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7 - Neck and distant disease spread

Published online by Cambridge University Press:  24 August 2009

Robert Hermans
Affiliation:
University Hospital Leuven, Belgium
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Summary

Nodal metastases

Background

Cervical nodal metastases have a significant impact on the outcome of patients with squamous cell cancer (SCC) of the head and neck (HNSCC). Nodal metastases are a cause of mortality in patients in whom the primary cancer is controlled, and they increase the risk of distant metastases. Prognosis decreases with increasing nodal stage and overall the rate of cure is halved in those patients with nodal spread. Classification of nodal groups was based originally on anatomical location according to Rouvière and later adapted to surgical levels. These surgical levels have since been translated to radiological levels using anatomical landmarks on axial computed tomography (CT) and are in the process of being adapted to clinical target volumes for image-guided radiotherapy. Both anatomical sites and levels are currently used in clinical practice (Fig. 7.1). Disease within the nodes tends to spread in an orderly fashion down the neck, although skip metastases are found in 5% of patients and routes of spread may be altered by bulky nodal disease and previous treatment. The sites of preferential nodal spread from primary HNSCC are shown inTable 7.1. Staging nodal metastases is performed using the TNM classification set out by the American Joint Committee on Cancer (Table 7.2). For nodal staging purposes, 3 and 6 cm are the important size criteria. Nodal metastases denote advanced stage disease (N1, stage III; N2, stage IV).

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Publisher: Cambridge University Press
Print publication year: 2008

