Lymphadenopathy

Lymph nodes are common sites of metastatic disease in gynecologic tumors and are an important prognostic factor in these malignancies. For example, the 5-year survival for a patient with vulvar cancer and normal nodes is 90%, compared with a patient with nodal disease, whose 5-year survival rate is 50%.

Normal lymph nodes (including pelvic) are typically oblong bean-shaped and small, with the transverse diameter less than or equal to 10 mm. They have a peripheral hypoechogenic band with a hyperechogenic (fatty) hilum. The vascular pattern of normal lymph nodes is characteristic, with the feeding artery and vein coursing in and out from the hilum. Lymph nodes containing tumor tend to be enlarged, with an irregular border and loss of normal sonographic architecture. They are rounded in shape rather than oblong, and their blood-flow pattern can become multifocal and disorganized.