OBJECTIVE: To evaluate set-up error for head and neck cancer (HNC) patients according to each neck lymph node (LN) level. And clinical factors affecting set-up error were analyzed.
METHODS: Reference points (RP1, RP2, RP3, and RP4) representing neck LN levels I to IV were designated. These RP were contoured on simulation computed tomography (CT) and cone-beam CT of 89 HNC patients with the same standard. After image registration was performed, movement of each RP was measured. Univariable logistic regression analyses were performed to analyze clinical factors related to measured movements.
RESULTS: The mean value of deviation of all axes was 1.6 mm, 1.3 mm, 1.8 mm, and 1.5 mm for RP1, RP2, RP3, and RP4, respectively. Deviation was over 3 mm in 24 patients. Movement of more than 3 mm was observed only in RP1 and RP3. In RP1, it was related to bite block use. Movement exceeding 3 mm was most frequently observed in RP3. Primary tumor and metastatic LN volume change were clinical factors related to the RP3 movement.
CONCLUSIONS: Planning target volume margin of 4 mm for neck LN level I, 3 mm for neck LN level II, 5 mm for neck LN level III, and 3 mm for neck LN level IV was required to include all movements of each LN level. In patients using bite block, changes in primary tumor volume, and metastatic LN volume were related to significant movement.

Purpose: To assess whether the three-dimensional reconstructions of preoperative computed tomography (CT) scans are helpful for establishing extranodal extension (ENE) in head and neck carcinoma. Approach: Patients with a histological diagnosis of ENE ( pENE + ) were considered \"cases\" and patients with negative histological examination for ENE ( pENE - ) were considered \"controls.\" Cases and controls were divided into two groups: a major nodes (MaN) group (lymph nodes on CT > 15    mm ) and a minor nodes (MiN) group (lymph nodes on CT ≤ 15    mm ). The preoperative CT scans were uploaded to the Anatomage Table and were randomly and blindly provided to the radiologist for assessment. The findings at the Anatomage Table were compared with those of CT and magnetic resonance imaging (MRI) scans. Results: Analysis of data from the MaN group showed that the Anatomage Table had a higher percentage of concordance with histopathological examination (90%) than the CT and MRI scans. The Anatomage Table had 100% sensitivity in identifying all pENE + patients, associated with a lower specificity. The negative predictive value of 100% allowed identification of pENE - patients. In the MiN group, on the other hand, sensitivity was lower, related to a high number of false-negative results. Conclusions: The Anatomage Table could represent a useful tool for preoperatively establishing the extranodal extension of cervical lymph node metastasis.

Cervical metastasis of squamous cell carcinoma from an unknown primary site occurs in approximately 2-4% of head and neck tumor cases. Without identification of the primary site, proper management cannot be achieved, resulting in significant morbidity and a lower cure rate. For the primary site assessment, positron emission tomography/computed tomography (PET/CT) using the radiotracer 18F-fluorodeoxyglucose (FDG) is the imaging modality of choice and has been shown to be superior to CT alone. Here, we report a case of cervical metastasis of squamous cell carcinoma in an 82-year-old man. 18F-FDG PET/CT revealed a tongue-base lesion, although neck CT detected no lesions because of artifacts from dental prosthesis, which was suspected as the primary site. The final diagnosis was confirmed as tongue-base cancer with neck lymph node metastases through biopsy. These results suggest that 18F-FDG PET/CT is a valuable diagnostic tool in patients with cervical metastatic lymph nodes because it can demonstrate primary tumors in patients with dental prosthesis.

This review paper describes the possibilities of visualization of regional lymph nodes using contrast-enhanced ultrasound. Discussed is the experience of contrast-enhanced ultrasound implication for differential diagnosis of regional metastases of squamous cell carcinoma of the oral mucosa. The basics of the technique of contrast-enhanced ultrasound examination of the neck lymphatic basin are described.
В данной работе представлено описание возможностей визуализации регионарных лимфоузлов с применением контрастно-усиленного ультразвука. Обсуждается опыт применения контрастно-усиленного ультразвука в дифференциальной диагностике регионарных метастазов плоскоклеточного рака слизистой полости рта. Описываются основы методики технического и клинического обеспечения выполнения контрастно-усиленного ультразвука для обследования лимфоаппарата шеи.

