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Chest
Diagnosis
Mediastinal Abnormalities
Lymphadenopathy
Intrathoracic Lymph Node Metastases
Pathways of Lymph Node Spread in Lung Cancer
Pathways of Lymph Node Spread in Lung Cancer
Gerald F. Abbott, MD, FACR; Florian J. Fintelmann, MD, FRCPC
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KEY FACTS

  • Terminology

    • General Anatomic Considerations

      • Lymphatic Drainage Patterns

        • Clinical Implications

          TERMINOLOGY

          • Definitions

            • Lymph node metastases: Presence of macroscopic or microscopic tumor in regional or distant lymph nodes
            • Skip metastases: Direct metastases of lung cancer to mediastinal lymph nodes without hilar lymph node involvement

          • Staging

            • TNM staging system for lung cancer created by International Union Against Cancer and the American Joint Committee on Cancer
            • Lymph node designation (N) determined by location of lymph node metastases
              • N0: No lymphadenopathy
              • N1: Ipsilateral, peripheral, or hilar-interlobar zone involvement
              • N2: Ipsilateral upper or lower paratracheal, aorticopulmonary, or subcarinal zone involvement
              • N3: Contralateral upper or lower paratracheal, aorticopulmonary, hilar-interlobar, or any supraclavicular involvement
              • Extrathoracic lymph node involvement designated as distant metastases (M1 disease)

          IMAGING ANATOMY

          • General Anatomic Considerations

            CLINICAL IMPLICATIONS

            • Clinical Importance

              Selected References

              1. El-Sherief AH et al: International association for the study of lung cancer (IASLC) lymph node map: radiologic review with CT illustration. Radiographics. 34(6):1680-91, 2014
              2. Kligerman S et al: A radiologic review of the new TNM classification for lung cancer. AJR Am J Roentgenol. 2010 Mar;194(3):562-73. Review. Erratum in: AJR Am J Roentgenol. 194(5):1404, 2010
              3. Topol M et al: The problem of direct lymph drainage of the bronchopulmonary segments into the mediastinal and hilar lymph nodes. Clin Anat. 22(4):509-16, 2009
              4. Suwatanapongched T et al: CT of thoracic lymph nodes. Part II: diseases and pitfalls. Br J Radiol. 79(948):999-1000, 2006
              5. Okada M et al: Border between N1 and N2 stations in lung carcinoma: lessons from lymph node metastatic patterns of lower lobe tumors. J Thorac Cardiovasc Surg. 129(4):825-30, 2005
              6. Sharma A et al: Patterns of lymphadenopathy in thoracic malignancies. Radiographics. 24(2):419-34, 2004
              7. Aquino SL et al: Source and direction of thoracic lymphatics: Part I--upper thorax. J Comput Assist Tomogr. 27(2):292-6, 2003
              8. Marom EM et al: Radiologic findings of bronchogenic carcinoma with pulmonary metastases at presentation. Clin Radiol. 54(10):665-8, 1999
              9. Riquet M: [Mediastinal lymphatic spread of bronchopulmonary cancer.] Rev Mal Respir. 8(5):443-58, 1991
              Related Anatomy
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              References
              Tables

              Tables

              KEY FACTS

              • Terminology

                • General Anatomic Considerations

                  • Lymphatic Drainage Patterns

                    • Clinical Implications

                      TERMINOLOGY

                      • Definitions

                        • Lymph node metastases: Presence of macroscopic or microscopic tumor in regional or distant lymph nodes
                        • Skip metastases: Direct metastases of lung cancer to mediastinal lymph nodes without hilar lymph node involvement

                      • Staging

                        • TNM staging system for lung cancer created by International Union Against Cancer and the American Joint Committee on Cancer
                        • Lymph node designation (N) determined by location of lymph node metastases
                          • N0: No lymphadenopathy
                          • N1: Ipsilateral, peripheral, or hilar-interlobar zone involvement
                          • N2: Ipsilateral upper or lower paratracheal, aorticopulmonary, or subcarinal zone involvement
                          • N3: Contralateral upper or lower paratracheal, aorticopulmonary, hilar-interlobar, or any supraclavicular involvement
                          • Extrathoracic lymph node involvement designated as distant metastases (M1 disease)

                      IMAGING ANATOMY

                      • General Anatomic Considerations

                        CLINICAL IMPLICATIONS

                        • Clinical Importance

                          Selected References

                          1. El-Sherief AH et al: International association for the study of lung cancer (IASLC) lymph node map: radiologic review with CT illustration. Radiographics. 34(6):1680-91, 2014
                          2. Kligerman S et al: A radiologic review of the new TNM classification for lung cancer. AJR Am J Roentgenol. 2010 Mar;194(3):562-73. Review. Erratum in: AJR Am J Roentgenol. 194(5):1404, 2010
                          3. Topol M et al: The problem of direct lymph drainage of the bronchopulmonary segments into the mediastinal and hilar lymph nodes. Clin Anat. 22(4):509-16, 2009
                          4. Suwatanapongched T et al: CT of thoracic lymph nodes. Part II: diseases and pitfalls. Br J Radiol. 79(948):999-1000, 2006
                          5. Okada M et al: Border between N1 and N2 stations in lung carcinoma: lessons from lymph node metastatic patterns of lower lobe tumors. J Thorac Cardiovasc Surg. 129(4):825-30, 2005
                          6. Sharma A et al: Patterns of lymphadenopathy in thoracic malignancies. Radiographics. 24(2):419-34, 2004
                          7. Aquino SL et al: Source and direction of thoracic lymphatics: Part I--upper thorax. J Comput Assist Tomogr. 27(2):292-6, 2003
                          8. Marom EM et al: Radiologic findings of bronchogenic carcinoma with pulmonary metastases at presentation. Clin Radiol. 54(10):665-8, 1999
                          9. Riquet M: [Mediastinal lymphatic spread of bronchopulmonary cancer.] Rev Mal Respir. 8(5):443-58, 1991