Neck Nodal Disease

Part of the Medical Radiology book series (MEDRAD)


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 evaluation and are reliant on anatomic criteria, which are described in this chapter. 18F-FDG PET/CT provides functional information by virtue of tumour hypermetabolism although its role in staging is not established. Neck nodal distribution and nodal staging using the current levels-based and TNM systems respectively are described. Besides N stage, other nodal features demonstrable on imaging, including extracapsular spread and precise location, 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, 18F-FDG PET/CT may have some advantages; currently there is great interest in the development of other functional techniques such as diffusion-weighted MRI.


Nodal Metastasis Sentinel Node Sentinel Node Biopsy Neck Dissection Metastatic Node 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Abdel Razek AA, Soliman NY, Elkhamary S, Alsharaway MK, Tawfik A (2006) Role of diffusion-weighted MR imaging in cervical lymphadenopathy. Eur Radiol 16:1468–1477PubMedCrossRefGoogle Scholar
  2. Abdel Razek AA, Kandeel AY, Soliman N et al (2007) Role of diffusion-weighted echo-planar MR imaging in differentiation of residual or recurrent head and neck tumors and posttreatment changes. Am J Neuroradiol 28:1146–1152PubMedCrossRefGoogle Scholar
  3. Adams S, Baum RP, Stuckensen T, Bitter K, Hor G (1998) Prospective comparison of 18F-FDG PET with conventional imaging modalities (CT, MRI, US) in lymph node staging of head and neck cancer. Eur J Nucl Med 25:1255–1260PubMedCrossRefGoogle Scholar
  4. Ahuja A, Ying M (2002) An overview of neck node sonography. Invest Radiol 37:333–342PubMedCrossRefGoogle Scholar
  5. Ahuja AT, Chow L, Chick W, King W, Metreweli C (1995) Metastatic cervical nodes in papillary carcinoma of the thyroid: ultrasound and histological correlation. Clin Radiol 50:229–231PubMedCrossRefGoogle Scholar
  6. Ahuja A, Ying M, King A, Yuen HY (2001a) Lymph node hilus: gray scale and power Doppler sonography of cervical nodes. J Ultrasound Med 20:987–992, quiz 94Google Scholar
  7. Ahuja AT, Ying M, Ho SS, Metreweli C (2001b) Distribution of intranodal vessels in differentiating benign from metastatic neck nodes. Clin Radiol 56:197–201CrossRefGoogle Scholar
  8. Ahuja A, Ying M, Yuen YH, Metrewelli C (2001c) Power Doppler sonography to differentiate tuberculous cervical lymphadenopathy from nasopharyngeal carcinoma. AJNR 22:735–740Google Scholar
  9. Alkureishi LW, Ross GL, Shoaib T et al (2010) Sentinel node biopsy in head and neck squamous cell cancer: 5-year follow-up of a European multicenter trial. Ann Surg Oncol 17:2459–2464PubMedCrossRefGoogle Scholar
  10. Alvarez Amezaga J, Barbier Herrero L, Pijoan del Barrio JI et al (2007) Diagnostic efficacy of sentinel node biopsy in oral squamous cell carcinoma. Cohort study and meta-analysis. Med Oral Patol Oral Cir Bucal 12E:235–243Google Scholar
  11. Alvi A, Johnson JT (1997) Development of distant metastasis after treatment of advanced-stage head and neck cancer. Head Neck 19:500–505PubMedCrossRefGoogle Scholar
  12. Andersen PE, Warren F, Spiro J et al (2002) Results of selective neck dissection in management of the node-positive neck. Arch Otolaryngol Head Neck Surg 128:1180–1184PubMedGoogle Scholar
  13. Apter S, Avigdor A, Gayer G, Portnoy O, Zissin R, Hertz M (2002) Calcification in lymphoma occurring before therapy: CT features and clinical correlation. Am J Roentgenol 178:935–938Google Scholar
  14. Ariji Y, Kimura Y, Hayashi N et al (1998) Power Doppler sonography of cervical lymph nodes in patients with head and neck cancer. Am J Neuroradiol 19:303–307PubMedGoogle Scholar
  15. Armstrong JG, Harrison LB, Thaler HT et al (1992) The indications for elective treatment of the neck in cancer of the major salivary glands. Cancer 69:615–619PubMedCrossRefGoogle Scholar
  16. Atula TS, Varpula MJ, Kurki TJ, Klemi PJ, Grenman R (1997) Assessment of cervical lymph node status in head and neck cancer patients: palpation, computed tomography and low field magnetic resonance imaging compared with ultrasound-guided fine-needle aspiration cytology. Eur J Radiol 25:152–161PubMedCrossRefGoogle Scholar
