An imaging-based classification for the cervical nodes designed as an adjunct to recent clinically based nodal classifications

Over the past 18 years, numerous classifications have been proposed to dist inguish among the diverse nodal levels. Some classifications have used surg ical landmarks, others physical assessment criteria. These classifications do not agree precisely and exhibit sufficient variation that competent phys icians could arrive at slightly different staging of the patient's nodal di sease. In the past 2 decades, computed tomography and magnetic resonance im aging have offered progressively more refined anatomical precision, reprodu cibility, and visualization of deep, clinically inaccessible structures. Be cause the majority of patients with head and neck malignancies presently un dergo sectional imaging prior to treatment planning, we felt: a need to int egrate anatomical imaging criteria with the 2 most commonly used nodal clas sifications: those of the American Joint Committee on Cancer and those of t he American Academy of Otolaryngology-Head and Neck Surgery. The imaging-ba sed nodal classification proposed herein has been developed in. consultatio n with surgeons interested in such classifications in the hope that the res ultant classification would find ready acceptance by both clinicians and im agers. It is our desire that the best attributes of imaging, combined with those of the physical assessment, can result in a better and more consisten tly reproducible nodal staging than is possible by either approach alone.