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Nodal Dissection in Neck
Patricia A. Hudgins, MD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Clinical Issues

        TERMINOLOGY

        • Abbreviations

          • Neck dissection (ND)
            • Selective neck dissection (SND)
            • Modified (radical) neck dissection (MND)
            • Radical neck dissection (RND)
        • Synonyms

          • Cervical lymph node dissection
        • Definitions

          • SND
            • Most common surgical dissection performed for H&N cancer
            • Resection of known or potential nodal levels while preserving functional, nonlymphatic structures
              • SND (I-III): Resection of nodes in levels I, II, III (supraomohyoid SND)
                • Performed in patients with oral cavity squamous cell carcinoma (SCCa)
                • Submandibular gland (SMG) usually resected with level IB nodes
              • SND (II-IV): Resection of nodes in levels II-IV (lateral SND)
                • Performed in patients with laryngeal and pharyngeal cancer
              • SND (II-V): Resection of nodes in levels II-V (posterolateral SND)
              • SND (VI): Resection of nodes in level VI only (central ND)
                • Performed in patients with thyroid carcinoma
          • MND
            • Resection of all nodes in levels I or II-V and preservation ≥ 1 nonlymphatic structure [internal jugular vein (IJV), sternocleidomastoid muscle (SCM), or CNXI]
          • RND
            • Resection of nodal levels I or II-V and IJV, SCM, & CNXI
              • SMG resected with level I nodes
          • Extended neck dissection (END)
            • RND + removal of additional structures
              • e.g., carotid artery

        IMAGING

        • General Features

          • Imaging Recommendations

            • CT Findings

              • MR Findings

                • Ultrasonographic Findings

                  • Nuclear Medicine Findings

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        • Gross Pathologic & Surgical Features

