Nodal disease assessment in pelvic malignancy

Abstract

•. The accurate identification and characterisation of lymph nodes is essential in staging pelvic malignancies. •. The confirmed presence of nodal metastases has important prognostic and therapeutic significance for most pelvic cancers. •. Identification of metastatic nodes using imaging techniques helps in treatment planning, the assessment of disease response and the detection of recurrence. •. CT and MRI form first-line imaging modalities, with fluorodeoxyglucose positron emission tomography/CT becoming routinely used for certain types of tumour. •. Nodal size is the most widely used imaging criterion; however, abnormal lymph node morphology can be a useful indicator. •. Emerging imaging techniques, such as diffusion-weighted imaging, have been demonstrated to improve diagnostic accuracy. •. No imaging technique currently exists with a high enough diagnostic performance to completely negate the need for histological confirmation. Accurate identification and characterisation of lymph nodes is essential in staging pelvic malignancies. Confirmation of nodal metastases carries important prognostic and therapeutic significance. Identification of metastatic lymph nodes on imaging can help in treatment planning, disease response and detection of disease recurrence. In this article, the performance of currently available imaging modalities will be discussed. Evolving techniques, such as diffusion-weighted imaging, MR lymphography with nanoparticles, 18-fluorodeoxyglucose positron emission tomography/CT, lymphoscintigraphy and more novel techniques, will also be reviewed. However, no single imaging technique has emerged with high enough diagnostic performance to completely obviate the need for histological confirmation. Nodal size remains the most widely used imaging criterion.