Objective: To evaluate the diagnostic value of DWI in assessment of metastatic neck lymph node in a sample of Iranian patients with Head and Neck cancer. Methods: 25 patients with 80 neck lymph nodes were analyzed using 1.5 T MRI. DWI was performed with b values of 0 and 1,000 s/mm2. Short axis diameter and ADC values (min, max and mean) were calculated for metastatic and non-metastatic neck LNs and results were compared with histopathological findings. The optimal ADC thresholds were analyzed using receiver coefficient characteristic (ROC) curves for discriminating between metastatic and benign neck lymph nodes. Result: Histopathological findings revealed that there are 45% (n=36) metastatic and 55% (n=44) non-metastatic neck LNs respectively. There was no statistically significant difference in short axis diameter between the two groups (p = 0.346). However, The ADC values of metastatic neck LNs were significantly lower than those of non-metastatic neck LNs (p < 0.001); 0.90 ± 0.10 × 10-3 mm2/s vs 1.06 ± 0.12 × 10-3 mm2/s ( ADC mean ), 0.78 ± 0.08 × 10-3 mm2/s vs 0.92 ± 0.20× 10-3 mm2/s ( ADC min ) and 1.02 ± 0.12 × 10-3 mm2/s vs 1.24 ± 0.15 × 10-3 mm2/s (ADC max ). The optimal mean ADC threshold value was equal to 0.996 × 10-3 mm2/s for differentiating malignant from benign lymph nodes with sensitivity, specificity and accuracy of 80.56 %, 77.27 % and 71.59 % respectively. Conclusion: MR diffusion imaging and ADC values as a non-invasive technique can assess metastatic neck LNs in head and neck cancer with higher sensitivity, specificity and accuracy.

OBJECTIVE: Epidemiological and clinical analysis of lymphoid tissue neoplasms in the neck region over a 15-year period.
METHODS: There was performed retrospective analysis of 97 patients, aged 17 to 88 years, mean age of 60.3 years. The analysis included data from subjective study, physical examination, image and histopathological studies Results: Almost all cases were lymphoid neoplasms - 95 patients (98%). B cell lymphoma was the most commonly diagnosed lymphoma - 74 cases (76%), followed by Hodgkin's lymphoma- 19 cases (20%). Only two patients had T-cell lymphoma (2%). There was observed prevalence among women, K: M ratio for the whole group was 51: 46, while male predominance was reported in Hodgkin's lymphoma patients (K: M = 7: 12). Over the 15-year period, there was an increase in the number of lymphoid tumors. The most common location on the neck were lymph nodes - 71 (73.2%). Extranodal localizations (26.8%) were most often associated with salivary glands: parotid and submandibular involvement and with the dominant lymphoma of the marginal zone MALT (14 cases). In 57% of patients the fine needle aspiration biopsy (FNAB) results were false, with positive results only in 32% of patients.
CONCLUSIONS: Tumors from lymphoid tissue in the neck region are most commonly B-cell lymphomas or Hodgkin,s lymphomas. Non-specific clinical signs and non-specific radiological images, as well as non-diagnostic results o FNAB, make it difficult to effectively differentiate lymphomas with cancer metastasis in neck lymph nodes. Histopathology results of the excised lymph nodes remains a standard for lymphoma diagnosis.

BACKGROUND: We sought to validate the consensus recommendation and assess dosimetric significance of selective omission of nodal level V from intensity-modulated radiotherapy (IMRT) clinical target volume (CTV) for oropharyngeal cancer.
METHODS: IMRT plans and clinical outcomes for 112 patients with oropharyngeal cancer (nodal classification N0-N2b) were analyzed for coverage of ipsilateral and contralateral nodal level V. Additionally, new IMRT plans were generated in 6 randomly selected patients to assess its dosimetric impact.
RESULTS: With median follow-up of 3.4 years, there were no failures identified in nodal level V with or without nodal level V omission. Upon dosimetric evaluation, significant reduction in integral dose, V10 Gy , V20 Gy , V30 Gy , V40 Gy , and V50 Gy was observed by excluding unilateral and bilateral level V from the CTV.
CONCLUSIONS: We clinically validate the consensus recommendation for selective omission of level V nodal coverage in IMRT planning of patients with oropharyngeal cancer and demonstrate significant dosimetric advantages.