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References

Rouvière, H.. Lymphatic System of the Head and Neck. (Ann Arbor, MI: Edwards Brothers, 1938).Google Scholar
Shah, J. P., Strong, E., Spiro, R. H., et al. Surgical grand rounds: neck dissection – current status and future possibilities. Clin Bull 11 (1981), 25–33.Google ScholarPubMed
Robbins, K. T., Clayman, G, Levine, P. A., For the American Head and Neck Society, American Academy of Otolaryngology-Head and Neck Surgery. 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 (2002), 751–758.CrossRefGoogle ScholarPubMed
Som, P. M., Curtin, H. D., Mancuso, A. A.. Imaging-based classification for evaluation of neck metastatic adenopathy. Am J Roentgenol 174 (2000), 837–844.CrossRefGoogle ScholarPubMed
Levendag, P., Braaksma, M., Coche, E., et al. Rotterdam and Brussels CT-based neck nodal delineation compared with the surgical levels as defined by the American Academy of Otolaryngology-Head and Neck Surgery. Int J Radiat Oncol Biol Phys 58 (2004), 113–123.CrossRefGoogle ScholarPubMed
Greene, F. L., Page, D. L., Fleming, I. D., et al. AJCC Cancer Staging Manual 6th edn. (New York: Springer-Verlag, 2002).CrossRefGoogle Scholar
Curtin, H. D., Ishwaran, H., Mancuso, A. A., et al. Comparison of CT and MR imaging in staging of neck metastases. Radiology 207 (1998), 123–130.CrossRefGoogle Scholar
Brekel, M. W. M., Stel, H. V., Castelijns, J. A., et al. Cervical lymph node metastasis: assessment of radiologic criteria. Radiology 177 (1990), 379–384.CrossRefGoogle ScholarPubMed
Brekel, M. W. M., Castelijns, J. A., Snow, G. B.. The size of lymph nodes in the neck on sonograms as a radiologic criterion for metastasis: how reliable is it?Am J Neuroradiol 19 (1998), 695–700.Google Scholar
Steinkamp, H. J., Cornehl, M., Hosten, N, et al. Cervical lymphadenopathy: ratio of long to short-axis diameter as a predictor of malignancy. Br J Radiol 68 (1995), 266–270.CrossRefGoogle Scholar
King, A. D., Tse, G. M. K., Ahuja, A. T., et al. Comparison of the diagnostic accuracy of CT, MR imaging and US for the detection of necrosis in metastatic neck nodes. Radiology 230 (2004), 720–726.CrossRefGoogle Scholar
King, A. D., Tse, G. M. K., Yuen, E. H. Y., et al. Comparison of CT and MR imaging for the detection of extranodal neoplastic spread in metastatic neck nodes. Eur J Radiol 52 (2004), 264–270.CrossRefGoogle Scholar
Ying, M., Ahuja, A. T., Brook, F., Metreweli, C.. Vascularity and grey-scale sonographic features of normal cervical lymph nodes: variations with nodal size. Clin Radiol 56 (2001), 416–419.CrossRefGoogle ScholarPubMed
Ahuja, A. T., Ying, M., King, A. D., Yuen, E. H. Y.. Lymph node hilus: gray scale and power Doppler sonography of cervical nodes. J Ultrasound Med 20 (2001), 987–992.CrossRefGoogle ScholarPubMed
Ahuja, A. T., Ying, M., Ho, S. S., Metreweli, C.. Distribution of intranodal vessels in differentiating benign from metastatic nodes. Clin Radiol 56 (2001), 197–201.CrossRefGoogle Scholar
Brekel, M. W. M., Castelijns, J. A., Stel, H. V., et al. Occult metastatic neck disease: detection with US and US-guided fine-needle aspiration cytology. Radiology 180 (1991), 457–461.CrossRefGoogle ScholarPubMed
Castelijns, J. A., Brekel, M. W. M.. Imaging of lymphadenopathy in the neck. Eur Radiol 12 (2002), 727–738.CrossRefGoogle Scholar
Brekel, M. W. M., Castelijns, J. A., Stel, H. V., et al. Modern imaging techniques and ultrasound-guided aspiration cytology for the assessment of neck node metastases: a prospective comparative study. Eur Arch Otorhinolaryngol 250 (1993), 11–17.CrossRefGoogle ScholarPubMed
Atula, T. S., Varpula, M. J., Kurki, T. J. I., Klemi, P. J., Grénman, R.. 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 (1997), 152–161.CrossRefGoogle ScholarPubMed
Stuckensen, T., Kovács, A. F., Adams, S., Baum, R. P.. 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 (2000), 319–324.CrossRefGoogle ScholarPubMed
Bondt, R. B. J., Nelemans, P. J., Hofman, P. A. M., et al. Detection of lymph node metastases in head and neck cancer: a meta-analysis comparing US, USgFNAC, CT and MR imaging. Eur J Radiol 64 (2007), 266–272.CrossRefGoogle ScholarPubMed
Weiss, M. H., Harrison, L. B., Isaacs, R. S.. Use of decision analysis in planning a management strategy for the stage N0 neck. Arch Otolaryngol Head Neck Surg 120 (1994), 699–702.CrossRefGoogle ScholarPubMed
Gourin, C. G.. Is selective neck dissection adequate treatment for node-positive disease?Arch Otolaryngol Head Neck Surg 130 (2004), 1431–1434.CrossRefGoogle ScholarPubMed
Brekel, M. W. M., Castelijns, J. A., Reitsma, L. C., et al. Outcome of observing the N0 neck using ultrasonographic-guided cytology for follow-up. Arch Otolaryngol Head Neck Surg 125 (1999), 153–156.CrossRefGoogle ScholarPubMed
Adelstein, D. J., Saxton, J. P., Rybicki, L. A., et al. Multiagent concurrent chemoradiotherapy for locoregionally advanced squamous cell head and neck cancer: mature results from a single institution. J Clin Oncol 24 (2006), 1064–1071.CrossRefGoogle ScholarPubMed
Schoder, H., Yeung, H. W.. Positron emission imaging of head and neck cancer, including thyroid carcinoma. Semin Nucl Med 34 (2004), 180–197.CrossRefGoogle ScholarPubMed
Braams, J. W., Pruim, J, Freling, N. J. M., et al. Detection of lymph node metastases of squamous-cell cancer of the head and neck with FDG-PET and MRI. J Nucl Med 36 (1995), 211–216.Google ScholarPubMed
Kitagawa, Y., Sano, K., Nishizawa, S., et al. FDG-PET for prediction of tumor aggressiveness and response to intra-arterial chemotherapy and radiotherapy in head and neck cancer. Eur J Nucl Med Mol Imaging 30 (2003), 63–71.CrossRefGoogle ScholarPubMed
