From the Guidelines
The lymph node drainage for the uterus primarily involves three main pathways, including the external iliac, internal iliac, and common iliac lymph nodes, as well as the parametrial, obturator, and sacral lymph nodes, with the fundus of the uterus uniquely draining into the para-aortic lymph nodes and potentially the superficial inguinal lymph nodes via the round ligament pathway. The lymphatic drainage of the uterus is complex and involves multiple pathways, making it essential to understand for the staging and treatment of gynecological cancers, particularly cervical and endometrial cancers. According to the most recent evidence from 1, the uterine body lymphatic trunks commonly cross over the obliterated umbilical artery, with the most common location of pelvic sentinel lymph nodes being medial to the external iliac, ventral to the hypogastric, or in the superior part of the obturator region.
Some key points to consider in the lymph node drainage of the uterus include:
- The external iliac, internal iliac, and common iliac lymph nodes are primary sites of drainage for the uterus, as noted in 1 and 1.
- The parametrial, obturator, and sacral lymph nodes also play a role in the lymphatic drainage of the uterus, as mentioned in 1 and 1.
- The fundus of the uterus has a unique drainage pattern that includes the para-aortic lymph nodes, as discussed in 1 and 1.
- The superficial inguinal lymph nodes may also be involved in the drainage of the uterus via the round ligament pathway, as noted in 1 and 1.
Understanding the lymphatic drainage of the uterus is crucial for the proper assessment of disease spread and planning of treatment strategies in gynecological oncology, as emphasized in 1, 1, and 1. The evidence from these studies highlights the importance of considering the complex lymphatic drainage patterns of the uterus in the management of gynecological cancers.
From the Research
Lymph Node Drainage for the Uterus
The lymph node drainage for the uterus involves several pathways and nodes. Key findings from studies include:
- The uterus is drained by lymph nodes located in the lateral part of the parametrium and under the external iliac vein, with a median of 2.4 lymph nodes per side 2.
- Two main routes of lymphatic drainage have been identified: one along the external iliac vessels and another along the infundibulopelvic ligament 2.
- The cervix is primarily drained to lymph nodes located on the posterior aspect of the external iliac vein, especially near the hypogastric artery origin 2.
- In the case of endometrial cancer, lymphatic drainage occurs along two main pathways: one extending to the external iliac area and another to the para-aortic area 2.
Specific Pathways and Nodes
Studies have identified specific pathways and nodes involved in uterine lymph node drainage, including:
- An upper paracervical pathway (UPP) with draining medial external and/or obturator lymph nodes 3.
- A lower paracervical pathway (LPP) with draining internal iliac and/or presacral lymph nodes 3.
- Iliac lymphatic nodes, which receive afferent vessels from the different pelvic organs and play a crucial role in the lymphatic system of the pelvis 4.
Clinical Implications
Understanding the anatomy of the pelvic lymphatic system is essential for the evaluation and treatment of cancers in the pelvic region, including uterine cancer 4. The distribution and nodal tumor burden of urothelial bladder cancer in different anatomical pelvic regions can impact the extent of lymphadenectomy and reported lymph node parameters 5.