  17. Bisdas S, Baghi M, Huebner F et al (2007) In vivo proton MR spectroscopy of primary tumours, nodal and recurrent disease of the extracranial head and neck. Eur Radiol 17:251–257PubMedCrossRefGoogle Scholar
  18. Brouwer J, de Bree R, Comans EF, Castelijns JA, Hoekstra OS, Leemans CR (2004) Positron emission tomography using [18F]fluorodeoxyglucose (FDG-PET) in the clinically negative neck: is it likely to be superior? Eur Arch Otorhinolaryngol 261:479–483PubMedCrossRefGoogle Scholar
  19. Brouwer J, Senft A, de Bree R et al (2006) Screening for distant metastases in patients with head and neck cancer: is there a role for (18)FDG-PET? Oral Oncol 42:275–280PubMedCrossRefGoogle Scholar
  20. Bussels B, Hermans R, Reijnders A, Dirix P, Nuyts S, Van den Bogaert W (2006) Retropharyngeal nodes in squamous cell carcinoma of oropharynx: incidence, localization, and implications for target volume. Int J Radiat Oncol Biol Phys 65:733–738PubMedCrossRefGoogle Scholar
  21. Carvalho P, Baldwin D, Carter R, Parsons C (1991) Accuracy of CT in detecting squamous carcinoma metastases in cervical lymph nodes. Clin Radiol 44:79–81PubMedCrossRefGoogle Scholar
  22. Castelijns JA, van den Brekel MW (2002) Imaging of lymphadenopathy in the neck. Eur Radiol 12:727–738PubMedCrossRefGoogle Scholar
  23. Cheson BD, Horning SJ, Coiffier B et al (1999) Report of an international workshop to standardize response criteria for non-Hodgkin’s lymphomas. NCI Sponsored International Working Group. J Clin Oncol 17:1244Google Scholar
  24. Chisin R, Weber AL (1994) Imaging of lymphoma manifestations in the extracranial head and neck region. Leuk Lymphoma 12:177–189PubMedCrossRefGoogle Scholar
  25. Collins SL (1987) Controversies in the management of cancer of the neck. In: Thawley SE, Panje WR (eds) Comprehensive management of head and neck tumours. Saunders, Philadelphia, pp 1386–1443Google Scholar
  26. Collins CD (2006) PET in lymphoma. Cancer Imaging 6S:63–70CrossRefGoogle Scholar
  27. Curtin HD, Ishwaran H, Mancuso AA, Dalley RW, Caudry DJ, McNeil BJ (1998) Comparison of CT and MR imaging in staging of neck metastases. Radiology 207:123–130PubMedGoogle Scholar
  28. de Bondt RB, Nelemans PJ, Hofman PA 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 64:266–272PubMedCrossRefGoogle Scholar
  29. de Bondt RB, Hoeberigs MC, Nelemans PJ et al (2009a) Diagnostic accuracy and additional value of diffusion-weighted imaging for discrimination of malignant cervical lymph nodes in head and neck squamous cell carcinoma. Neuroradiology 51:183–192PubMedCrossRefGoogle Scholar
  30. de Bondt RB, Nelemans PJ, Bakers F et al (2009b) Morphological MRI criteria improve the detection of lymph node metastases in head and neck squamous cell carcinoma: multivariate logistic regression analysis of MRI features of cervical lymph nodes. Eur Radiol 19:626–633PubMedCrossRefGoogle Scholar
  31. de Bree R, Deurloo EE, Snow GB, Leemans CR (2000) Screening for distant metastases in patients with head and neck cancer. Laryngoscope 110:397–401PubMedCrossRefGoogle Scholar
  32. de Bree R, van der Putten L, Brouwer J, Castelijns JA, Hoekstra OS, Leemans CR (2009) Detection of locoregional recurrent head and neck cancer after (chemo)radiotherapy using modern imaging. Oral Oncol 45:386–393PubMedCrossRefGoogle Scholar
  33. Dirix P, Nuyts S, Bussels B, Hermans R, Van den Bogaert W (2006) Prognostic influence of retropharyngeal lymph node metastasis in squamous cell carcinoma of the oropharynx. Int J Radiat Oncol Biol Phys 65:739–744PubMedCrossRefGoogle Scholar
  34. Don DM, Anzai Y, Lufkin RB, Fu YS, Calcaterra TC (1995) Evaluation of cervical lymph node metastases in squamous cell carcinoma of the head and neck. Laryngoscope 105:669–674PubMedCrossRefGoogle Scholar
  35. Dragoni F, Cartoni C, Pescarmona E et al (1999) The role of high resolution pulsed and color Doppler ultrasound in the differential diagnosis of benign and malignant lymphadenopathy: results of multivariate analysis. Cancer 85:2485–2490PubMedCrossRefGoogle Scholar
  36. Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A 3rd (2010) American joint committee on cancer, cancer staging manual, 7th edn. Springer, New YorkGoogle Scholar
  37. Eisenkraft BL, Som PM (1999) The spectrum of benign and malignant etiologies of cervical node calcification. Am J Roentgenol 172:1433–1437Google Scholar
