![]() The chief reason why the clinical significance of supra-renal PAN metastasis remains unclear in patients with epithelial ovarian cancer, including primary peritoneal cancer and fallopian tube cancer, is that metastasis to these nodes has received little attention in the past. According to the International Federation of Gynecology and Obstetrics (FIGO) staging classification, the supra-renal PANs are classified as regional lymph nodes, but it is stated that there is controversy regarding whether supra-renal PAN metastasis should be considered as regional lymph node metastasis (stage III) or distant metastasis (stage IV), and this issue should be investigated further in the future. In patients with epithelial ovarian cancer, primary peritoneal cancer, or fallopian tube cancer, the clinical implications of supra-renal PAN metastasis are unclear. These nodes can be broadly classified into supra-renal PANs located cephalad (superior) to the renal veins and infra-renal PANs located caudad (inferior) to the renal veins, while the infra-renal PANs can be further classified into nodes located between the renal veins and the inferior mesenteric artery and nodes located between the inferior mesenteric artery and the aortic bifurcation. The para-aortic lymph nodes (PANs) are located around the abdominal aorta and inferior vena cava and are the regional lymph nodes of the intraperitoneal organs. Further studies are needed to better define the clinical significance of supra-renal PAN metastasis. In patients with epithelial ovarian cancer, supra-renal PAN metastases might be considered to be distant rather than regional metastases. None of the patients had isolated supra-renal PAN metastasis, while patients with supra-renal PAN metastasis also had multiple metastases to the infra-renal PAN and PLN. ![]() None of the 14 patients with pT1 or pT2 disease had supra-renal PAN metastasis, while 4/11 patients (36.4%) with pT3 or ypT3 disease had such metastases. Supra-renal PAN metastasis was found in 4/25 patients (16.0%). Patient factors, perioperative factors, the number of dissected lymph nodes, and pathological lymph node metastasis were investigated. The subjects were 25 patients with epithelial ovarian cancer, primary peritoneal cancer, or fallopian tube cancer who underwent systematic dissection of the para-aortic nodes, including the supra-renal PAN, and pelvic lymph nodes (PLN). This study was a preliminary retrospective evaluation of the pattern of supra-renal PAN metastasis in patients with epithelial ovarian cancer. See the article: normal mesenteric lymph nodes.In patients with epithelial ovarian cancer, whether metastasis to para-aortic lymph nodes located cephalad to the renal veins (supra-renal PAN) should be classified as regional lymph node metastasis or distant metastasis remains controversial. As such a figure of 5 mm is considered normal 6. Mesenteric nodes are increasingly visualised as a result of multidetector volume acquisition and are most easily seen on coronal reformats.Īlthough 3 mm has previously been used as the upper limit for the short axis diameter of mesenteric lymph nodes, up to 39% of healthy normal patients have larger nodes than this. See the article: mediastinal lymph node enlargement. In the setting of lung cancer staging a sensitivity of 0.83 and a specificity of 0.82 are quoted for CT 5. This does not, of course, take into consideration the fact that all nodal metastases must start at microscopic size, and thus using only size criteria will miss micrometastases. In general 10 mm is considered the upper limit for normal nodes (short axis diameter) 3-5. See the article: cervical lymph node metastasis (radiologic criteria). Measuring short axis diameter best represents the size of the lymph node in CT imaging 9. ![]() The upper limit in size of a normal node varies with location, and the size cut-off used depends on the desired sensitivity and specificity. There are many causes of lymph node enlargement which include:ĭrug-induced: e.g.
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