Pictorial illustration of patterns of lymphatic spread in abdominal and pelvic malignancies: Recognizing the common and uncommon pathways

1074 Learning Objectives 1. Review the major pathways of lymphatic drainage of metastases from abdominal and pelvic malignancies. 2. Illustrate common pattern of lymphatic spread on PET/CT, diagnostic CT or MRI. 3. Recognize interesting and uncommon lymphatic spread pathways. Accurate classification of nodal involvement is important for tumor staging, treatment planning, evaluating treatment response and estimating of prognosis. The contribution of PET/CT in this critical aspect of management of patients with malignancies has been enormous and profound. To help young nuclear medicine residents as well as those who do not have ready access to PET/CT technology, we present a review of common and uncommon pathways of lymphatic drainage from abdominal and pelvic malignancies (excluding lymphoma), involving the cervix, endometrium, anal, rectum, colon, stomach, liver and so on. Although lymphatic pathways are well illustrated in anatomy textbooks, we aim to present a pictorial review of lymphatic pathways of tumor spread as seen on PET/CT images that can be used as a road map when evaluating images of patients with abdominal and pelvic malignancies. This presentation includes not only PET/CT images, but also anatomic illustrations and correlative imaging including diagnostic CT and/or MRI. In an era of multimodality approach, this presentation is expected to meet the needs of imaging physicians from many specialties