  38. Ferlito A, Shaha AR, Rinaldo A, Mondin V (2001) Management of clinically negative cervical lymph nodes in patients with malignant neoplasms of the parotid gland. J Otorhinolaryngol Relat Spec 63:123–126CrossRefGoogle Scholar
  39. Fischbein NJ, Noworolski SM, Henry RG, Kaplan MJ, Dillon WP, Nelson SJ (2003) Assessment of metastatic cervical adenopathy using dynamic contrast-enhanced MR imaging. Am J Neuroradiol 24:301–311PubMedGoogle Scholar
  40. Frankenthaler RA, Byers RM, Luna MA, Callender DL, Wolf P, Goepfert H (1993) Predicting occult lymph node metastasis in parotid cancer. Arch Otolaryngol Head Neck Surg 119:517–520PubMedCrossRefGoogle Scholar
  41. Freeman SB (2005) Advanced cervical metastasis involving the carotid artery. Curr Opin Otolaryngol Head Neck Surg 13:107–111PubMedCrossRefGoogle Scholar
  42. Friedman M, Roberts N, Kirshenbaum GL, Colombo J (1993) Nodal size of metastatic squamous cell carcinoma of the neck. Laryngoscope 103:854–856PubMedCrossRefGoogle Scholar
  43. Fulcher AS (1993) Cervical lymphadenopathy due to Kikuchi disease: US and CT appearance. J Comput Assist Tomogr 17:131–133PubMedCrossRefGoogle Scholar
  44. Furukawa MK, Furukawa M (2010) Diagnosis of lymph node metastases of head and neck cancer and evaluation of effects of chemoradiotherapy using ultrasonography. Int J Clin Oncol 15:23–32PubMedCrossRefGoogle Scholar
  45. Gormly K, Glastonbury CM (2004) Calcified nodal metastasis from squamous cell carcinoma of the head and neck. Australas Radiol 48:240–242PubMedCrossRefGoogle Scholar
  46. Grabenbauer GG, Steininger H, Meyer M et al (1998) Nodal CT density and total tumor volume as prognostic factors after radiation therapy of stage III/IV head and neck cancer. Radiother Oncol 47:175–183PubMedCrossRefGoogle Scholar
  47. Gritzmann N, Grasl MC, Helmer M, Steiner E (1990) Invasion of the carotid artery and jugular vein by lymph node metastases: detection with sonography. Am J Roentgenol 154:411–414Google Scholar
  48. Hanna E, Wanamaker J, Adelstein D, Tubbs R, Lavertu P (1997) Extranodal lymphomas of the head and neck. A 20-year experience. Arch Otolaryngol Head Neck Surg 123:1318–1323PubMedCrossRefGoogle Scholar
  49. Hicks RJ, Mac Manus MP, Seymour JF (2005) Initial staging of lymphoma with positron emission tomography and computed tomography. Semin Nucl Med 35:165–175PubMedCrossRefGoogle Scholar
  50. Hoft S, Muhle C, Brenner W, Sprenger E, Maune S (2002) Fine-needle aspiration cytology of the sentinel lymph node in head and neck cancer. J Nucl Med 43:1585–1590PubMedGoogle Scholar
  51. Holzapfel K, Duetsch S, Fauser C, Eiber M, Rummeny EJ, Gaa J (2009) Value of diffusion-weighted MR imaging in the differentiation between benign and malignant cervical lymph nodes. Eur J Radiol 72:381–387PubMedCrossRefGoogle Scholar
  52. Hoskin PJ, Saunders MI, Goodchild K, Powell ME, Taylor NJ, Baddeley H (1999) Dynamic contrast enhanced magnetic resonance scanning as a predictor of response to accelerated radiotherapy for advanced head and neck cancer. Br J Radiol 72:1093–1098PubMedGoogle Scholar
  53. Hyde NC, Prvulovich E, Newman L, Waddington WA, Visvikis D, Ell P (2003) A new approach to pre-treatment assessment of the N0 neck in oral squamous cell carcinoma: the role of sentinel node biopsy and positron emission tomography. Oral Oncol 39:350–360PubMedCrossRefGoogle Scholar
  54. Inohara H, Enomoto K, Tomiyama Y et al (2009) The role of CT and (18)F-FDG PET in managing the neck in node-positive head and neck cancer after chemoradiotherapy. Acta Otolaryngol 129:893–899PubMedCrossRefGoogle Scholar
  55. Isles MG, McConkey C, Mehanna HM (2008) A systematic review and meta-analysis of the role of positron emission tomography in the follow up of head and neck squamous cell carcinoma following radiotherapy or chemoradiotherapy. Clin Otolaryngol 33:210–222PubMedCrossRefGoogle Scholar
  56. Johnson JT (1990) A surgeon looks at cervical lymph nodes. Radiology 175:607–610PubMedGoogle Scholar
  57. Kim S, Loevner L, Quon H et al (2009) Diffusion-weighted magnetic resonance imaging for predicting and detecting early response to chemoradiation therapy of squamous cell carcinomas of the head and neck. Clin Cancer Res 15:986–994PubMedCrossRefGoogle Scholar
  58. Kim S, Loevner LA, Quon H et al (2010) Prediction of response to chemoradiation therapy in squamous cell carcinomas of the head and neck using dynamic contrast-enhanced MR imaging. Am J Neuroradiol 31:262–268PubMedCrossRefGoogle Scholar
