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Learning The Nodal Stations in The Abdomen: Pictorial Review
Learning The Nodal Stations in The Abdomen: Pictorial Review
PICTORIAL REVIEW
N,
F E MORO
MD
and 2J SZKLARUK,
PhD, MD
Baylor College of Medicine, One Baylor Plaza, BCM 360 and 2Diagnostic Radiology, The University of Texas, M.D.
Anderson Cancer Center, 1515 Holcombe Boulevard Box 57, Houston, Texas 77030, USA
ABSTRACT. The normal pathways of lymphatic drainage from the abdominal organs
have been well described in the classic anatomy literature. Knowledge of the location
and nomenclature of the common nodal stations in the abdomen are essential for
complete report of radiological findings. CT is ubiquitous in the evaluation of oncology
patients. Utilizing colour-coded CT images of the abdomen we will present the
nomenclature and location of the nodal stations for common abdominal neoplasms,
including those of the stomach, pancreas, liver, colon and the kidney. Understanding
the nomenclature and the usual lymphatic pathways of metastasis will help radiologists
detect disease spread from abdominal tumours. The goal of this pictorial review is to
present the nodal stations, nomenclature and location of regional lymph nodes for the
most common abdominal neoplasms. In addition, the reader can use this document as a
handbook to learn and review this information.
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Gastric cancer
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Colorectal cancer
NX Regional lymph nodes cannot be assessed
N1 Metastasis in 1 to 3 regional lymph nodes
N2 Metastasis in 4 or more regional lymph nodes
Pancreatic cancer
NX Regional lymph nodes cannot be assessed
N0 No regional lymph node metastasis
N1 Regional lymph node metastasis
Hepatocellular carcinoma
NX Regional lymph nodes cannot be assessed
N0 No regional lymph node metastasis
N1 Regional lymph node metastasis
Hepatocellular carcinoma
Hepatoduodenal ligament, Figure 12
Caval lymph nodes, Figure 18
Hepatic artery, Figures 7, 11
Colorectal cancer
Pericolic/perirectal, Figures 9, 17, 18
Ileocolic, Figures 19, 20
Right colic, Figure 8
Middle colic, Figure 7
Left colic, Figure 17
Inferior mesenteric artery (IMA), Figures 19, 21
Superior rectal (haemorrhoidal), Figure 22
Pancreatic cancer
Peripancreatic, Figures 10, 11, 13
Hepatic artery, Figures 7, 11
Coeliac axis, Figures 12, 13
Pyloric, Figure 15
Splenic region, Figure 13
Pancreatic cancer
Pancreatic cancer is the second most common gastrointestinal malignancy and is the fifth leading cause of
cancer-related death. The majority of cases are ductal
The British Journal of Radiology, October 2007
Retrocrural, Figure 23
Inferior diaphragmatic, Figure 23
Anterior diaphragmatic, Figure 24
Middle diaphragmatic, Figure 24
Gastro-oesophageal, Figure 24
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following nodal stations: left gastric (pink); greater curvature (blue); left inferior phrenic (green).
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following nodal stations: coeliac axis (green); hepatoduodenal (blue); common hepatic (red).
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Hepatocellular carcinoma
diet (high in fat). Risk is also increased with obesity, chronic
pancreatitis, prior gastric surgery, diabetes, cirrhosis and
exposure to radiation or chemicals [15, 16]. It is resectable
only in approximately 10% of the cases at presentation. The
resectability of a local tumour depends on the involvement
of major vascular structures, mainly arterial structures
(coeliac axes, superior mesenteric artery), and length of
involvement or occlusion of major venous structures
(superior mesenteric vein) [14]. The identification of nodal
disease is difficult. The accuracy of both CT and MRI is
limited [17, 18]. The survival without treatment is 5 months
and with treatment (surgeryneoadjuvant chemoradiation
with poor results) 814 months [16].
The nodal staging for pancreatic cancer based on AJCC
criteria is listed in Table 1. Table 2 lists the regional
lymph nodes for pancreatic cancer and the corresponding CT colour-coded images of the abdomen demonstrating the anatomical location.
Colorectal cancer
Colorectal adenocarcinoma is the third most common
cancer and the third most common cause of cancer
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Lymphoproliferative diseases
9.
Conclusion
This pictorial review can be used as a handbook to
learn the nomenclature, location and regional lymph
nodes for the most common abdominal neoplasms as
detected with CT imaging.
Acknowledgment
We would like to thank Nicholas Lang for his
assistance with the artwork and Nancy L Villarreal for
helping in the preparation of the manuscript.
10.
11.
12.
13.
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