The lymphatic pathway is an important route of metastasis in gynecological malignancy. Therefore, the examination of lymph nodes is an essential part of the ultrasound evaluation in patients with known or suspected gynecological malignancy. The lymph nodes most frequently involved in gynecological malignancy (apart from vulvar cancer) are parietal (retroperitoneal) and visceral abdominopelvic lymph nodes. In advanced disease, more distant lymph-node regions, such as the inguinal, axillary and supraclavicular lymph nodes, can also be involved. The standardized description of lymph nodes has been published previously by the Vulvar International Tumor Analysis (VITA) collaborative group. Herein, a collaborative group of gynecologists and gynecological oncologists with extensive ultrasound experience presents a systematic methodology for ultrasonographic lymph-node assessment performed as part of the locoregional and distant work-up to assess the extent of gynecological malignancy. The aim of this consensus opinion is also to describe the anatomical classification and drainage pathways of the lymphatic system as relevant to the gynecological organs. © 2024 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Department of Biomedical Science for Health University of Milan Milan Italy

Department of Clinical Surgical Diagnostic and Pediatric Sciences Unit of Obstetrics and Gynaecology University of Pavia IRCCS San Matteo Hospital Foundation Pavia Italy

Department of Gynaecological Oncology KK Women's and Children's Hospital Singapore

Department of Gynecologic Oncology ARNAS Civico Di Cristina Benfratelli University of Palermo Palermo Italy

Department of Gynecology Obstetrics and Neonatology 1st Faculty of Medicine Charles University and General University Hospital Prague Prague Czech Republic

Department of Obstetrics and Gynaecology Faculty of Medicine Semmelweis University Budapest Hungary

Department of Radiology 1st Faculty of Medicine Charles University and General University Hospital Prague Prague Czech Republic

Department of Woman and Child Health and Public Health Fondazione Policlinico Universitario Agostino Gemelli IRCCS Università Cattolica del Sacro Cuore Rome Italy

Gemelli Woman Health Center for Digital and Personalized Medicine Dipartimento Scienze della Vita e Sanità Pubblica Università Cattolica del Sacro Cuore Rome Italy

Institute of Anatomy 1st Faculty of Medicine Charles University Prague Czech Republic

Obstetrics and Gynaecology Department University Hospital Waterford Waterford Ireland

Unità Operativa di Chirurgia degli Organi Genitali Esterni Femminili Divisione di Ginecologia Oncologica Dipartimento Scienze della Salute della Donna del Bambino e di Sanità Pubblica Fondazione Policlinico Universitario A Gemelli IRCCS Rome Italy

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