  59. King AD (2008) Imaging for staging and management of thyroid cancer. Cancer Imaging 8:57–69PubMedCrossRefGoogle Scholar
  60. King AD, Ahuja AT, Metreweli C (1999) MRI of tuberculous cervical lymphadenopathy. J Comput Assist Tomogr 23:244–247PubMedCrossRefGoogle Scholar
  61. King AD, Ahuja AT, Leung SF et al (2000) Neck node metastases from nasopharyngeal carcinoma: MR imaging of patterns of disease. Head Neck 22:275–281PubMedCrossRefGoogle Scholar
  62. King AD, Yeung DK, Ahuja AT, Leung SF, Tse GM, van Hasselt AC (2004a) In vivo proton MR spectroscopy of primary and nodal nasopharyngeal carcinoma. Am J Neuroradiol 25:484–490PubMedGoogle Scholar
  63. King AD, Tse GM, Ahuja AT et al (2004b) Necrosis in metastatic neck nodes: diagnostic accuracy of CT, MR imaging, and US. Radiology 230:720–726PubMedCrossRefGoogle Scholar
  64. King AD, Tse GM, Yuen EH et al (2004c) Comparison of CT and MR imaging for the detection of extranodal neoplastic spread in metastatic neck nodes. Eur J Radiol 52:264–270PubMedCrossRefGoogle Scholar
  65. King AD, Lei KI, Ahuja AT (2004d) MRI of neck nodes in non-Hodgkin’s lymphoma of the head and neck. Br J Radiol 77:111–115PubMedCrossRefGoogle Scholar
  66. King AD, Yeung DK, Ahuja AT et al (2005) Human cervical lymphadenopathy: evaluation with in vivo 1H-MRS at 1.5 T. Clin Radiol 60:592–598PubMedCrossRefGoogle Scholar
  67. King AD, Ahuja AT, Yeung DK et al (2007) Malignant cervical lymphadenopathy: diagnostic accuracy of diffusion-weighted MR imaging. Radiology 245:806–813PubMedCrossRefGoogle Scholar
  68. King AD, Ma BB, Yau YY et al (2008) The impact of 18F-FDG PET/CT on assessment of nasopharyngeal carcinoma at diagnosis. Br J Radiol 81:291–298PubMedCrossRefGoogle Scholar
  69. King AD, Yeung DK, Yu KH et al (2010) Pretreatment and early intratreatment prediction of clinicopathologic response of head and neck cancer to chemoradiotherapy using 1H-MRS. J Magn Reson Imaging 32:199–203PubMedCrossRefGoogle Scholar
  70. Korkmaz H, Yoo GH, Du W et al (2002) Predictors of nodal metastasis in salivary gland cancer. J Surg Oncol 80:186–189PubMedCrossRefGoogle Scholar
  71. Koyama T, Ueda H, Togashi K, Umeoka S, Kataoka M, Nagai S (2004) Radiologic manifestations of sarcoidosis in various organs. Radiographics 24:87–104PubMedCrossRefGoogle Scholar
  72. Krabbe CA, Dijkstra PU, Pruim J et al (2008) FDG PET in oral and oropharyngeal cancer. Value for confirmation of N0 neck and detection of occult metastases. Oral Oncol 44:31–36PubMedCrossRefGoogle Scholar
  73. Kubicek GJ, Champ C, Fogh S et al (2010) FDG-PET staging and importance of lymph node SUV in head and neck cancer. Head Neck Oncol 2:19Google Scholar
  74. Kwee TC, Ludwig I, Uiterwaal CS et al (2010) ADC measurements in the evaluation of lymph nodes in patients with non-Hodgkin lymphoma: feasibility study. MAGMA 24:1–8PubMedCrossRefGoogle Scholar
  75. La Barge DV 3rd, Salzman KL, Harnsberger HR et al (2008) Sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease): imaging manifestations in the head and neck. Am J Roentgenol 191W:299–306CrossRefGoogle Scholar
  76. Labadie RF, Yarbrough WG, Weissler MC, Pillsbury HC, Mukherji SK (2000) Nodal volume reduction after concurrent chemo- and radiotherapy: correlation between initial CT and histopathologic findings. Am J Neuroradiol 21:310–314PubMedGoogle Scholar
  77. Larsen SR, Johansen J, Sorensen JA, Krogdahl A (2009) The prognostic significance of histological features in oral squamous cell carcinoma. J Oral Pathol Med 38:657–662PubMedCrossRefGoogle Scholar
  78. Layland MK, Sessions DG, Lenox J (2005) The influence of lymph node metastasis in the treatment of squamous cell carcinoma of the oral cavity, oropharynx, larynx, and hypopharynx: N0 versus N+. Laryngoscope 115:629–639PubMedCrossRefGoogle Scholar
  79. Leemans CR, Tiwari R, Nauta JJ, van der Waal I, Snow GB (1993) Regional lymph node involvement and its significance in the development of distant metastases in head and neck carcinoma. Cancer 71:452–456PubMedCrossRefGoogle Scholar
  80. Lell M, Baum U, Greess H et al (2000) Head and neck tumors: imaging recurrent tumor and post-therapeutic changes with CT and MRI. Eur J Radiol 33:239–247PubMedCrossRefGoogle Scholar
