Neck Nodal Disease
Neck nodal metastases are common in head and neck cancer and influence prognosis profoundly. This chapter focuses on the commonest cancer type, squamous cell carcinoma, although other malignancies are also outlined. CT, MRI and US are the mainstay imaging
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ents 1 Introduction
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2 Nodal Group Classification and Pathways of Lymphatic Drainage
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3 Imaging Modalities 3.1 CT and MRI 3.2 US and US-Guided Fine-Needle Aspiration Cytology (US-FNAC) 3.3 FDG-PET Imaging 3.4 Lymphoscintigraphy for Sentinel Node Localisation
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4 Imaging Criteria for Malignant Nodes 4.1 Size and Nodal Clustering 4.2 Shape 4.3 Hilum 4.4 Vascular Pattern 4.5 Internal Heterogeneity 4.6 Border Irregularity 4.7 FDG-PET Uptake
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5 Advanced Techniques
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8 I mpact of Nodal Imaging on Patient Management 8.1 Detection of Metastatic Nodes 8.2 Extranodal Extension and Infiltration of Adjacent Structures 8.3 Identification of Patients at High Risk for Distant Metastases
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9 Treatment Assessment 9.1 Prediction of Treatment Response to (Chemo)Radiotherapy 9.2 Post-treatment Assessment 9.3 Post-treatment Surveillance
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10 Brief Overview of Non-HNSCC Lymphadenopathies 10.1 Lymphoma 10.2 Thyroid Cancer 10.3 Salivary Gland Carcinoma 10.4 Nasopharyngeal Carcinoma 10.5 Skin Cancer
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11 Squamous Cell Carcinoma of Unknown Primary
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6 Micrometastases
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12 Non-malignant Lymphadenopathy
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7 Nodal Staging
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13 Conclusion
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References
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K. S. S. Bhatia (*) Imaging Department, Imperial College Healthcare NHS Trust, London, UK e-mail: [email protected]; [email protected] A. D. King Department of Diagnostic Radiology and Organ Imaging, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China e-mail: [email protected]
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Abstract
Neck nodal metastases are common in head and neck cancer and influence prognosis profoundly. This chapter focuses on the commonest cancer type, squamous cell carcinoma, although other malignancies are also outlined. CT, MRI and US are the mainstay imaging modalities for routine nodal evaluations and
Med Radiol Diagn Imaging (2020) https://doi.org/10.1007/174_2020_238, © Springer Nature Switzerland AG
K. S. S. Bhatia and A. D. King
are reliant on anatomic criteria, which are described in this chapter. FDG-PET CT provides functional information by virtue of tumour hypermetabolism although its role in staging is not fully established. Neck nodal distribution and nodal staging using the current level-based and TNM systems, respectively, are described. Besides N-stage, other nodal features demonstrable on imaging, including entranodal extension and precise locations, can influence therapy and prognosis. Anatomic imaging is particularly challenging in the post-treatment neck, especially for assessment of residual nodal cancer following chemoradiation. In this regard, functional imaging tools may have some advantages compared to anatomy-based imaging.
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Introduction
Cancers of the head and neck ca
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