Maeda, M., Kato, H., Sakuma, H., Maier, S. E., Takeda, K.. Usefulness of the apparent diffusion coefficient in line scan diffusion-weighted imaging for distinguishing between squamous cell carcinomas and malignant lymphomas of the head and neck. Am J Neuroradiol 26 (2005), 1186–1192.Google ScholarPubMed
Razek, A. A. Abdel, Soliman, N. Y., Elkhamary, S., Alsharaway, M. K., Tawfik, A.. Role of diffusion-weighted MR imaging in cervical lymphadenopathy. Eur Radiol 16 (2006), 1468–1477.CrossRefGoogle ScholarPubMed
King, A. D., Ahuja, A. T., Yeung, D. K., et al. Malignant cervical lymphadenopathy: diagnostic accuracy of diffusion-weighted MRI imaging. Radiology 245 (2007), 806–813.CrossRefGoogle Scholar
Fischbein, N. J., Noworolski, S. M., Henry, R. G., et al. Assessment of metastatic cervical adenopathy using dynamic contrast-enhanced MR imaging. Am J Neuroradiol 24 (2003), 301–311.Google ScholarPubMed
Tomura, N., Omachi, K., Sakuma, I., et al. Dynamic contrast-enhanced magnetic resonance imaging in radiotherapeutic efficacy in the head and neck tumors. Am J Otolaryngol 26 (2005), 163–167.CrossRefGoogle ScholarPubMed
Hoskin, P. J., Saunders, M. I., Goodchild, K., et al. Dynamic contrast enhanced magnetic resonance scanning as a predictor of response to accelerated radiotherapy for advanced head and neck cancer. Br J Radiol 72 (1999), 1093–1098.CrossRefGoogle ScholarPubMed
Mukherji, S. K., Schiro, S., Castillo, M., et al. Proton MR spectroscopy of squamous cell carcinoma of the extracranial head and neck. Am J Neuroradiol 18 (1997), 1057–1072.Google ScholarPubMed
Sigal, R., Vogl, T., Casselman, J., et al. 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 (2002), 1104–1113.CrossRefGoogle ScholarPubMed
Dennington, M. L., Carter, D. R., Meyers, A. D.. Distant metastases in head and neck epidermoid carcinoma. Laryngoscope 90 (1980), 196–201.CrossRefGoogle ScholarPubMed
Bree, R., Deurloo, E. E., Snow, G. B., Leemans, C. R.. Screening for distant metastases in patients with head and neck cancer. Laryngoscope 110 (2000), 397–401.CrossRefGoogle ScholarPubMed
Calhourn, K. H., Fulmer, P., Weiss, R., Hokanson, J. A.. Distant metastases from head and neck squamous cell carcinomas. Laryngoscope 104 (1994), 1199–1205.Google Scholar
Houghton, D. J., Hughes, M. L., Garvey, C., et al. Role of chest CT scanning in the management of patients presenting with head and neck cancer. Head Neck 20 (1998), 614–618.3.0.CO;2-J>CrossRefGoogle ScholarPubMed
Troell, R. J., Terris, D. J.. Detection of metastases from head and neck cancers. Laryngoscope 105 (1995), 247–250.CrossRefGoogle ScholarPubMed
Leemans, C. R., Tiwari, R., Nauta, J. J. P., Waal, I., Snow, G. B.. Regional lymph node involvement and its significance in the development of distant metastases in head and neck carcinoma. Cancer 71 (1993), 452–456.3.0.CO;2-B>CrossRefGoogle ScholarPubMed
Alvi, A., Johnson, J. T.. Development of distant metastasis after treatment of advanced-stage head and neck cancer. Head Neck 19 (1997), 500–505.3.0.CO;2-2>CrossRefGoogle ScholarPubMed
Kotwall, C., Sako, K., Razack, M. S., Rao, U., Bakamjian, V., Shedd, D. P.. Metastatic patterns in squamous cell cancer of the head and neck. Am J Surg 154 (1987), 439–442.CrossRefGoogle ScholarPubMed
Reiner, B., Siegel, E., Sawyer, R., et al. The impact of routine CT of the chest on the diagnosis and management of newly diagnosed squamous cell carcinoma of the head and neck. Am J Roentgenol 169 (1997), 667–671.CrossRefGoogle ScholarPubMed
Brouwer, J., Bree, R., Hoekstra, O. S., et al. Screening for distant metastases in patients with head and neck cancer: is chest computed tomography sufficient?Laryngoscope 115 (2005), 1813–1817.CrossRefGoogle ScholarPubMed
Brouwer, J., Senft, A., Bree, R., et al. Screening for distant metastases in patients with head and neck cancer: is there a role for (18)FDG-PET?Oral Oncol 42 (2006), 275–280.CrossRefGoogle Scholar
Vansteenkiste, J. F.. Imaging in lung cancer: positron emission tomography scan. Eur Respir J 19 (2002), 49–60.CrossRefGoogle Scholar
Schwartz, D. L., Rajendran, J., Yueh, B., et al. Staging of head and neck squamous cell cancer with extended-field FDG-PET. Arch Otolaryngol Head Neck Surg 129 (2003), 1173–1178.CrossRefGoogle ScholarPubMed
Teknos, T. N., Rosenthal, E. L., Lee, D., Taylor, R., Marn, C. S.. Positron emission tomography in the evaluation of stage III and IV head and neck cancer. Head Neck 23 (2001), 1056–1060.CrossRefGoogle ScholarPubMed
Keyes, J. W., Chen, M. Y., Watson, N. E., et al. FDG PET evaluation of head and neck cancer: value of imaging the thorax. Head Neck 22 (2000), 105–110.3.0.CO;2-N>CrossRefGoogle ScholarPubMed
Haughey, B. H., Gates, G. A., Arfken, C. L., Harvey, J. H.. Meta-analysis of second malignant tumors in head and neck cancer: the case for an endoscopic screening protocol. Ann Otol Rhinol Laryngol 101 (1992), 105–112.CrossRefGoogle ScholarPubMed
Goerres, G. W., Schmid, D. T., Gratz, K. W., Schulthess, G. K., Eyrich, G. K.. Impact of whole body positron emission tomography on initial staging and therapy in patients with squamous cell carcinoma of the oral cavity. Oral Oncol 39 (2003), 547–551.CrossRefGoogle ScholarPubMed
Stokkel, M. P. M., Moons, K. G. M., Broek, F. W. ten, Rijk, P. P., Hordijk, G. J.. 18F-fluorodeoxyglucose dual-head positron emission tomography as a procedure for detecting simultaneous primary tumors in cases of head and neck. Cancer 86 (2000), 2370–2377.3.0.CO;2-B>CrossRefGoogle Scholar

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