Advances in Gynecologic Tumor-associated Lymphatic Vessels

The lymphatic system, hematogenous system, and implantation represent the major metastatic routes of gynecologic malignancies, among which lymphatic dissemination is the most prevalent and closely linked to patient prognosis. While vascular metastasis has been extensively studied, with well-established mechanisms such as tumor-induced angiogenesis, immune mimicry, and stromal remodeling, research on lymphatic metastasis remains relatively limited. This gap is largely attributable to the poor visibility of lymphatic vessels, the delayed identification of specific biomarkers, and the technical and economic challenges of isolating primary lymphatic endothelial cells. Consequently, the depth of research on lymphatic metastasis lags far behind than that of hematogenous metastasis, especially the targeted investigations into gynecologic tumor-associated lymphatic vessels (TALVs) are still at an early stage. This manuscript first reviews the current progress in mechanistic studies of lymphatic metastasis in gynecologic malignancies, then highlights the mainstream clinical lymphatic imaging techniques and experimental models in basic research, and finally discusses feasible gene detection approaches for further reference.