Chapter 2 Squamous Cell Carcinoma of the Head and Neck-Imaging Evaluation of Regional Lymph Nodes and Implications for Management.

The presence of cervical lymph node metastases is a major prognostic factor in squamous cell carcinoma of the head and neck. The presence of a solitary ipsilateral metastatic lymph node reduces expected survival by almost 50%, and the presence of regional metastatic nodes at the time of presentation is the strongest predictor of recurrence or the development of distant metastases or both. Therefore, accurate identification of metastatic cervical lymph nodes is essential for staging and treatment planning. Pretreatment imaging is important for identifying clinically occult pathologic nodes as well as delineating nodal size and morphologic characteristics used in staging. The role of imaging and its implications for management are reviewed, with emphasis on the traditional modalities and imaging criteria, including evaluation for extranodal extension.