Diagnostic evaluation of the pelvic and abdominal lymphatic system

Evaluation of the pelvic and abdominal lymphatic systems is the subject of renewed interest by radiologists, radiotherapists, surgeons and medical oncologists. The primary reason for this interest has been the rapid advance of diagnostic imaging technology, particulary in ultrasonography and computerized tomography (CT). Another reason is the realization that with some neoplasms, particularly gynecologic neoplasms, there has been little progress in long-term survival in spite of aggressive local management. A possible explanation for this is "understaging" of neoplasms by previous radiologic procedures. Although lymphangiography has a proved and well-defined place in the diagnostic regimen, it remains tedious, time-consuming and invasive. Gray-scale ultrasound and CT have been widely used for several years and their role, limitations and relationship to lymphangiography have become established. The purpose of this monograph is to provide a short review of the lymphatic system and lymphangiogram, with particular attention to the recent radiologic literature. The role and limitations of the various diagnostic modalities are discussed and the lymphatic drainage and common pelvic neoplasms (as approached in the recent literature) are reviewed. No attempt has been made to define the lymphatic drainage of abdominal visceral organs.