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Nodal Squamous Cell Carcinoma
Hilda E. Stambuk, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Abbreviations

                • Nodal squamous cell carcinoma (SCCa)
              • Synonyms

                • SCCa nodal metastases
              • Definitions

                • Metastatic spread of primary head & neck SCCa to lymph nodes

              IMAGING

              • General Features

                • CT Findings

                  • MR Findings

                    • Ultrasonographic Findings

                      • Nuclear Medicine Findings

                        • Imaging Recommendations

                          DIFFERENTIAL DIAGNOSIS

                            PATHOLOGY

                            • General Features

                              • Staging, Grading, & Classification

                                • 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. Sananmuang T et al: Pre- and post-radiotherapy radiologic nodal features and oropharyngeal cancer outcomes. Laryngoscope. 131(4):E1162-71, 2021
                                                  2. Stack BC Jr et al: FDG-PET/CT and Pathology in Newly Diagnosed Head and Neck Cancer: ACRIN 6685 Trial, FDG-PET/CT cN0. Otolaryngol Head Neck Surg. 164(6):1230-1239, 2021
                                                  3. Stadler TM et al: FDG-PET-CT/MRI in head and neck squamous cell carcinoma: Impact on pretherapeutic N classification, detection of distant metastases, and second primary tumors. Head Neck. 43(7):2058-2068, 2021
                                                  4. Driessen DAJJ et al: Novel Diagnostic Approaches for Assessment of the Clinically Negative Neck in Head and Neck Cancer Patients. Front Oncol. 10:637513, 2020
                                                  5. Elhalawani H et al: Data from a terminated study on iron oxide nanoparticle magnetic resonance imaging for head and neck tumors. Sci Data. 7(1):63, 2020
                                                  6. Faraji F et al: Computed tomography performance in predicting extranodal extension in HPV-positive oropharynx cancer. Laryngoscope. 130(6):1479-1486, 2020
                                                  7. Hiyama T et al: Extra-nodal extension in head and neck cancer: how radiologists can help staging and treatment planning. Jpn J Radiol. 38(6):489-506, 2020
                                                  8. Mahieu R et al: New Developments in Imaging for Sentinel Lymph Node Biopsy in Early-Stage Oral Cavity Squamous Cell Carcinoma. Cancers (Basel). 12(10), 2020
                                                  9. Yan F et al: Predictive value of computed tomography in identifying extranodal extension in human papillomavirus-positive versus human papillomavirus-negative head and neck cancer. Head Neck. ePub, 2020
                                                  10. de Veij Mestdagh PD et al: Mapping of sentinel lymph node drainage using SPECT/CT to tailor elective nodal irradiation in head and neck cancer patients (SUSPECT-2): a single-center prospective trial. BMC Cancer. 19(1):1110, 2019
                                                  11. Forghani R et al: Head and neck squamous cell carcinoma: prediction of cervical lymph node metastasis by dual-energy CT texture analysis with machine learning. Eur Radiol. 29(11):6172-6181, 2019
                                                  12. Noor A et al: Predictive value of computed tomography in identifying extracapsular spread of cervical lymph node metastases in p16 positive oropharyngeal squamous cell carcinoma. J Med Imaging Radiat Oncol. 63(4):500-509, 2019
                                                  13. Tian S et al: Prognostic value of radiographically defined extranodal extension in human papillomavirus-associated locally advanced oropharyngeal carcinoma. Head Neck. 41(9):3056-3063, 2019
                                                  14. Traylor KS et al: Squamous Cell Carcinoma: PET/CT and PET/MRI of the Pretreatment and Post-Treatment Neck. Semin Ultrasound CT MR. 40(5):400-413, 2019
                                                  15. Abdel Razek AAK et al: Arterial spin labeling perfusion-weighted MR imaging: correlation of tumor blood flow with pathological degree of tumor differentiation, clinical stage and nodal metastasis of head and neck squamous cell carcinoma. Eur Arch Otorhinolaryngol. 275(5):1301-1307, 2018
                                                  16. Dai YL et al: State of the art MRI in head and neck cancer. Clin Radiol. 73(1):45-59, 2018
                                                  17. Kann BH et al: Pretreatment Identification of Head and Neck Cancer Nodal Metastasis and Extranodal Extension Using Deep Learning Neural Networks. Sci Rep. 8(1):14036, 2018
                                                  18. Mundada P et al: Utility of MRI with morphologic and diffusion weighted imaging in the detection of post-treatment nodal disease in head and neck squamous cell carcinoma. Eur J Radiol. 101:162-169, 2018