  81. Liauw SL, Mancuso AA, Amdur RJ et al (2006) Postradiotherapy neck dissection for lymph node-positive head and neck cancer: the use of computed tomography to manage the neck. J Clin Oncol 24:1421–1427PubMedCrossRefGoogle Scholar
  82. Lin D, Glastonbury CM, Rafaelian O, Eisele DW, Wang SJ (2007) Management of advanced nodal disease following chemoradiation for head and neck squamous cell carcinoma: role of magnetic resonance imaging. J Otolaryngol 36:350–356PubMedGoogle Scholar
  83. Lloyd S, Yu JB, Ross DA, Wilson LD, Decker RH (2010) A prognostic index for predicting lymph node metastasis in minor salivary gland cancer. Int J Radiat Oncol Biol Phys 76:169–175PubMedCrossRefGoogle Scholar
  84. Machens A, Hinze R, Thomusch O, Dralle H (2002) Pattern of nodal metastasis for primary and reoperative thyroid cancer. World J Surg 26:22–28PubMedCrossRefGoogle Scholar
  85. Mann WJ, Beck A, Schreiber J, Maurer J, Amedee RG, Gluckmann JL (1994) Ultrasonography for evaluation of the carotid artery in head and neck cancer. Laryngoscope 104:885–888PubMedCrossRefGoogle Scholar
  86. Martinez-Gimeno C, Rodriguez EM, Vila CN, Varela CL (1995) Squamous cell carcinoma of the oral cavity: a clinicopathologic scoring system for evaluating risk of cervical lymph node metastasis. Laryngoscope 105:728–733PubMedCrossRefGoogle Scholar
  87. McMasters KM, Swetter SM (2003) Current management of melanoma: benefits of surgical staging and adjuvant therapy. J Surg Oncol 82:209–216PubMedCrossRefGoogle Scholar
  88. Medina JE (1998) Neck dissection in the treatment of cancer of major salivary glands. Otolaryngol Clin North Am 31:815–822PubMedCrossRefGoogle Scholar
  89. Merritt RM, Williams MF, James TH, Porubsky ES (1997) Detection of cervical metastasis: a meta-analysis comparing computed tomography with physical examination. Arch Otolaryngol Head Neck Surg 123:149–152PubMedCrossRefGoogle Scholar
  90. Moon WK, Han MH, Chang KH et al (1997) CT and MR imaging of head and neck tuberculosis. Radiographics 17:391–402PubMedGoogle Scholar
  91. Mukherji SK, Schiro S, Castillo M, Kwock L, Muller KE, Blackstock W (1997) Proton MR spectroscopy of squamous cell carcinoma of the extracranial head and neck: in vitro and in vivo studies. Am J Neuroradiol 18:1057–1072PubMedGoogle Scholar
  92. Munck JN, Cvitkovic E, Piekarski JD et al (1991) Computed tomographic density of metastatic lymph nodes as a treatment-related prognostic factor in advanced head and neck cancer. J Natl Cancer Inst 83:569–575PubMedCrossRefGoogle Scholar
  93. Myers JN, Greenberg JS, Mo V, Roberts D (2001) Extracapsular spread A significant predictor of treatment failure in patients with squamous cell carcinoma of the tongue. Cancer 92:3030–3036PubMedCrossRefGoogle Scholar
  94. Na DG, Lim HK, Byun HS, Kim HD, Ko YH, Baek JH (1997a) Differential diagnosis of cervical lymphadenopathy: usefulness of color Doppler sonography. Am J Roentgenol 168:1311–1316Google Scholar
  95. Na DG, Chung TS, Byun HS, Kim HD, Ko YH, Yoon JH (1997b) Kikuchi disease: CT and MR findings. Am J Neuroradiol 18:1729–1732PubMedGoogle Scholar
  96. Ng SH, Yen TC, Chang JT et al (2006) Prospective study of [18F]fluorodeoxyglucose positron emission tomography and computed tomography and magnetic resonance imaging in oral cavity squamous cell carcinoma with palpably negative neck. J Clin Oncol 24:4371–4376PubMedCrossRefGoogle Scholar
  97. Nieuwenhuis EJ, Colnot DR, Pijpers HJ et al (2000) Lymphoscintigraphy and ultrasound-guided fine needle aspiration cytology of sentinel lymph nodes in head and neck cancer patients. Recent Results Cancer Res 157:206–217PubMedCrossRefGoogle Scholar
  98. Nieuwenhuis EJ, Castelijns JA, Pijpers R et al (2002) Wait-and-see policy for the N0 neck in early-stage oral and oropharyngeal squamous cell carcinoma using ultrasonography-guided cytology: is there a role for identification of the sentinel node? Head Neck 24:282–289PubMedCrossRefGoogle Scholar
  99. Ojiri H, Mendenhall WM, Stringer SP, Johnson PL, Mancuso AA (2002) Post-RT CT results as a predictive model for the necessity of planned post-RT neck dissection in patients with cervical metastatic disease from squamous cell carcinoma. Int J Radiat Oncol Biol Phys 52:420–428PubMedCrossRefGoogle Scholar
