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Pathways of Lymph Node Spread for Mesothelioma
Christopher M. Walker, MD
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KEY FACTS

  • Terminology

    • Imaging Anatomy

      • Clinical Implications

        TERMINOLOGY

        • Abbreviations

          • Malignant pleural mesothelioma (MPM)
        • Definitions

          • Presence of macroscopic or microscopic neoplasm within regional or distant lymph nodes
        • Background

          • MPM
            •  Most common primary malignancy of pleura
            • 2nd most common pleural malignancy after pleural metastases
            • Strong association with asbestos exposure; long latency period following exposure to diagnosis (20-50 years)
            • Occurs in up to 10% people exposed to asbestos
            • Poor prognosis with most succumbing to disease within 1 year of diagnosis
        • Staging

          • TNM staging system created by International Mesothelioma Interest Group
            • Surgical staging considered superior to radiologic staging
            • Lymph node (N) stage is defined by location of lymph node metastases
              • NX: Lymph nodes cannot be assessed
              • N0: No regional lymph nodes
              • N1: Ipsilateral bronchopulmonary or hilar lymph nodes
              • N2: Ipsilateral mediastinal lymph nodes, including ipsilateral internal mammary and peridiaphragmatic lymph nodes
              • N3: Contralateral mediastinal lymph nodes, contralateral internal mammary lymph nodes and any supraclavicular lymph node
              • Extrathoracic lymph nodes (including axillary lymph nodes) are usually characterized as distant metastases (M1 disease)

        IMAGING ANATOMY

        • General Anatomic Considerations

          • Anatomic Relationships

            • Lymphatic Drainage

              CLINICAL IMPLICATIONS

              • Clinical Importance

                Selected References

                1. Nickell LT Jr et al: Multimodality imaging for characterization, classification, and staging of malignant pleural mesothelioma. Radiographics. 34(6):1692-706, 2014
                2. Kruse M et al: FDG PET/CT in the management of primary pleural tumors and pleural metastases. AJR Am J Roentgenol. 201(2):W215-26, 2013
                3. Sharma A et al: Patterns of lymphadenopathy in thoracic malignancies. Radiographics. 24(2):419-34, 2004
                4. Wang ZJ et al: Malignant pleural mesothelioma: evaluation with CT, MR imaging, and PET. Radiographics. 24(1):105-19, 2004
                5. Heelan RT et al: Staging of malignant pleural mesothelioma: comparison of CT and MR imaging. AJR Am J Roentgenol. 172(4):1039-47, 1999
                6. Miller BH et al: From the archives of the AFIP. Malignant pleural mesothelioma: radiologic-pathologic correlation. Radiographics. 16(3):613-44, 1996
                7. Sahin AA et al: Malignant pleural mesothelioma caused by environmental exposure to asbestos or erionite in rural Turkey: CT findings in 84 patients. AJR Am J Roentgenol. 161(3):533-7, 1993
                8. Patz EF Jr et al: Malignant pleural mesothelioma: value of CT and MR imaging in predicting resectability. AJR Am J Roentgenol. 159(5):961-6, 1992
                9. Kawashima A et al: Malignant pleural mesothelioma: CT manifestations in 50 cases. AJR Am J Roentgenol. 155(5):965-9, 1990
                10. Huncharek M et al: Extrathoracic lymph node metastases in malignant pleural mesothelioma. Chest. 93(2):443-4, 1988
                11. Kim SB et al: Diagnosis of malignant pleural mesothelioma by axillary lymph node biopsy. Chest. 91(2):279-81, 1987
                12. Mirvis S et al: CT of malignant pleural mesothelioma. AJR Am J Roentgenol. 140(4):665-70, 1983
                13. Alexander E et al: CT of malignant pleural mesothelioma. AJR Am J Roentgenol. 137(2):287-91, 1981
                Related Anatomy
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                References
                Tables

                Tables

                KEY FACTS

                • Terminology

                  • Imaging Anatomy

                    • Clinical Implications

                      TERMINOLOGY

                      • Abbreviations

                        • Malignant pleural mesothelioma (MPM)
                      • Definitions

                        • Presence of macroscopic or microscopic neoplasm within regional or distant lymph nodes
                      • Background

                        • MPM
                          •  Most common primary malignancy of pleura
                          • 2nd most common pleural malignancy after pleural metastases
                          • Strong association with asbestos exposure; long latency period following exposure to diagnosis (20-50 years)
                          • Occurs in up to 10% people exposed to asbestos
                          • Poor prognosis with most succumbing to disease within 1 year of diagnosis
                      • Staging

                        • TNM staging system created by International Mesothelioma Interest Group
                          • Surgical staging considered superior to radiologic staging
                          • Lymph node (N) stage is defined by location of lymph node metastases
                            • NX: Lymph nodes cannot be assessed
                            • N0: No regional lymph nodes
                            • N1: Ipsilateral bronchopulmonary or hilar lymph nodes
                            • N2: Ipsilateral mediastinal lymph nodes, including ipsilateral internal mammary and peridiaphragmatic lymph nodes
                            • N3: Contralateral mediastinal lymph nodes, contralateral internal mammary lymph nodes and any supraclavicular lymph node
                            • Extrathoracic lymph nodes (including axillary lymph nodes) are usually characterized as distant metastases (M1 disease)

                      IMAGING ANATOMY

                      • General Anatomic Considerations

                        • Anatomic Relationships

                          • Lymphatic Drainage

                            CLINICAL IMPLICATIONS

                            • Clinical Importance

                              Selected References

                              1. Nickell LT Jr et al: Multimodality imaging for characterization, classification, and staging of malignant pleural mesothelioma. Radiographics. 34(6):1692-706, 2014
                              2. Kruse M et al: FDG PET/CT in the management of primary pleural tumors and pleural metastases. AJR Am J Roentgenol. 201(2):W215-26, 2013
                              3. Sharma A et al: Patterns of lymphadenopathy in thoracic malignancies. Radiographics. 24(2):419-34, 2004
                              4. Wang ZJ et al: Malignant pleural mesothelioma: evaluation with CT, MR imaging, and PET. Radiographics. 24(1):105-19, 2004
                              5. Heelan RT et al: Staging of malignant pleural mesothelioma: comparison of CT and MR imaging. AJR Am J Roentgenol. 172(4):1039-47, 1999
                              6. Miller BH et al: From the archives of the AFIP. Malignant pleural mesothelioma: radiologic-pathologic correlation. Radiographics. 16(3):613-44, 1996
                              7. Sahin AA et al: Malignant pleural mesothelioma caused by environmental exposure to asbestos or erionite in rural Turkey: CT findings in 84 patients. AJR Am J Roentgenol. 161(3):533-7, 1993
                              8. Patz EF Jr et al: Malignant pleural mesothelioma: value of CT and MR imaging in predicting resectability. AJR Am J Roentgenol. 159(5):961-6, 1992
                              9. Kawashima A et al: Malignant pleural mesothelioma: CT manifestations in 50 cases. AJR Am J Roentgenol. 155(5):965-9, 1990
                              10. Huncharek M et al: Extrathoracic lymph node metastases in malignant pleural mesothelioma. Chest. 93(2):443-4, 1988
                              11. Kim SB et al: Diagnosis of malignant pleural mesothelioma by axillary lymph node biopsy. Chest. 91(2):279-81, 1987
                              12. Mirvis S et al: CT of malignant pleural mesothelioma. AJR Am J Roentgenol. 140(4):665-70, 1983
                              13. Alexander E et al: CT of malignant pleural mesothelioma. AJR Am J Roentgenol. 137(2):287-91, 1981