                                                  19. Zhang H et al: Utility of PET-CT in detecting nodal metastasis in cN0 early stage oral cavity squamous cell carcinoma. Oral Oncol. 80:89-92, 2018
                                                  20. Cho JK et al: Preoperative 18F-FDG-PET/CT vs Contrast-Enhanced CT to Identify Regional Nodal Metastasis among Patients with Head and Neck Squamous Cell Carcinoma. Otolaryngol Head Neck Surg. 157(3):439-447, 2017
                                                  21. Kelly HR et al: Chapter 2 Squamous Cell Carcinoma of the Head and Neck-Imaging Evaluation of Regional Lymph Nodes and Implications for Management. Semin Ultrasound CT MR. 38(5):466-478, 2017
                                                  22. Kulzer MH et al: Chapter 1 Neck Anatomy, Imaging-Based Level Nodal Classification and Impact of Primary Tumor Site on Patterns of Nodal Metastasis. Semin Ultrasound CT MR. 38(5):454-465, 2017
                                                  23. Aiken AH et al: Implementation of a novel surveillance template for head and neck cancer: neck imaging reporting and data system (NI-RADS). J Am Coll Radiol. 13(6):743-746.e1, 2016
                                                  24. de Bree R et al: Radiologic extranodal spread and matted nodes: Important predictive factors for development of distant metastases in patients with high-risk head and neck cancer. Head Neck. 38 Suppl 1:E1452-8, 2016
                                                  25. Fujita A et al: Imaging characteristics of metastatic nodes and outcomes by HPV status in head and neck cancers. Laryngoscope. 126(2):392-8, 2016
                                                  26. Gaddikeri S et al: Dynamic contrast-enhanced MR imaging in head and neck cancer: techniques and clinical applications. AJNR Am J Neuroradiol. 37(4):588-95, 2016
                                                  27. Kim SG et al: Potential role of PET/MRI for imaging metastatic lymph nodes in head and neck cancer. AJR Am J Roentgenol. 1-9, 2016
                                                  28. Aiken AH et al: Accuracy of preoperative imaging in detecting nodal extracapsular spread in oral cavity squamous cell carcinoma. AJNR Am J Neuroradiol. 36(9):1776-81, 2015
                                                  29. de Bree R et al: Advances in diagnostic modalities to detect occult lymph node metastases in head and neck squamous cell carcinoma. Head Neck. 37(12):1829-39, 2015
                                                  30. Eisenmenger LB et al: Imaging of head and neck lymph nodes. Radiol Clin North Am. 53(1):115-32, 2015
                                                  31. Forghani R et al: Imaging evaluation of lymphadenopathy and patterns of lymph node spread in head and neck cancer. Expert Rev Anticancer Ther. 15(2):207-24, 2015
                                                  32. Lee JR et al: Preoperative contrast-enhanced CT versus ¹⁸F-FDG PET/CT evaluation and the prognostic value of extranodal extension for surgical patients with head and heck squamous cell carcinoma. Ann Surg Oncol. 22 Suppl 3:S1020-7, 2015
                                                  33. Maxwell JH et al: Accuracy of computed tomography to predict extracapsular spread in p16-positive squamous cell carcinoma. Laryngoscope. 125(7):1613-8, 2015
                                                  34. Payne KF et al: The role of diffusion-weighted magnetic resonance imaging in the diagnosis, lymph node staging and assessment of treatment response of head and neck cancer. Int J Oral Maxillofac Surg. 44(1):1-7, 2015
                                                  35. Plaxton NA et al: Characteristics and Limitations of FDG PET/CT for Imaging of Squamous Cell Carcinoma of the Head and Neck: A Comprehensive Review of Anatomy, Metastatic Pathways, and Image Findings. AJR Am J Roentgenol. 205(5):W519-31, 2015
                                                  36. Barchetti F et al: The role of 3 Tesla diffusion-weighted imaging in the differential diagnosis of benign versus malignant cervical lymph nodes in patients with head and neck squamous cell carcinoma. Biomed Res Int. 2014:532095, 2014
                                                  37. Grégoire V et al: Delineation of the neck node levels for head and neck tumors: a 2013 update. DAHANCA, EORTC, HKNPCSG, NCIC CTG, NCRI, RTOG, TROG consensus guidelines. Radiother Oncol. 110(1):172-81, 2014
                                                  38. Chai RL et al: Accuracy of computed tomography in the prediction of extracapsular spread of lymph node metastases in squamous cell carcinoma of the head and neck. JAMA Otolaryngol Head Neck Surg. 139(11):1187-94, 2013
                                                  39. Hoang JK et al: Evaluation of cervical lymph nodes in head and neck cancer with CT and MRI: tips, traps, and a systematic approach. AJR Am J Roentgenol. 200(1):W17-25, 2013