  100. Pfister DG, Ang K, Brockstein B et al (2000) NCCN practice guidelines for head and neck cancers. Oncology (Williston Park) 14:163–194Google Scholar
  101. Pillsbury HC 3rd, Clark M (1997) A rationale for therapy of the N0 neck. Laryngoscope 107:1294–1315PubMedCrossRefGoogle Scholar
  102. Regis De Brito Santos I, Kowalski LP, Cavalcante De Araujo V, Flavia Logullo A, Magrin J (2001) Multivariate analysis of risk factors for neck metastases in surgically treated parotid carcinomas. Arch Otolaryngol Head Neck Surg 127:56–60PubMedGoogle Scholar
  103. Robbins KT, Clayman G, Levine PA et al (2002) Neck dissection classification update: revisions proposed by the American Head and Neck Society and the American Academy of Otolaryngology-Head and Neck Surgery. Arch Otolaryngol Head Neck Surg 128:751–758PubMedGoogle Scholar
  104. Rodriguez-Cuevas S, Labastida S, Baena L, Gallegos F (1995) Risk of nodal metastases from malignant salivary gland tumors related to tumor size and grade of malignancy. Eur Arch Otorhinolaryngol 252:139–142PubMedGoogle Scholar
  105. Roh JL, Yeo NK, Kim JS et al (2007) Utility of 2-[18F] fluoro-2-deoxy-d-glucose positron emission tomography and positron emission tomography/computed tomography imaging in the preoperative staging of head and neck squamous cell carcinoma. Oral Oncol 43:887–893PubMedCrossRefGoogle Scholar
  106. Rosario PW, de Faria S, Bicalho L et al (2005) Ultrasonographic differentiation between metastatic and benign lymph nodes in patients with papillary thyroid carcinoma. J Ultrasound Med 24:1385–1389PubMedGoogle Scholar
  107. Saito A, Takashima S, Takayama F, Kawakami S, Momose M, Matsushita T (2001) Spontaneous extensive necrosis in non-Hodgkin lymphoma: prevalence and clinical significance. J Comput Assist Tomogr 25:482–486PubMedCrossRefGoogle Scholar
  108. Schmitz S, Machiels JP, Weynand B, Gregoire V, Hamoir M (2009) Results of selective neck dissection in the primary management of head and neck squamous cell carcinoma. Eur Arch Otorhinolaryngol 266:437–443PubMedCrossRefGoogle Scholar
  109. Schoder H, Yeung HW (2004) Positron emission imaging of head and neck cancer, including thyroid carcinoma. Semin Nucl Med 34:180–197PubMedCrossRefGoogle Scholar
  110. Schwartz DL, Rajendran J, Yueh B et al (2003) Staging of head and neck squamous cell cancer with extended-field FDG-PET. Arch Otolaryngol Head Neck Surg 129:1173–1178PubMedCrossRefGoogle Scholar
  111. Schwartz DL, Ford E, Rajendran J et al (2005) FDG-PET/CT imaging for preradiotherapy staging of head-and-neck squamous cell carcinoma. Int J Radiat Oncol Biol Phys 61:129–136PubMedCrossRefGoogle Scholar
  112. Senft A, de Bree R, Hoekstra OS (2008) Screening for distant metastases in head and neck cancer patients by chest CT or whole body FDG-PET: a prospective multicenter trial. Radiother Oncol 87:221–229PubMedCrossRefGoogle Scholar
  113. Shear M, Hawkins DM, Farr HW (1976) The prediction of lymph node metastases from oral squamous carcinoma. Cancer 37:1901–1907PubMedCrossRefGoogle Scholar
  114. Shozushima M, Suzuki M, Nakasima T, Yanagisawa Y, Sakamaki K, Takeda Y (1990) Ultrasound diagnosis of lymph node metastasis in head and neck cancer. Dentomaxillofac Radiol 19:165–170PubMedGoogle Scholar
  115. Snow GB, Annyas AA, van Slooten EA, Bartelink H, Hart AA (1982) Prognostic factors of neck node metastasis. Clin Otolaryngol Allied Sci 7:185–192PubMedCrossRefGoogle Scholar
  116. Sobin L, Gospodarowicz M, Wittekind C (2009) International union against cancer. TNM classification of malignant tumours, 7th edn. Wiley-Blackwell, New YorkGoogle Scholar
  117. Som PM, Urken ML, Biller H, Lidov M (1993) Imaging the postoperative neck. Radiology 187:593–603PubMedGoogle Scholar
  118. Som PM, Brandwein M, Lidov M, Lawson W, Biller HF (1994) The varied presentations of papillary thyroid carcinoma cervical nodal disease: CT and MR findings. Am J Neuroradiol 15:1123–1128PubMedGoogle Scholar
  119. Som PM, Curtin HD, Mancuso AA (1999) An imaging-based classification for the cervical nodes designed as an adjunct to recent clinically based nodal classifications. Arch Otolaryngol Head Neck Surg 125:388–396PubMedGoogle Scholar
  120. Souter MA, Allison RS, Clarkson JH, Cowan IA, Coates MH, Wells JE (2009) Sensitivity and specificity of computed tomography for detection of extranodal spread from metastatic head and neck squamous cell carcinoma. J Laryngol Otol 123:778–782PubMedCrossRefGoogle Scholar
