Imaging-based nodal classification for evaluation of neck metastatic adenopathy

OBJECTIVE, This study was undertaken to create an imaging-based classificat ion for the lymph nodes of the neck that will be readily accepted by clinic ians, result in consistent nodal classification, and be easily used by radi ologists. SUBJECTS AND METHODS. Over an 18-month period, the necks of 50 patients wit h cervical lymphadenopathy were scanned with CT, MR imaging, or both. Imagi ng anatomic landmarks were sought that would create a nodal classification of these necks similar to the clinically based nodal classifications of the American Joint Committee on Cancer and the American Academy of Otolaryngol ogy-Head and Neck Surgery. Each nodal level was defined to ensure consisten t nodal classification and eliminate areas of confusion existing in the cli nically based classifications. RESULTS, Necks were classified using the imaging-based classification and t hen compared with the classification of the same necks using the most commo n clinically based classifications. The imaging-based nodal classifications of the superficial nodes were the same as the clinically based classificat ions; however, the deep nodes of eight patients were found only by imaging. The anatomic precision and the level definition afforded by sectional imag ing allowed the radiologists to use the imaging-based classification in a c onsistent manner, CONCLUSION. This imaging-based classification has been endorsed by clinicia ns who specialize in head and neck cancer. The boundaries of the nodal leve ls were easily discerned by radiologists and yielded consistent nodal class ifications. The reproducibility of this classification will allow it to bec ome an essential component of future classifications of metastatic neck dis ease.