                                                  40. Fukunari F et al: Cervical lymph nodes with or without metastases from oral squamous carcinoma: a correlation of MRI findings and histopathologic architecture. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 109(6):890-9, 2010
                                                  41. Ghadjar P et al: Incidence of small lymph node metastases with evidence of extracapsular extension: clinical implications in patients with head and neck squamous cell carcinoma. Int J Radiat Oncol Biol Phys. 78(5):1366-72, 2010
                                                  42. Vandecaveye V et al: Applications of diffusion-weighted magnetic resonance imaging in head and neck squamous cell carcinoma. Neuroradiology. 52(9):773-84, 2010
                                                  43. Holzapfel K et al: Value of diffusion-weighted MR imaging in the differentiation between benign and malignant cervical lymph nodes. Eur J Radiol. 72(3):381-7, 2009
                                                  44. Vandecaveye V et al: Head and neck squamous cell carcinoma: value of diffusion-weighted MR imaging for nodal staging. Radiology. 251(1):134-46, 2009
                                                  45. Kimura Y et al: MR imaging criteria for the prediction of extranodal spread of metastatic cancer in the neck. AJNR Am J Neuroradiol. 29(7):1355-9, 2008
                                                  46. Mack MG et al: Cervical lymph nodes. Eur J Radiol. 66(3):493-500, 2008
                                                  47. Nakamura T et al: Nodal imaging in the neck: recent advances in US, CT and MR imaging of metastatic nodes. Eur Radiol. 17(5):1235-41, 2007
                                                  48. Vogl T et al: Lymph node staging. Top Magn Reson Imaging. 2007 Aug;18(4):303-16. Review. Erratum in: Top Magn Reson Imaging. 18(6):471, 2007
                                                  49. Abdel Razek AA et al: Role of diffusion-weighted MR imaging in cervical lymphadenopathy. Eur Radiol. 16(7):1468-77, 2006
                                                  50. Gor DM et al: Imaging of cervical lymph nodes in head and neck cancer: the basics. Radiol Clin North Am. 44(1):101-10, viii, 2006
                                                  51. Kawai Y et al: Turbo short tau inversion recovery imaging for metastatic node screening in patients with head and neck cancer. AJNR Am J Neuroradiol. 27(6):1283-7, 2006
                                                  52. Schöder H et al: 18F-FDG PET/CT for detecting nodal metastases in patients with oral cancer staged N0 by clinical examination and CT/MRI. J Nucl Med. 47(5):755-62, 2006
                                                  53. King AD et al: Necrosis in metastatic neck nodes: diagnostic accuracy of CT, MR imaging, and US. Radiology. 230(3):720-6, 2004
                                                  54. Ahuja A et al: Sonography of neck lymph nodes. Part II: abnormal lymph nodes. Clin Radiol. 58(5):359-66, 2003
                                                  55. Fischbein NJ et al: Assessment of metastatic cervical adenopathy using dynamic contrast-enhanced MR imaging. AJNR Am J Neuroradiol. 24(3):301-11, 2003
                                                  56. Giridharan W et al: Lymph node metastases in the lower neck. Clin Otolaryngol. 28(3):221-6, 2003
                                                  57. Kosuda S et al: Feasibility and cost-effectiveness of sentinel lymph node radiolocalization in stage N0 head and neck cancer. Arch Otolaryngol Head Neck Surg. 129(10):1105-9, 2003
                                                  58. Sumi M et al: Discrimination of metastatic cervical lymph nodes with diffusion-weighted MR imaging in patients with head and neck cancer. AJNR Am J Neuroradiol. 24(8):1627-34, 2003
                                                  59. Wax MK et al: The role of positron emission tomography in the evaluation of the N-positive neck. Otolaryngol Head Neck Surg. 129(3):163-7, 2003
                                                  60. Ishikawa M et al: MR imaging of lymph nodes in the head and neck. Magn Reson Imaging Clin N Am. 10(3):527-42, 2002
                                                  61. Som PM et al: Imaging-based nodal classification for evaluation of neck metastatic adenopathy. AJR Am J Roentgenol. 174(3):837-44, 2000
                                                  62. Robbins KT: Classification of neck dissection: current concepts and future considerations. Otolaryngol Clin North Am. 31(4):639-55, 1998
                                                  Related Anatomy
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                                                  Related Differential Diagnoses
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                                                  References
                                                  Tables