  121. Steinkamp HJ, Maurer J, Cornehl M, Knobber D, Hettwer H, Felix R (1994) Recurrent cervical lymphadenopathy: differential diagnosis with color-duplex sonography. Eur Arch Otorhinolaryngol 251:404–409PubMedCrossRefGoogle Scholar
  122. Steinkamp HJ, Cornehl M, Hosten N, Pegios W, Vogl T, Felix R (1995) Cervical lymphadenopathy: ratio of long- to short-axis diameter as a predictor of malignancy. Br J Radiol 68:266–270PubMedCrossRefGoogle Scholar
  123. Steinkamp HJ, van der Hoeck E, Bock JC, Felix R (1999) The extracapsular spread of cervical lymph node metastases: the diagnostic value of computed tomography. Rofo 170:457–462PubMedGoogle Scholar
  124. Steinkamp HJ, Beck A, Werk M, Felix R (2002) Extracapsular spread of cervical lymph node metastases: diagnostic value of magnetic resonance imaging. Rofo 174:50–55PubMedCrossRefGoogle Scholar
  125. Stennert E, Kisner D, Jungehuelsing M et al (2003) High incidence of lymph node metastasis in major salivary gland cancer. Arch Otolaryngol Head Neck Surg 129:720–723PubMedCrossRefGoogle Scholar
  126. Stuckensen T, Kovacs AF, Adams S, Baum RP (2000) Staging of the neck in patients with oral cavity squamous cell carcinomas: a prospective comparison of PET, ultrasound, CT and MRI. J Craniomaxillofac Surg 28:319–324PubMedCrossRefGoogle Scholar
  127. Sumi M, Sakihama N, Sumi T et al (2003) Discrimination of metastatic cervical lymph nodes with diffusion-weighted MR imaging in patients with head and neck cancer. Am J Neuroradiol 24:1627–1634PubMedGoogle Scholar
  128. Syed R, Bomanji JB, Nagabhushan N et al (2005) Impact of combined (18)F-FDG PET/CT in head and neck tumours. Br J Cancer 92:1046–1050PubMedCrossRefGoogle Scholar
  129. Tankere F, Camproux A, Barry B, Guedon C, Depondt J, Gehanno P (2000) Prognostic value of lymph node involvement in oral cancers: a study of 137 cases. Laryngoscope 110:2061–2065PubMedCrossRefGoogle Scholar
  130. Terhaard CH, Lubsen H, Van der Tweel I, et al (2004) Salivary gland carcinoma: independent prognostic factors for locoregional control, distant metastases, and overall survival: results of the Dutch head and neck oncology cooperative group. Head Neck 26:681–692 (discussion 92–93)Google Scholar
  131. Traynor SJ, Cohen JI, Gray J, Andersen PE, Everts EC (1996) Selective neck dissection and the management of the node-positive neck. Am J Surg 172:654–657PubMedCrossRefGoogle Scholar
  132. van den Brekel MW, Stel HV, Castelijns JA et al (1990) Cervical lymph node metastasis: assessment of radiologic criteria. Radiology 177:379–384PubMedGoogle Scholar
  133. van den Brekel MW, Stel HV, Castelijns JA, Croll GJ, Snow GB (1991) Lymph node staging in patients with clinically negative neck examinations by ultrasound and ultrasound-guided aspiration cytology. Am J Surg 162:362–366PubMedCrossRefGoogle Scholar
  134. van den Brekel MW, Stel HV, van der Valk P, van der Waal I, Meyer CJ, Snow GB (1992) Micrometastases from squamous cell carcinoma in neck dissection specimens. Eur Arch Otorhinolaryngol 249:349–353PubMedCrossRefGoogle Scholar
  135. van den Brekel MW, Castelijns JA, Stel HV, Golding RP, Meyer CJ, Snow GB (1993) Modern imaging techniques and ultrasound-guided aspiration cytology for the assessment of neck node metastases: a prospective comparative study. Eur Arch Otorhinolaryngol 250:11–17PubMedCrossRefGoogle Scholar
  136. van den Brekel MW, van der Waal I, Meijer CJ, Freeman JL, Castelijns JA, Snow GB (1996) The incidence of micrometastases in neck dissection specimens obtained from elective neck dissections. Laryngoscope 106:987–991PubMedCrossRefGoogle Scholar
  137. van den Brekel MW, Castelijns JA, Snow GB (1998a) The size of lymph nodes in the neck on sonograms as a radiologic criterion for metastasis: how reliable is it? Am J Neuroradiol 19:695–700PubMedGoogle Scholar
  138. van den Brekel MW, Pameijer FA, Koops W, Hilgers FJ, Kroon BB, Balm AJ (1998b) Computed tomography for the detection of neck node metastases in melanoma patients. Eur J Surg Oncol 24:51–54PubMedCrossRefGoogle Scholar
  139. van den Brekel MW, Castelijns JA, Reitsma LC, Leemans CR, van der Waal I, Snow GB (1999) Outcome of observing the N0 neck using ultrasonographic-guided cytology for follow-up. Arch Otolaryngol Head Neck Surg 125:153–156PubMedGoogle Scholar
