747 - Lymphatic Imaging as a Potential Platform for Metastasis-Directed Interventions

Learning Objectives: 1. Review established interventional radiology (IR) techniques for lymphatic imaging and intervention.

2. Describe intranodal and ductal access approaches for diagnostic and therapeutic use.

3. Summarize current outcomes for nodal ablation in metastatic disease.

4. Highlight future applications of lymphatic imaging in interventional oncology.

Background: The lymphatic system plays a central role in fluid balance and metastatic spread, yet it remains relatively underutilized in imaging and interventions {1,2}. With advances in MR lymphangiography, intranodal contrast delivery, and ICG fluorescence, detailed mapping of central and peripheral lymphatics is now feasible {1,3,4}. These tools have transformed IR’s ability to diagnose and treat lymphatic leaks and may play a potential role in oncologic interventions {2-5}.

Clinical Findings/Procedure Details: Intranodal techniques provide safe, reliable access for both imaging and intervention. Dynamic contrast MR lymphangiography, using dilute gadolinium injected intranodally at low rates, generates high-resolution maps of lymphatic flow and drainage pathways {1–4}. Beyond leak management, IR can ablate oligometastatic lymph nodes, with meta-analytic data showing a 98% technical success rate with local control in most patients, with only ~1% major complication rate {5}. Building on this foundation, lymphatic imaging may serve as a platform for future therapies in interventional oncology.

Conclusion and/or Teaching Points: IR has progressed from managing lymphatic leaks to reproducible mapping and selective nodal interventions. Early data suggest that nodal ablation can be performed safely, though evidence remains limited to small observational studies. Nonetheless, intranodal access and advanced imaging position the lymphatic system as an area of growing interest for interventional oncology.