                                                  Tables

                                                  KEY FACTS

                                                  • Terminology

                                                    • Imaging

                                                      • Top Differential Diagnoses

                                                        • Pathology

                                                          • Clinical Issues

                                                            • Diagnostic Checklist

                                                              TERMINOLOGY

                                                              • Abbreviations

                                                                • Nodal squamous cell carcinoma (SCCa)
                                                              • Synonyms

                                                                • SCCa nodal metastases
                                                              • Definitions

                                                                • Metastatic spread of primary head & neck SCCa to lymph nodes

                                                              IMAGING

                                                              • General Features

                                                                • CT Findings

                                                                  • MR Findings

                                                                    • Ultrasonographic Findings

                                                                      • Nuclear Medicine Findings

                                                                        • Imaging Recommendations

                                                                          DIFFERENTIAL DIAGNOSIS

                                                                            PATHOLOGY

                                                                            • General Features

                                                                              • Staging, Grading, & Classification

                                                                                • 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. Sananmuang T et al: Pre- and post-radiotherapy radiologic nodal features and oropharyngeal cancer outcomes. Laryngoscope. 131(4):E1162-71, 2021
                                                                                                  2. Stack BC Jr et al: FDG-PET/CT and Pathology in Newly Diagnosed Head and Neck Cancer: ACRIN 6685 Trial, FDG-PET/CT cN0. Otolaryngol Head Neck Surg. 164(6):1230-1239, 2021
                                                                                                  3. Stadler TM et al: FDG-PET-CT/MRI in head and neck squamous cell carcinoma: Impact on pretherapeutic N classification, detection of distant metastases, and second primary tumors. Head Neck. 43(7):2058-2068, 2021
                                                                                                  4. Driessen DAJJ et al: Novel Diagnostic Approaches for Assessment of the Clinically Negative Neck in Head and Neck Cancer Patients. Front Oncol. 10:637513, 2020
                                                                                                  5. Elhalawani H et al: Data from a terminated study on iron oxide nanoparticle magnetic resonance imaging for head and neck tumors. Sci Data. 7(1):63, 2020
                                                                                                  6. Faraji F et al: Computed tomography performance in predicting extranodal extension in HPV-positive oropharynx cancer. Laryngoscope. 130(6):1479-1486, 2020
                                                                                                  7. Hiyama T et al: Extra-nodal extension in head and neck cancer: how radiologists can help staging and treatment planning. Jpn J Radiol. 38(6):489-506, 2020
                                                                                                  8. Mahieu R et al: New Developments in Imaging for Sentinel Lymph Node Biopsy in Early-Stage Oral Cavity Squamous Cell Carcinoma. Cancers (Basel). 12(10), 2020
                                                                                                  9. Yan F et al: Predictive value of computed tomography in identifying extranodal extension in human papillomavirus-positive versus human papillomavirus-negative head and neck cancer. Head Neck. ePub, 2020