                          • Microscopic Features

                            CLINICAL ISSUES

                            • Presentation

                              • Demographics

                                • Natural History & Prognosis

                                  • Treatment

                                    DIAGNOSTIC CHECKLIST

                                    • Consider

                                      • Image Interpretation Pearls

                                        • Reporting Tips

                                          Selected References

                                          1. Fleischman GM et al: Accuracy of ultrasonography-guided fine-needle aspiration in detecting persistent nodal disease after chemoradiotherapy. JAMA Otolaryngol Head Neck Surg. 142(4):377-82, 2016
                                          2. Kito S et al: Alterations in 18F-FDG accumulation into neck-related muscles after neck dissection for patients with oral cancers. Med Oral Patol Oral Cir Bucal. 21(3):e341-8, 2016
                                          3. Malik A et al: Prospective study of the pattern of lymphatic metastasis in relation to the submandibular gland in patients with carcinoma of the oral cavity. Head Neck. ePub, 2016
                                          4. Mehanna H et al: PET-CT surveillance versus neck dissection in advanced head and neck cancer. N Engl J Med. 374(15):1444-54, 2016
                                          5. Motiee-Langroudi M et al: Occult level IV metastases in clinically node-negative patients with oral tongue squamous cell carcinoma. J Laryngol Otol. 130(5):474-7, 2016
                                          6. Patel TD et al: Efficacy of elective neck dissection in T1/T2N0M0 oral tongue squamous cell carcinoma: a population-based analysis. Otolaryngol Head Neck Surg. ePub, 2016
                                          7. Tang L et al: When should elective neck dissection be performed in maxillary gingival and alveolar squamous cell carcinoma with a cN0 neck? A systematic review. Int J Oral Maxillofac Surg. ePub, 2016
                                          8. Wang K et al: Impact of post-chemoradiotherapy superselective/selective neck dissection on patient reported quality of life. Oral Oncol. 58:21-6, 2016
                                          9. Ferris R et al: American Thyroid Association Consensus Review of the anatomy, terminology and rationale for lateral neck dissection in differentiated thyroid cancer. Thyroid. 22(5) 501-8, 2012
                                          10. Givi B et al: Selective neck dissection in node-positive squamous cell carcinoma of the head and neck. Otolaryngol Head Neck Surg. 147(4)707-15, 2012
                                          11. Kang SW et al: A comparative study of the surgical outcomes of robotic and conventional open modified radical neck dissection for papillary thyroid carcinoma with lateral neck node metastasis. Surg Endosc. 26(11):3251-7, 2012
                                          12. Mulla MG et al: Lateral cervical lymph node metastases in papillary thyroid cancer: a systematic review of imaging-guided and prophylactic removal of the lateral compartment. Clin Endocrinol (Oxf). 77(1):126-31, 2012
                                          13. Stack BC Jr et al: American Thyroid Association consensus review and statement regarding the anatomy, terminology, and rationale for lateral neck dissection in differentiated thyroid cancer. Thyroid. 22(5):501-8, 2012
                                          14. Veenstra HJ et al: Lymphatic drainage patterns from melanomas on the shoulder or upper trunk to cervical lymph nodes and implications for the extent of neck dissection. Ann Surg Oncol. 19(12):3906-12, 2012
                                          15. Wiegand S et al: Prevalence of level V metastases in node-positive head and neck squamous cell carcinoma. Anticancer Res. 31(11):3959-61, 2011
                                          16. Malone J et al: Neck dissection after chemoradiation for carcinoma of the upper aerodigestive tract: indications and complications. Curr Opin Otolaryngol Head Neck Surg. 18(2):89-94, 2010
                                          17. Pisello F et al: Neck node dissection in thyroid cancer. A review. G Chir. 31(3):112-8, 2010
                                          18. Shepard PM et al: Therapeutic selective neck dissection outcomes. Otolaryngol Head Neck Surg. 142(5):741-6, 2010
                                          19. Teymoortash A et al: Postoperative morbidity after different types of selective neck dissection. Laryngoscope. 120(5):924-9, 2010
                                          20. Carr SD et al: Upper limb dysfunction following selective neck dissection: a retrospective questionnaire study. Head Neck. 31(6):789-92, 2009
                                          21. Celik B et al: Accessory nerve function after level 2b-preserving selective neck dissection. Head Neck. 31(11):1496-501, 2009
                                          22. Da Mosto MC et al: Pattern of lymph node metastases in squamous cell carcinoma of the tonsil: implication for selective neck dissection. Oral Oncol. 45(3):212-7, 2009
                                          23. Hillel AT et al: Selective versus comprehensive neck dissection after chemoradiation for advanced oropharyngeal squamous cell carcinoma. Otolaryngol Head Neck Surg. 141(6):737-42, 2009
                                          24. Lim YC et al: Therapeutic selective neck dissection (level II-V) for node-positive hypopharyngeal carcinoma: is it oncologically safe? Acta Otolaryngol. 129(1):57-61, 2009
                                          25. Mukhija V et al: Selective neck dissection following adjuvant therapy for advanced head and neck cancer. Head Neck. 31(2):183-8, 2009
                                          26. Pagedar NA et al: Selective neck dissection: a review of the evidence. Oral Oncol. 45(4-5):416-20, 2009
                                          27. Schiefke F et al: Function, postoperative morbidity, and quality of life after cervical sentinel node biopsy and after selective neck dissection. Head Neck. 31(4):503-12, 2009
                                          28. Schmitz S et al: Results of selective neck dissection in the primary management of head and neck squamous cell carcinoma. Eur Arch Otorhinolaryngol. 266(3):437-43, 2009
                                          29. Varghese BT et al: Treatment outcome in patients undergoing surgery for carcinoma larynx and hypopharynx: a follow-up study. Acta Otolaryngol. 129(12):1480-5, 2009
                                          30. Christopoulos A et al: Neck dissection following concurrent chemoradiation for advanced head and neck carcinoma: pathologic findings and complications. J Otolaryngol Head Neck Surg. 37(4):452-6, 2008
                                          31. Hoyt BJ et al: IIb or not IIb: oncologic role of submuscular recess inclusion in selective neck dissections. J Otolaryngol Head Neck Surg. 37(5):689-93, 2008
                                          32. Patel RS et al: Effectiveness of selective neck dissection in the treatment of the clinically positive neck. Head Neck. 30(9):1231-6, 2008
                                          33. Santoro R et al: Nodal metastases at level IIb during neck dissection for head and neck cancer: clinical and pathologic evaluation. Head Neck. 30(11):1483-7, 2008
                                          34. Hudgins PA et al: Selective neck dissection: CT and MR imaging findings. AJNR Am J Neuroradiol. 26(5):1174-7, 2005
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Terminology

                                            • Imaging

                                              • Clinical Issues

                                                TERMINOLOGY

                                                • Abbreviations

                                                  • Neck dissection (ND)
                                                    • Selective neck dissection (SND)
                                                    • Modified (radical) neck dissection (MND)
                                                    • Radical neck dissection (RND)
                                                • Synonyms

