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Nodal metastases of nasopharyngeal carcinoma: patterns of disease on MRI and FDG PET

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

The patterns of nodal spread of nasopharyngeal carcinoma (NPC) have an important influence on treatment planning, but have not yet been fully addressed. We prospectively used MRI and FDG PET to document the patterns of nodal spread in NPC. One hundred and one patients with newly diagnosed NPC were studied with MRI and FDG PET. On MRI, nodes were considered as metastatic according to criteria regarding size, the presence of nodal necrosis, and extracapsular spread. FDG PET images were interpreted visually, and nodes were considered metastatic if they showed prominent FDG uptake against the background. Nodal metastases were found in 89 of our 101 patients. Analysis of the distributions of nodal metastases in these 89 patients showed that retropharyngeal nodes were less frequently involved than cervical nodes (82.0% vs 95.5%). The vast majority of cervical nodal metastases were to the internal jugular chain, including nodes at levels II, III, and IV, with decreasing incidences of 95.5%, 60.7%, and 34.8%, respectively. Level V nodal involvement was found in 27% of patients. Supraclavicular fossa nodal metastases were not uncommon and occurred in 22.5% of patients. Skip metastases in the lower-level nodes or supraclavicular fossa nodes occurred in 7.9% of patients. Mediastinal and abdominal metastatic adenopathy was present in 4.5% and 3.4% of patients, respectively, and was associated with advanced nodal metastasis in the supraclavicular fossa. Level VI (2.2%), level VII (1.1%), submandibular (2.2%), and parotid (3.4%) nodal metastases were uncommon and were always associated with advanced ipsilateral nodal metastases of the neck. We conclude that the combined use of FDG PET and MRI can comprehensively depict the pattern of nodal metastasis in NPC patients. Nodal metastases principally affected level II nodes, from which lymphatic spread extended down in an orderly manner to involve level III, level IV, and the supraclavicular fossa nodes, or extended posteriorly to involve level V nodes. The frequency of skip metastases was 7.9%. Distant spread to mediastinal or abdominal nodes was found in 3–5% of patients, usually in association with supraclavicular nodal metastases.

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Acknowledgements

This work was supported by grants NSC 92-2314-B-182A-081 from the National Science Council, Taiwan and CMRPG32034 from the Chang Gung Memorial Hospital and University.

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Authors and Affiliations

  1. Department of Diagnostic Radiology, Chang Gung Memorial Hospital Linkou Medical Center, Taiwan

    Shu-Hang Ng & Sheung-Fat Ko

  2. Department of Radiation Oncology, Chang Gung Memorial Hospital Linkou Medical Center, Taiwan

    Joseph Tung-Chieh Chang

  3. Department of Nuclear Medicine, Chang Gung Memorial Hospital Linkou Medical Center, 5 Fu-Shin St, 333, Kueishan, Taoyuan, Taiwan

    Sheng-Chieh Chan, Yu-Chen Chang & Tzu-Chen Yen

  4. Department of Medical Oncology, Chang Gung Memorial Hospital Linkou Medical Center, Taiwan

    Hung-Ming Wang

  5. Department of Otorhinolaryngology, Chang Gung Memorial Hospital Linkou Medical Center, Taiwan

    Chun-Ta Liao

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  1. Shu-Hang Ng
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  2. Joseph Tung-Chieh Chang
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  4. Sheung-Fat Ko
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  8. Tzu-Chen Yen
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Correspondence to Tzu-Chen Yen.

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Ng, SH., Chang, J.TC., Chan, SC. et al. Nodal metastases of nasopharyngeal carcinoma: patterns of disease on MRI and FDG PET. Eur J Nucl Med Mol Imaging 31, 1073–1080 (2004). https://doi.org/10.1007/s00259-004-1498-9

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  • DOI: https://doi.org/10.1007/s00259-004-1498-9

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