                                                                                                  10. de Veij Mestdagh PD et al: Mapping of sentinel lymph node drainage using SPECT/CT to tailor elective nodal irradiation in head and neck cancer patients (SUSPECT-2): a single-center prospective trial. BMC Cancer. 19(1):1110, 2019
                                                                                                  11. Forghani R et al: Head and neck squamous cell carcinoma: prediction of cervical lymph node metastasis by dual-energy CT texture analysis with machine learning. Eur Radiol. 29(11):6172-6181, 2019
                                                                                                  12. Noor A et al: Predictive value of computed tomography in identifying extracapsular spread of cervical lymph node metastases in p16 positive oropharyngeal squamous cell carcinoma. J Med Imaging Radiat Oncol. 63(4):500-509, 2019
                                                                                                  13. Tian S et al: Prognostic value of radiographically defined extranodal extension in human papillomavirus-associated locally advanced oropharyngeal carcinoma. Head Neck. 41(9):3056-3063, 2019
                                                                                                  14. Traylor KS et al: Squamous Cell Carcinoma: PET/CT and PET/MRI of the Pretreatment and Post-Treatment Neck. Semin Ultrasound CT MR. 40(5):400-413, 2019
                                                                                                  15. Abdel Razek AAK et al: Arterial spin labeling perfusion-weighted MR imaging: correlation of tumor blood flow with pathological degree of tumor differentiation, clinical stage and nodal metastasis of head and neck squamous cell carcinoma. Eur Arch Otorhinolaryngol. 275(5):1301-1307, 2018
                                                                                                  16. Dai YL et al: State of the art MRI in head and neck cancer. Clin Radiol. 73(1):45-59, 2018
                                                                                                  17. Kann BH et al: Pretreatment Identification of Head and Neck Cancer Nodal Metastasis and Extranodal Extension Using Deep Learning Neural Networks. Sci Rep. 8(1):14036, 2018
                                                                                                  18. Mundada P et al: Utility of MRI with morphologic and diffusion weighted imaging in the detection of post-treatment nodal disease in head and neck squamous cell carcinoma. Eur J Radiol. 101:162-169, 2018
                                                                                                  19. Zhang H et al: Utility of PET-CT in detecting nodal metastasis in cN0 early stage oral cavity squamous cell carcinoma. Oral Oncol. 80:89-92, 2018
                                                                                                  20. Cho JK et al: Preoperative 18F-FDG-PET/CT vs Contrast-Enhanced CT to Identify Regional Nodal Metastasis among Patients with Head and Neck Squamous Cell Carcinoma. Otolaryngol Head Neck Surg. 157(3):439-447, 2017
                                                                                                  21. Kelly HR et al: Chapter 2 Squamous Cell Carcinoma of the Head and Neck-Imaging Evaluation of Regional Lymph Nodes and Implications for Management. Semin Ultrasound CT MR. 38(5):466-478, 2017
                                                                                                  22. Kulzer MH et al: Chapter 1 Neck Anatomy, Imaging-Based Level Nodal Classification and Impact of Primary Tumor Site on Patterns of Nodal Metastasis. Semin Ultrasound CT MR. 38(5):454-465, 2017
                                                                                                  23. Aiken AH et al: Implementation of a novel surveillance template for head and neck cancer: neck imaging reporting and data system (NI-RADS). J Am Coll Radiol. 13(6):743-746.e1, 2016
                                                                                                  24. de Bree R et al: Radiologic extranodal spread and matted nodes: Important predictive factors for development of distant metastases in patients with high-risk head and neck cancer. Head Neck. 38 Suppl 1:E1452-8, 2016
                                                                                                  25. Fujita A et al: Imaging characteristics of metastatic nodes and outcomes by HPV status in head and neck cancers. Laryngoscope. 126(2):392-8, 2016
                                                                                                  26. Gaddikeri S et al: Dynamic contrast-enhanced MR imaging in head and neck cancer: techniques and clinical applications. AJNR Am J Neuroradiol. 37(4):588-95, 2016