                                                  • Cervical lymph node dissection
                                                • Definitions

                                                  • SND
                                                    • Most common surgical dissection performed for H&N cancer
                                                    • Resection of known or potential nodal levels while preserving functional, nonlymphatic structures
                                                      • SND (I-III): Resection of nodes in levels I, II, III (supraomohyoid SND)
                                                        • Performed in patients with oral cavity squamous cell carcinoma (SCCa)
                                                        • Submandibular gland (SMG) usually resected with level IB nodes
                                                      • SND (II-IV): Resection of nodes in levels II-IV (lateral SND)
                                                        • Performed in patients with laryngeal and pharyngeal cancer
                                                      • SND (II-V): Resection of nodes in levels II-V (posterolateral SND)
                                                      • SND (VI): Resection of nodes in level VI only (central ND)
                                                        • Performed in patients with thyroid carcinoma
                                                  • MND
                                                    • Resection of all nodes in levels I or II-V and preservation ≥ 1 nonlymphatic structure [internal jugular vein (IJV), sternocleidomastoid muscle (SCM), or CNXI]
                                                  • RND
                                                    • Resection of nodal levels I or II-V and IJV, SCM, & CNXI
                                                      • SMG resected with level I nodes
                                                  • Extended neck dissection (END)
                                                    • RND + removal of additional structures
                                                      • e.g., carotid artery

