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From the Journals

New Consensus on Ultrasound Lymph Node Assessment in Gynecologic Cancer

"Ultrasound represents a highly effective tool with which to identify potentially infiltrated lymph nodes in a patient presenting with gynecological cancer," wrote the authors of the recent consensus opinion.

Conexiant

A recently published consensus opinion provides standardized terminology and detailed guidance for the ultrasound assessment of lymph nodes in gynecologic cancer staging, emphasizing its importance in determining the extent of disease. 

Published in Ultrasound in Obstetrics and Gynecology and authored by a multidisciplinary group of gynecologists and radiologists, the opinion outlines a systematic approach to improve diagnostic precision during locoregional and distant metastasis evaluation.

According to the consensus opinion, parietal (retroperitoneal) and visceral abdominopelvic lymph nodes are most frequently involved in patients with gynecologic malignancies. Distant lymph nodes—including the inguinal, axillary, and supraclavicular regions—may also be affected in patients with advanced disease.

The collaborative effort builds on previous work by the Vulvar International Tumor Analysis group and extends the standardized methodology to include detailed examination protocols, anatomical classifications, and lymphatic drainage pathways relevant to gynecologic cancers.

Key points from the consensus opinion include:

  • Anatomical classifications: Lymph nodes are categorized into peripheral and nonperipheral groups; peripheral nodes include supraclavicular, axillary, and inguinal nodes, while nonperipheral nodes encompass thoracic, abdominal (lumbar), and pelvic (iliac) nodes.

  • Imaging techniques: Detailed ultrasonographic protocols are outlined for accurate identification and characterization of lymph nodes. Key parameters for assessment include node size, shape, border definition, internal structure, and vascularity.

  • Clinical relevance: The authors stressed that standardized lymph node examination contributes significantly to cancer staging and treatment planning.

The authors described techniques for distinguishing normal from pathological lymph nodes based on specific ultrasound markers. Lymph nodes with irregular margins, heterogenous echotexture, and abnormal vascularity may warrant further investigation. Advanced imaging techniques, such as color Doppler and elastography, are recommended for enhanced evaluation.

"The purpose of this consensus opinion is to provide a methodological guide to allow a structured, systematic approach towards assessment of the lymph nodes as part of gynecological cancer staging," wrote first author Daniela Fischerova, MD, PhD, of the Department of Gynecology, Obstetrics and Neonatology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic, and colleagues.

The consensus opinion highlights the value of integrating systematic ultrasonographic assessment into routine cancer staging. Enhanced diagnostic accuracy could lead to better patient outcomes through more tailored treatment approaches.

The authors suggested that further research is needed to validate the proposed techniques across diverse clinical settings. Continued collaboration between gynecologists and radiologists is encouraged to refine diagnostic protocols.

The authors reported no conflicts of interest.