                                                                                                  27. Kim SG et al: Potential role of PET/MRI for imaging metastatic lymph nodes in head and neck cancer. AJR Am J Roentgenol. 1-9, 2016
                                                                                                  28. Aiken AH et al: Accuracy of preoperative imaging in detecting nodal extracapsular spread in oral cavity squamous cell carcinoma. AJNR Am J Neuroradiol. 36(9):1776-81, 2015
                                                                                                  29. de Bree R et al: Advances in diagnostic modalities to detect occult lymph node metastases in head and neck squamous cell carcinoma. Head Neck. 37(12):1829-39, 2015
                                                                                                  30. Eisenmenger LB et al: Imaging of head and neck lymph nodes. Radiol Clin North Am. 53(1):115-32, 2015
                                                                                                  31. Forghani R et al: Imaging evaluation of lymphadenopathy and patterns of lymph node spread in head and neck cancer. Expert Rev Anticancer Ther. 15(2):207-24, 2015
                                                                                                  32. Lee JR et al: Preoperative contrast-enhanced CT versus ¹⁸F-FDG PET/CT evaluation and the prognostic value of extranodal extension for surgical patients with head and heck squamous cell carcinoma. Ann Surg Oncol. 22 Suppl 3:S1020-7, 2015
                                                                                                  33. Maxwell JH et al: Accuracy of computed tomography to predict extracapsular spread in p16-positive squamous cell carcinoma. Laryngoscope. 125(7):1613-8, 2015
                                                                                                  34. Payne KF et al: The role of diffusion-weighted magnetic resonance imaging in the diagnosis, lymph node staging and assessment of treatment response of head and neck cancer. Int J Oral Maxillofac Surg. 44(1):1-7, 2015
                                                                                                  35. Plaxton NA et al: Characteristics and Limitations of FDG PET/CT for Imaging of Squamous Cell Carcinoma of the Head and Neck: A Comprehensive Review of Anatomy, Metastatic Pathways, and Image Findings. AJR Am J Roentgenol. 205(5):W519-31, 2015
                                                                                                  36. Barchetti F et al: The role of 3 Tesla diffusion-weighted imaging in the differential diagnosis of benign versus malignant cervical lymph nodes in patients with head and neck squamous cell carcinoma. Biomed Res Int. 2014:532095, 2014
                                                                                                  37. Grégoire V et al: Delineation of the neck node levels for head and neck tumors: a 2013 update. DAHANCA, EORTC, HKNPCSG, NCIC CTG, NCRI, RTOG, TROG consensus guidelines. Radiother Oncol. 110(1):172-81, 2014
                                                                                                  38. Chai RL et al: Accuracy of computed tomography in the prediction of extracapsular spread of lymph node metastases in squamous cell carcinoma of the head and neck. JAMA Otolaryngol Head Neck Surg. 139(11):1187-94, 2013
                                                                                                  39. Hoang JK et al: Evaluation of cervical lymph nodes in head and neck cancer with CT and MRI: tips, traps, and a systematic approach. AJR Am J Roentgenol. 200(1):W17-25, 2013
                                                                                                  40. Fukunari F et al: Cervical lymph nodes with or without metastases from oral squamous carcinoma: a correlation of MRI findings and histopathologic architecture. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 109(6):890-9, 2010
                                                                                                  41. Ghadjar P et al: Incidence of small lymph node metastases with evidence of extracapsular extension: clinical implications in patients with head and neck squamous cell carcinoma. Int J Radiat Oncol Biol Phys. 78(5):1366-72, 2010
                                                                                                  42. Vandecaveye V et al: Applications of diffusion-weighted magnetic resonance imaging in head and neck squamous cell carcinoma. Neuroradiology. 52(9):773-84, 2010