                                                IMAGING

                                                • General Features

                                                  • Imaging Recommendations

                                                    • CT Findings

                                                      • MR Findings

                                                        • Ultrasonographic Findings

                                                          • Nuclear Medicine Findings

                                                            DIFFERENTIAL DIAGNOSIS

                                                              PATHOLOGY

                                                              • General Features

                                                                • Gross Pathologic & Surgical Features

                                                                  • Microscopic Features

                                                                    CLINICAL ISSUES

                                                                    • Presentation

                                                                      • Demographics

                                                                        • Natural History & Prognosis

                                                                          • Treatment

                                                                            DIAGNOSTIC CHECKLIST

                                                                            • Consider

                                                                              • Image Interpretation Pearls

                                                                                • Reporting Tips

                                                                                  Selected References

                                                                                  1. Fleischman GM et al: Accuracy of ultrasonography-guided fine-needle aspiration in detecting persistent nodal disease after chemoradiotherapy. JAMA Otolaryngol Head Neck Surg. 142(4):377-82, 2016
                                                                                  2. Kito S et al: Alterations in 18F-FDG accumulation into neck-related muscles after neck dissection for patients with oral cancers. Med Oral Patol Oral Cir Bucal. 21(3):e341-8, 2016
                                                                                  3. Malik A et al: Prospective study of the pattern of lymphatic metastasis in relation to the submandibular gland in patients with carcinoma of the oral cavity. Head Neck. ePub, 2016
                                                                                  4. Mehanna H et al: PET-CT surveillance versus neck dissection in advanced head and neck cancer. N Engl J Med. 374(15):1444-54, 2016
                                                                                  5. Motiee-Langroudi M et al: Occult level IV metastases in clinically node-negative patients with oral tongue squamous cell carcinoma. J Laryngol Otol. 130(5):474-7, 2016
                                                                                  6. Patel TD et al: Efficacy of elective neck dissection in T1/T2N0M0 oral tongue squamous cell carcinoma: a population-based analysis. Otolaryngol Head Neck Surg. ePub, 2016
                                                                                  7. Tang L et al: When should elective neck dissection be performed in maxillary gingival and alveolar squamous cell carcinoma with a cN0 neck? A systematic review. Int J Oral Maxillofac Surg. ePub, 2016
                                                                                  8. Wang K et al: Impact of post-chemoradiotherapy superselective/selective neck dissection on patient reported quality of life. Oral Oncol. 58:21-6, 2016
                                                                                  9. Ferris R et al: American Thyroid Association Consensus Review of the anatomy, terminology and rationale for lateral neck dissection in differentiated thyroid cancer. Thyroid. 22(5) 501-8, 2012
                                                                                  10. Givi B et al: Selective neck dissection in node-positive squamous cell carcinoma of the head and neck. Otolaryngol Head Neck Surg. 147(4)707-15, 2012
                                                                                  11. Kang SW et al: A comparative study of the surgical outcomes of robotic and conventional open modified radical neck dissection for papillary thyroid carcinoma with lateral neck node metastasis. Surg Endosc. 26(11):3251-7, 2012
                                                                                  12. Mulla MG et al: Lateral cervical lymph node metastases in papillary thyroid cancer: a systematic review of imaging-guided and prophylactic removal of the lateral compartment. Clin Endocrinol (Oxf). 77(1):126-31, 2012
                                                                                  13. Stack BC Jr et al: American Thyroid Association consensus review and statement regarding the anatomy, terminology, and rationale for lateral neck dissection in differentiated thyroid cancer. Thyroid. 22(5):501-8, 2012
                                                                                  14. Veenstra HJ et al: Lymphatic drainage patterns from melanomas on the shoulder or upper trunk to cervical lymph nodes and implications for the extent of neck dissection. Ann Surg Oncol. 19(12):3906-12, 2012
                                                                                  15. Wiegand S et al: Prevalence of level V metastases in node-positive head and neck squamous cell carcinoma. Anticancer Res. 31(11):3959-61, 2011
                                                                                  16. Malone J et al: Neck dissection after chemoradiation for carcinoma of the upper aerodigestive tract: indications and complications. Curr Opin Otolaryngol Head Neck Surg. 18(2):89-94, 2010
                                                                                  17. Pisello F et al: Neck node dissection in thyroid cancer. A review. G Chir. 31(3):112-8, 2010
                                                                                  18. Shepard PM et al: Therapeutic selective neck dissection outcomes. Otolaryngol Head Neck Surg. 142(5):741-6, 2010
                                                                                  19. Teymoortash A et al: Postoperative morbidity after different types of selective neck dissection. Laryngoscope. 120(5):924-9, 2010
                                                                                  20. Carr SD et al: Upper limb dysfunction following selective neck dissection: a retrospective questionnaire study. Head Neck. 31(6):789-92, 2009
                                                                                  21. Celik B et al: Accessory nerve function after level 2b-preserving selective neck dissection. Head Neck. 31(11):1496-501, 2009
                                                                                  22. Da Mosto MC et al: Pattern of lymph node metastases in squamous cell carcinoma of the tonsil: implication for selective neck dissection. Oral Oncol. 45(3):212-7, 2009
                                                                                  23. Hillel AT et al: Selective versus comprehensive neck dissection after chemoradiation for advanced oropharyngeal squamous cell carcinoma. Otolaryngol Head Neck Surg. 141(6):737-42, 2009
                                                                                  24. Lim YC et al: Therapeutic selective neck dissection (level II-V) for node-positive hypopharyngeal carcinoma: is it oncologically safe? Acta Otolaryngol. 129(1):57-61, 2009
                                                                                  25. Mukhija V et al: Selective neck dissection following adjuvant therapy for advanced head and neck cancer. Head Neck. 31(2):183-8, 2009
                                                                                  26. Pagedar NA et al: Selective neck dissection: a review of the evidence. Oral Oncol. 45(4-5):416-20, 2009
                                                                                  27. Schiefke F et al: Function, postoperative morbidity, and quality of life after cervical sentinel node biopsy and after selective neck dissection. Head Neck. 31(4):503-12, 2009
                                                                                  28. Schmitz S et al: Results of selective neck dissection in the primary management of head and neck squamous cell carcinoma. Eur Arch Otorhinolaryngol. 266(3):437-43, 2009
                                                                                  29. Varghese BT et al: Treatment outcome in patients undergoing surgery for carcinoma larynx and hypopharynx: a follow-up study. Acta Otolaryngol. 129(12):1480-5, 2009
                                                                                  30. Christopoulos A et al: Neck dissection following concurrent chemoradiation for advanced head and neck carcinoma: pathologic findings and complications. J Otolaryngol Head Neck Surg. 37(4):452-6, 2008
                                                                                  31. Hoyt BJ et al: IIb or not IIb: oncologic role of submuscular recess inclusion in selective neck dissections. J Otolaryngol Head Neck Surg. 37(5):689-93, 2008
                                                                                  32. Patel RS et al: Effectiveness of selective neck dissection in the treatment of the clinically positive neck. Head Neck. 30(9):1231-6, 2008
                                                                                  33. Santoro R et al: Nodal metastases at level IIb during neck dissection for head and neck cancer: clinical and pathologic evaluation. Head Neck. 30(11):1483-7, 2008
                                                                                  34. Hudgins PA et al: Selective neck dissection: CT and MR imaging findings. AJNR Am J Neuroradiol. 26(5):1174-7, 2005