Editing Germ Cell Tumours (section)

==== Regional ====
* Regional lymph nodes comprises (7):
*# Inter-aortocaval
*# Para-aortic
*# Para-caval
*# Pre-aortic
*# Pre-caval
*# Retro-aortic
*# Retro-caval
* '''<span style="color:#ff0000">Modality</span>'''
** '''<span style="color:#ff0000">CT abdomen/pelvis with oral and IV contrast</span>'''
*** '''<span style="color:#ff0000">Most effective imaging modality for regional staging</span>'''
** MRI
*** Alternative to CT
* '''<span style="color:#ff0000">Imaging findings</span>'''
** '''<span style="color:#ff0000">Retroperitoneal lymph nodes</span>'''
*** '''<span style="color:#ff0000">Pattern of lymph drainage in the retroperitoneum is from right to left.</span>'''
**** '''<span style="color:#ff0000">For right testis tumors, the primary drainage site is the inter-aortocaval lymph nodes inferior to the renal vessels, followed by the paracaval and para-aortic nodes.</span>'''
**** '''<span style="color:#ff0000">For left testis tumors, the primary drainage site is the para-aortic lymph nodes, followed by the inter-aortocaval nodes.</span>'''
*** [[File:Retroperitoneal lymph flow.jpg|thumb|Direction of lymphatic flow in the retroperitoneum]]
** '''<span style="color:#ff0000">"Borderline" retroperitoneal lymph nodes</span>'''
*** '''<span style="color:#ff0000">Lymph nodes 5-9 mm in the primary landing zone should be viewed with suspicion for regional lymph node metastasis,</span> particularly if they are anterior to the great vessels'''
** '''Limitations'''
*** '''Understaging'''
**** 25-35% of patients with CSI NSGCT and a “normal” CT scan will be found to have pathologically involved retroperitoneal lymph nodes at RPLND
*** '''Overstaging'''
**** 12-40% of patients with CS IIA and IIB disease will be found to have pathologically negative lymph nodes at RPLND