  140. Vandecaveye V, De Keyzer F, Vander Poorten V et al (2009) Head and neck squamous cell carcinoma: value of diffusion-weighted MR imaging for nodal staging. Radiology 251:134–146PubMedCrossRefGoogle Scholar
  141. Vandecaveye V, Dirix P, De Keyzer F et al (2010) Predictive value of diffusion-weighted magnetic resonance imaging during chemoradiotherapy for head and neck squamous cell carcinoma. Eur Radiol 20:1703–1714PubMedCrossRefGoogle Scholar
  142. Vandecaveye V, Dirix P, De Keyzer F et al (2011) Diffusion weighted magnetic resonance imaging early after (chemo) radiotherapy to monitor treatment response in head and neck squamous cell carcinoma. Int J Radiat Oncol Biol Phys [Epub ahead of print]Google Scholar
  143. Vassallo P, Wernecke K, Roos N, Peters PE (1992) Differentiation of benign from malignant superficial lymphadenopathy: the role of high-resolution US. Radiology 183:215–220PubMedGoogle Scholar
  144. Wang HM, Ng SH, Wang CH, Liaw CC, Tsai MH, Lai GM (1996) Correlation between computed tomographic density of lymph node metastases and response to cisplatin-based chemotherapy in patients with head and neck squamous cell carcinoma in an area in which betel quid chewing is prevalent. Cancer 78:1972–1979PubMedCrossRefGoogle Scholar
  145. Wang P, Yu Q, Shi H (1999) CT findings of non-Hodgkin lymphoma in the head and neck. Zhonghua Kou Qiang Yi Xue Za Zhi 34:208–210PubMedGoogle Scholar
  146. Weiss MH, Harrison LB, Isaacs RS (1994) Use of decision analysis in planning a management strategy for the stage N0 neck. Arch Otolaryngol Head Neck Surg 120:699–702PubMedCrossRefGoogle Scholar
  147. Wong RJ (2008) Current status of FDG-PET for head and neck cancer. J Surg Oncol 97:649–652PubMedCrossRefGoogle Scholar
  148. Wong RJ, Lin DT, Schoder H et al (2002) Diagnostic and prognostic value of [(18)F]fluorodeoxyglucose positron emission tomography for recurrent head and neck squamous cell carcinoma. J Clin Oncol 20:4199–4208PubMedCrossRefGoogle Scholar
  149. Wu CH, Chang YL, Hsu WC, Ko JY, Sheen TS, Hsieh FJ (1998) Usefulness of Doppler spectral analysis and power Doppler sonography in the differentiation of cervical lymphadenopathies. Am J Roentgenol 171:503–509Google Scholar
  150. Xu W, Liu D, Lu Z (1998) CT scanning of the cervical lymph node metastases: compared with histologic sections. Lin Chuang Er Bi Yan Hou Ke Za Zhi 12:99–102PubMedGoogle Scholar
  151. Yao M, Graham MM, Smith RB et al (2004) Value of FDG PET in assessment of treatment response and surveillance in head-and-neck cancer patients after intensity modulated radiation treatment: a preliminary report. Int J Radiat Oncol Biol Phys 60:1410–1418PubMedCrossRefGoogle Scholar
  152. Yeung AR, Liauw SL, Amdur RJ et al (2008) Lymph node-positive head and neck cancer treated with definitive radiotherapy: can treatment response determine the extent of neck dissection? Cancer 112:1076–1082PubMedCrossRefGoogle Scholar
  153. Ying M, Ahuja A, Metreweli C (1998) Diagnostic accuracy of sonographic criteria for evaluation of cervical lymphadenopathy. J Ultrasound Med 17:437–445PubMedGoogle Scholar
  154. Ying M, Ahuja A, Brook F, Metreweli C (2001) Vascularity and grey-scale sonographic features of normal cervical lymph nodes: variations with nodal size. Clin Radiol 56:416–419PubMedCrossRefGoogle Scholar
  155. Yoo GH, Hocwald E, Korkmaz H et al (2000) Assessment of carotid artery invasion in patients with head and neck cancer. Laryngoscope 110:386–390PubMedCrossRefGoogle Scholar
  156. Yousem DM, Hatabu H, Hurst RW et al (1995) Carotid artery invasion by head and neck masses: prediction with MR imaging. Radiology 195:715–720PubMedGoogle Scholar
  157. Yusa H, Yoshida H, Iwasa S et al (2000) Ultrasonographic assessment for response to radiochemotherapy of metastatic cervical lymph nodes in head and neck cancer: usefulness of grey-scale and color doppler sonography. Ultrasound Med Biol 26:1081–1087PubMedCrossRefGoogle Scholar

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© Springer-Verlag Berlin Heidelberg 2011

Authors and Affiliations

  1. 1.Department of Diagnostic Radiology and Organ Imaging, Faculty of MedicinePrince of Wales Hospital, The Chinese University of Hong KongNew TerritoriesHong Kong SAR, China

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