Mansi Awasthi Saksena MD, Presenter: Nothing to Disclose

Marta Braschi MD, Abstract Co-Author: Nothing to Disclose

Amol Suryakant Katkar MBBS, Abstract Co-Author: Nothing to Disclose

Donald Kaufman MD, Abstract Co-Author: Nothing to Disclose

Peter Raff Mueller MD, Abstract Co-Author: Consultant, Cook Group Incorporated, Bloomington, IN

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

The purpose was to identify regions at highest risk for nodal metastases in bladder carcinoma as seen on lymphotropic nanoparticle enhanced MRI (LNMRI).

30 patients, mean age 67.8 years with bladder carcinoma underwent LNMRI. Studies were prospectively reviewed by 2 radiologists and nodes classified based on size, location and signal intensity. Pathological correlation was obtained by image guided biopsy (18) or surgical lymphadenectomy (5). The remaining 7 patients had radiologic followup.

151 malignant nodes were seen on LNMRI. The locations were para-aortic 41 (27.1%), common iliac 22 (14.5%), external iliac 41 (27.1), internal iliac 11 (7.3%), obturator 22 (14.5%) inguinal 5 (3%),presacral 5 (3%), mesenteric 1(0.6 %) , mediastinal 2 (1.3%) and perirectal 1 (0.6%). 8 (26%) patients demonstrated extrapelvic nodal metastases without any evidence of metastatic disease in the pelvis. Mean size of extrapelvic nodes was 13 mm (range 6-41mm).

Pelvic nodal dissection has been shown to be curative in node positive patients undergoing radical cystectomy. This study identifies the commonest nodal groups involved in metastatic bladder cancer namely the external iliac chain in the pelvis and paraaortic nodes. There is a subset of patients who have normal pelvic lymph nodes with extra pelvic nodal involvement. This underscores the need for effective presurgical evaluation of pelvic and extrapelvic lymph nodes.

Common sites of nodal metastases in bladder cancer are identified with a subset of patients demonstrating isolated extrapelvic nodal disease, which can be evaluated by LNMRI.

Saksena, M, Braschi, M, Katkar, A, Kaufman, D, Mueller, P, Harisinghani, M, Nodal Drainage pathways and patterns of lymph node involvement in bladder cancer..  Radiological Society of North America 2006 Scientific Assembly and Annual Meeting, November 26 - December 1, 2006 ,Chicago IL. http://archive.rsna.org/2006/4436564.html