                                                                                                  43. Holzapfel K et al: Value of diffusion-weighted MR imaging in the differentiation between benign and malignant cervical lymph nodes. Eur J Radiol. 72(3):381-7, 2009
                                                                                                  44. Vandecaveye V et al: Head and neck squamous cell carcinoma: value of diffusion-weighted MR imaging for nodal staging. Radiology. 251(1):134-46, 2009
                                                                                                  45. Kimura Y et al: MR imaging criteria for the prediction of extranodal spread of metastatic cancer in the neck. AJNR Am J Neuroradiol. 29(7):1355-9, 2008
                                                                                                  46. Mack MG et al: Cervical lymph nodes. Eur J Radiol. 66(3):493-500, 2008
                                                                                                  47. Nakamura T et al: Nodal imaging in the neck: recent advances in US, CT and MR imaging of metastatic nodes. Eur Radiol. 17(5):1235-41, 2007
                                                                                                  48. Vogl T et al: Lymph node staging. Top Magn Reson Imaging. 2007 Aug;18(4):303-16. Review. Erratum in: Top Magn Reson Imaging. 18(6):471, 2007
                                                                                                  49. Abdel Razek AA et al: Role of diffusion-weighted MR imaging in cervical lymphadenopathy. Eur Radiol. 16(7):1468-77, 2006
                                                                                                  50. Gor DM et al: Imaging of cervical lymph nodes in head and neck cancer: the basics. Radiol Clin North Am. 44(1):101-10, viii, 2006
                                                                                                  51. Kawai Y et al: Turbo short tau inversion recovery imaging for metastatic node screening in patients with head and neck cancer. AJNR Am J Neuroradiol. 27(6):1283-7, 2006
                                                                                                  52. Schöder H et al: 18F-FDG PET/CT for detecting nodal metastases in patients with oral cancer staged N0 by clinical examination and CT/MRI. J Nucl Med. 47(5):755-62, 2006
                                                                                                  53. King AD et al: Necrosis in metastatic neck nodes: diagnostic accuracy of CT, MR imaging, and US. Radiology. 230(3):720-6, 2004
                                                                                                  54. Ahuja A et al: Sonography of neck lymph nodes. Part II: abnormal lymph nodes. Clin Radiol. 58(5):359-66, 2003
                                                                                                  55. Fischbein NJ et al: Assessment of metastatic cervical adenopathy using dynamic contrast-enhanced MR imaging. AJNR Am J Neuroradiol. 24(3):301-11, 2003
                                                                                                  56. Giridharan W et al: Lymph node metastases in the lower neck. Clin Otolaryngol. 28(3):221-6, 2003
                                                                                                  57. Kosuda S et al: Feasibility and cost-effectiveness of sentinel lymph node radiolocalization in stage N0 head and neck cancer. Arch Otolaryngol Head Neck Surg. 129(10):1105-9, 2003
                                                                                                  58. Sumi M et al: Discrimination of metastatic cervical lymph nodes with diffusion-weighted MR imaging in patients with head and neck cancer. AJNR Am J Neuroradiol. 24(8):1627-34, 2003
                                                                                                  59. Wax MK et al: The role of positron emission tomography in the evaluation of the N-positive neck. Otolaryngol Head Neck Surg. 129(3):163-7, 2003
                                                                                                  60. Ishikawa M et al: MR imaging of lymph nodes in the head and neck. Magn Reson Imaging Clin N Am. 10(3):527-42, 2002
                                                                                                  61. Som PM et al: Imaging-based nodal classification for evaluation of neck metastatic adenopathy. AJR Am J Roentgenol. 174(3):837-44, 2000
                                                                                                  62. Robbins KT: Classification of neck dissection: current concepts and future considerations. Otolaryngol Clin North Am. 31(4):639-55, 1998