  31. Millán-Rodríguez F, Palou J, De la Torre-Holguera P, et al. Conventional CT signs in staging transitional cell tumors of the upper urinary tract. Eur Urol 1999;35:318–322

    Article  PubMed  Google Scholar 

  32. Leissner J , Hohenfellner R, Thüroff JW, et al. Lymphadenectomy in patients with transitional cell carcinoma of the urinary bladder; significance for staging and prognosis. Br J Urol 2000;85:817–823

    CAS  Google Scholar 

  33. Mills RD, Turner WH, Fleischmann A, et al. Pelvic lymph node metastases from bladder cancer: outcome in 83 patients after radical cystectomy and pelvic lymphadenectomy. J Urol 2001;166:19–23

    Article  PubMed  CAS  Google Scholar 

  34. Abdel-Latif M, Abol-Enein H, El-Baz M, et al. Nodal involvement in bladder cancer cases treated with radical cystectomy: incidence and prognosis. J Urol 2004;172:85–89

    Article  PubMed  Google Scholar 

  35. Koss JC, Arger PH, Coleman BG, et al. CT staging of bladder carcinoma. AJR 1981;137: 359–362

    PubMed  CAS  Google Scholar 

  36. Vock P, Haertel M, Fuchs WA, et al. Computed tomography in staging of carcinoma of the urinary bladder. Br J Urol 1982;54:158–163

    Article  PubMed  CAS  Google Scholar 

  37. Tanimoto A, Yuasa Y, Imai Y, et al. Bladder tumor staging: comparison of conventional and Gadolinium-enhanced dynamic MR imaging and CT. Radiology 1992;185:741–747

    PubMed  CAS  Google Scholar 

  38. Narumi Y, Kadota T, Inoue E, et al. Bladder tumors: staging with gadolinium-enhanced oblique MR imaging. Radiology 1993;187:145–150

    PubMed  CAS  Google Scholar 

  39. Hilton S, Herr HW, Teitcher JB, et al. CT detection of retroperitoneal lymph node metastases in patients with clinical stage I testicular nonseminomatous germ cell cancer: assessment of size and distribution criteria. AJR 1997;169:521–525

    PubMed  CAS  Google Scholar 

  40. Steyerberg EW, Vergouwe Y, Keizer HJ, et al. Residual mass histology in testicular cancer: development and validation of a clinical prediction rule. Stat Med 2001;20:3847–3859

    Article  PubMed  CAS  Google Scholar 

  41. Cremerius U, Effert PJ, Adam G, et al. FDG PET for detection and therapy control of metastatic germ cell tumor. J Nucl Med 1998;39:815–822

    PubMed  CAS  Google Scholar 

  42. Partin AW, Mangold LA, Lamm DM, et al. Contemporary update of prostate cancer staging nomograms (Partin tables) for the new millennium. Urology 2001;58:843–848

    Article  PubMed  CAS  Google Scholar 

  43. Spencer J, Golding S. CT evaluation of lymph node status at presentation of prostatic carcinoma. Br J Radiol 1992;65:199–201

    Article  PubMed  CAS  Google Scholar 

  44. Oyen R, Van Poppel HP, Ameye FE, et al. Lymph node staging of localized prostatic carcinoma with CT and CT-guided fine-needle aspiration biopsy: prospective study of 285 patients. Radiology 1994;190:315–322

    PubMed  CAS  Google Scholar 

  45. Wolf JS, Cher M, Dall’era M, et al. The use and accuracy of cross-sectional imaging and fine needle aspiration cytology for detection of pelvic lymph node metastases before radical prostatectomy. J Urol 1995;153: 993–999

    Article  PubMed  Google Scholar 

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Acknowledgments

We heartily acknowledge Dr. Tsuneo Saga, Dr. Yuji Nakamoto, and Dr. Umeoka in our department and Dr. Tsuyoshi Itoh in the Kyoto Medical Center for sincere and valuable advice when preparing this report.

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Authors and Affiliations

  1. Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan

    N. Morisawa & K. Togashi

  2. Department of Radiology, Kyoto Medical Center, 1-1 Fukakusa-Mukaihata-cho, Fushimi-ku, Kyoto, 606-8507, Japan

    N. Morisawa

  3. Department of Radiology, Kyoto University Hospital, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan

    T. Koyama

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  1. N. Morisawa
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  2. T. Koyama
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Correspondence to T. Koyama.

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Morisawa, N., Koyama, T. & Togashi, K. Metastatic lymph nodes in urogenital cancers: contribution of imaging findings. Abdom Imaging 31, 620–629 (2006). https://doi.org/10.1007/s00261-005-0244-5

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  • DOI: https://doi.org/10.1007/s00261-005-0244-5

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