Marion K Jantsch MD, Presenter: Nothing to Disclose

Anuradha Saokar MD, Abstract Co-Author: Nothing to Disclose

Peter Florin Hahn MD, PhD, Abstract Co-Author: Nothing to Disclose

Shahin Tabatabaei, Abstract Co-Author: Nothing to Disclose

Peter Raff Mueller MD, Abstract Co-Author: Nothing to Disclose

Mukesh Gobind Harisinghani MD, Abstract Co-Author: Nothing to Disclose

While node negative prostate cancer patients are primarily treated with radical prostatectomy or radiotherapy, patient that are node positive receive adjuvant hormone therapy with radiation. Accurate radiation planning requires precise knowledge of the sites of lymph node metastases. High resolution MR imaging performed with ferumoxtran-10 has shown to be extremely accurate for assessing the lymph node status in patients with prostate cancer. The purpose of our study was to use ferumoxtran-10 enhanced MRI scans to review the distribution of lymph node metastases in prostate cancer patients

Forty pathologically confirmed prostate cancer patients (age range 48-80 years) who had 135 positive lymph nodes in the abdomen and pelvis identified by ferumoxtran-10 enhanced MRI were included in this study. The size and location of the nodes was recorded. The lymph nodes were classified into the following anatomic regions – external iliac, obturator, internal iliac, common iliac, presacral, perirectal and paraaortic.

The distribution of the lymph nodes were as follows: External iliac: 24 (60%) patients; mean size 10.3mm Obturator: 17 (42.5%) patients; mean size 9.9mm Internal iliac: 13 patients (32.5%); mean size 5.8mm; Common iliac: 6 patients (15%); mean size 9.6mm Presacral lymph nodes: 10 patients (25%); mean size 8.3mm Perirectal nodes: 6 patients (15%); mean size 4.3mm Paraaortic lymph nodes: 6 patients (15%); mean size 9.8mm All patients with nodal metastases in the common iliac, presacral and perirectal areas had associated disease in the external iliac, obturator or internal iliac chain. Only one patient had metastastic paraaortic node in the absence of pelvic lymphadenopathy.

External iliac, obturator and internal iliac lymph nodes are the common sites of lymph nodes metastases in men with prostate cancer. The less common sites are the common iliac, presacral, perirectal and paraaortic regions; lymph node metastases in these locations are invariable associated with disease in the external iliac, obturator and internal iliac lymph nodes. Careful attention should be paid to the perirectal area since metastastic nodes in this region can be small in size

Jantsch, M, Saokar, A, Hahn, P, Tabatabaei, S, Mueller, P, Harisinghani, M, Nodal Drainage Pathways and Patterns of Lymph Node Involvement in Prostate Cancer.  Radiological Society of North America 2005 Scientific Assembly and Annual Meeting, November 27 - December 2, 2005 ,Chicago IL. http://archive.rsna.org/2005/4417450.html