Abstract
The aim of this study was to determine if volume of cervical lymph node measured via computed tomography (CT) could differentiate metastatic from benign lesions in head and neck cancer patients. We conducted a retrospective review of chart and images in a tertiary referring center in Taiwan. Patients with head and neck cancers underwent radical, modified radical or functional neck dissection were enrolled. The CT images before operation were reassessed by a radiologist and were compared with the results of pathological examination. A total of 102 patients were included for final analyses. Most patients were male (n = 96, 94%) and average age was 50.1 years. Although the average nodal volume in patients with cervical metastases was higher than those of patients without cervical metastases, it was not an independent factor associated with cervical metastasis after controlling for other variables; however, central nodal necrosis on enhanced CT image [odds ratio (OR) 18.95, P = 0.008) and minimal axial diameter >7.5 mm (OR 6.868, P = 0.001) were independent factors correlated with cervical metastasis. Therefore, the volume of cervical lymph node measured from CT images cannot predict cervical metastases in head and neck cancer patients. Measurement of minimal axial diameter of the largest lymph node is a simple and more accurate way to predict cervical metastasis instead.
Similar content being viewed by others
References
Choong NW, Cohen EEW (2006) Epidermal growth factor receptor directed therapy in head and neck cancer. Crit Rev Oncol Hematol 57:25–43. doi:10.1016/j.critrevonc.2005.06.002
Liu SA, Tsai WC, Wong YK et al (2006) Nutritional factors and survival of patients with oral cancer. Head Neck 28:998–1007. doi:10.1002/hed.20461
Ferlito A, Rinaldo A, Devaney KO et al (2002) Prognostic significance of microscopic and macroscopic extracapsular spread from metastatic tumor in the cervical lymph nodes. Oral Oncol 38:747–751. doi:10.1016/S1368-8375(02)00052-0
Kraus DH, Joe JK (2003) Neoplasms of the oral cavity and oropharynx. In: Snow JB, Ballenger JJ (eds) Otorhinolaryngology: head and neck surgery, 16th edn. BC Decker, Hamilton, pp 1408–1440
Weissman JL (2003) Building a better mousetrap: the diagnosis of metastatic cervical adenopathy. AJNR Am J Neuroradiol 24:297
van den Brekel MWM, Stel HV, Castelijns JA et al (1990) Cervical lymph node metastasis: assessment of radiologic criteria. Radiology 177:379–384
Sigal R, Vogl T, Casselman J et al (2002) Lymph node metastases from head and neck squamous cell carcinoma: MR imaging with ultrasmall superparamagnetic iron oxide particles (Sinerem MR)—results of a phase-III multicenter clinical trial. Eur Radiol 12:1104–1113. doi:10.1007/s003300101130
de Bondt RBJ, Nelemans PJ, Hofman PAM et al (2007) Detection of lymph node metastases in head and neck cancer: a meta-analysis comparing US, USgFNAC, CT and MR imaging. Eur J Radiol 4:266–272. doi:10.1016/j.ejrad.2007.02.037
Zenk J, Bozzato A, Steinhart H, Greess H, Iro H (2005) Metastatic and inflammatory cervical lymph nodes as analyzed by contrast-enhanced color-coded Doppler ultrasonography: quantitative dynamic perfusion patterns and histopathologic correlation. Ann Otol Rhinol Laryngol 114:43–47
Akoglu E, Dutipek M, Bekis R, Degirmenci B, Ada E, Guneri A (2005) Assessment of cervical lymph node metastasis with different imaging methods in patients with head and neck squamous cell carcinoma. J Otolaryngol 34:384–394. doi:10.2310/7070.2005.34605
Ng SH, Yen TC, Liao CT et al (2005) 18F-FDG PET and CT/MRI in oral cavity squamous cell carcinoma: a prospective study of 124 patients with histologic correlation. J Nucl Med 46:1136–1143
Schoder H, Yeung HW, Gonen M, Kraus D, Larson SM (2004) Head and neck cancer: clinical usefulness and accuracy of PET/CT image fusion. Radiology 231:65–72. doi:10.1148/radiol.2311030271
Chang CC, Chen MK, Liu MT, Wu HK (2002) The effect of primary tumor volumes in advanced T-staged nasopharyngeal tumors. Head Neck 24:940–946. doi:10.1002/hed.10151
Le Tourneau C, Velten M, Jung GM, Bronner G, Flesch H, Borel C (2005) Prognostic indicators for survival in head and neck squamous cell carcinomas: analysis of a series of 621 cases. Head Neck 27:801–808. doi:10.1002/hed.20254
Greene FL, Balch CM, Page DL et al (2002) AJCC cancer staging manual, 6th edn. Springer, Chicago
Som PM, Curtin HD, Mancuso AA (2000) Imaging-based nodal classification for evaluation of neck metastatic adenopathy. AJR 174:837–843
Yousem DM, Som PM, Hackney DB, Schwaibold F, Hendrix RA (1992) Central nodal necrosis and extracapsular neoplastic spread in cervical lymph nodes: MR imaging versus CT. Radiology 182:753–759
Hermans R, Op de beeck K, Van den Bogaert W et al (2001) The relation of CT-determined tumor parameters and local and regional outcome of tonsillar cancer after definitive radiation treatment. Int J Radiat Oncol Biol Phys 50:37–45. doi:10.1016/S0360-3016(00)01559-5
Castelijns JA, van den Brekel MWM (2002) Imaging of lymphadenopathy in the neck. Eur Radiol 12:727–738. doi:10.1007/s003300101102
Morimoto Y, Kurokawa H, Tanaka T et al (2006) Correlation between the incidence of central nodal necrosis in cervical lymph node metastasis and the extent of differentiation in oral squamous cell carcinoma. Dentomaxillofac Radiol 35:18–23. doi:10.1259/dmfr/24536918
Mukherji SK, Armao D, Joshi VM (2001) Cervical nodal metastases in squamous cell carcinoma of the head and neck: shat to expect. Head Neck 23:995–1005. doi:10.1002/hed.1144
Acknowledgment
The authors thank the Biostatistics Task Force of Taichung Veterans General Hospital for statistical analysis consulting.
Conflict of interest statement
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Liang, MT., Chen, C.CC., Wang, CP. et al. The association of lymph node volume with cervical metastatic lesions in head and neck cancer patients. Eur Arch Otorhinolaryngol 266, 883–887 (2009). https://doi.org/10.1007/s00405-008-0818-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00405-008-0818-2