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Squamous Cell Carcinoma in Spinal Accessory Node
Bronwyn E. Hamilton, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Abbreviations

                • Squamous cell carcinoma (SCCa)
              • Definitions

                • Spinal accessory node: Nodal chain accompanying spinal accessory nerve (CNXI)
                • Spinal accessory chain divided between 2 surgical levels
                  • Level IIB for upper spinal nodes deep to sternocleidomastoid muscle (SCM) but posterior to & not contacting internal jugular vein
                  • Level V for posterior cervical space (PCS); strictly posterior to SCM

              IMAGING

              • General Features

                • CT Findings

                  • MR Findings

                    • Ultrasonographic Findings

                      • Nonvascular Interventions

                        • Nuclear Medicine Findings

                          • Imaging Recommendations

                            DIFFERENTIAL DIAGNOSIS

                              PATHOLOGY

                              • General Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        • Staging of Head & Neck Squamous Cell Carcinoma

                                          DIAGNOSTIC CHECKLIST

                                          • Consider

                                            • Image Interpretation Pearls

                                              Selected References

                                              1. Faraji F et al: Computed tomography performance in predicting extranodal extension in HPV-positive oropharynx cancer. Laryngoscope. 130(6):1479-86, 2020
                                              2. Garreau B et al: The necessity of level IIb dissection for clinically negative neck oral squamous cell carcinoma. J Stomatol Oral Maxillofac Surg. 121(6):658-60, 2020
                                              3. Jović A et al: Diffusion-weighted MRI: impact of the size of the ROI in detecting metastases in subcentimeter lymph nodes in head and neck squamous cell carcinoma. Neuroradiology. 62(8):987-94, 2020
                                              4. Prestwich RJD et al: Second-look PET-CT following an initial incomplete PET-CT response to (chemo)radiotherapy for head and neck squamous cell carcinoma. Eur Radiol. 30(2):1212-20, 2020
                                              5. Toya R et al: Diagnostic value of FDG-PET/CT for the Identification of extranodal extension in patients with head and neck squamous cell carcinoma. Anticancer Res. 40(4):2073-7, 2020
                                              6. Zhai TT et al: Pre-treatment radiomic features predict individual lymph node failure for head and neck cancer patients. Radiother Oncol. 146:58-65, 2020
                                              7. Hosokawa S et al: Relevance of level IIb neck dissection in patients with head and neck squamous cell carcinomas. World J Surg. 43(12):3059-64, 2019
                                              8. Nishio N et al: Diagnosis of cervical lymph node metastases in head and neck cancer with ultrasonic measurement of lymph node volume. Auris Nasus Larynx. 46(6):889-95, 2019
                                              9. Roberts TJ et al: Number of positive nodes is superior to the lymph node ratio and American Joint Committee on Cancer N staging for the prognosis of surgically treated head and neck squamous cell carcinomas. Cancer. 122(9):1388-97, 2016
                                              10. Park SH et al: Surgical outcomes of 156 spinal accessory nerve injuries caused by lymph node biopsy procedures. J Neurosurg Spine. 23(4):518-25, 2015
                                              11. Arya S et al: Oral cavity squamous cell carcinoma: role of pretreatment imaging and its influence on management. Clin Radiol. 69(9):916-30, 2014
                                              12. Giacomini CP et al: Ultrasonographic evaluation of malignant and normal cervical lymph nodes. Semin Ultrasound CT MR. 34(3):236-47, 2013
                                              13. Kainuma K et al: Prevalence of level V metastasis in head and neck squamous cell carcinoma. Acta Otolaryngol. 133(2):218-24, 2013
                                              14. Lee SH et al: Diagnostic value of only 18F-fluorodeocyglucose positron emission tomography/computed tomography-positive lymph nodes in head and neck squamous cell carcinoma. Otolaryngol Head Neck Surg. 147(4):692-8, 2012
                                              15. Greene F, Trotti A III, Fritz A, Compton C, Byrd DR, Edge S. AJCC Cancer Staging Handbook. 7th ed. Chicago, IL: American Joint Committee on Cancer; 2010
                                              16. Durazzo MD et al: Anatomic landmarks for localization of the spinal accessory nerve. Clin Anat. 22(4):471-5, 2009
                                              17. Lee SH et al: Anatomical variations of the spinal accessory nerve and its relevance to level IIb lymph nodes. Otolaryngol Head Neck Surg. 141(5):639-44, 2009
                                              18. Ahuja AT et al: Ultrasound of malignant cervical lymph nodes. Cancer Imaging. 8:48-56, 2008
                                              19. Elsheikh MN et al: Elective supraomohyoid neck dissection for oral cavity squamous cell carcinoma: is dissection of sublevel IIB necessary? Oral Oncol. 44(3):216-9, 2008
                                              20. Smith R et al: Patterns of lymph node metastases to the submuscular recess. J Otolaryngol. 36(4):203-7, 2007
                                              21. Civantos FJ et al: Lymphatic mapping and sentinel lymphadenectomy for 106 head and neck lesions: contrasts between oral cavity and cutaneous malignancy. Laryngoscope. 112(3 Pt 2 Suppl 109):1-15, 2006
                                              22. Lim YC et al: Level IIb lymph node metastasis in laryngeal squamous cell carcinoma. Laryngoscope. 116(2):268-72, 2006
                                              23. Lim YC et al: Level V lymph node dissection in oral and oropharyngeal carcinoma patients with clinically node-positive neck: is it absolutely necessary? Laryngoscope. 116(7):1232-5, 2006
                                              24. Hudgins PA et al: Selective neck dissection: CT and MR imaging findings. AJNR Am J Neuroradiol. 26(5):1174-7, 2005
                                              25. McDuffie CM et al: Predictive factors for posterior triangle metastasis in HNSCC. Laryngoscope. 115(12):2114-7, 2005
                                              26. Coskun HH et al: Selective neck dissection for clinically N0 neck in laryngeal cancer: is dissection of level IIb necessary? Otolaryngol Head Neck Surg. 131(5):655-9, 2004
                                              27. Lev S et al: Imaging of cystic lesions. Radiol Clin North Am. 38(5):1013-27, 2000
                                              28. Curtin HD et al: Comparison of CT and MR imaging in staging of neck metastases. Radiology. 207(1):123-30, 1998
                                              29. Kaji AV et al: Imaging of cervical lymphadenopathy. Semin Ultrasound CT MR. 18(3):220-49, 1997
                                              30. Davidson BJ et al: Posterior triangle metastases of squamous cell carcinoma of the upper aerodigestive tract. Am J Surg. 166(4):395-8, 1993
                                              31. Parker GD et al: Radiologic evaluation of the normal and diseased posterior cervical space. AJR Am J Roentgenol. 157(1):161-5, 1991
                                              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

                                                            • Squamous cell carcinoma (SCCa)
                                                          • Definitions

                                                            • Spinal accessory node: Nodal chain accompanying spinal accessory nerve (CNXI)
                                                            • Spinal accessory chain divided between 2 surgical levels
                                                              • Level IIB for upper spinal nodes deep to sternocleidomastoid muscle (SCM) but posterior to & not contacting internal jugular vein
                                                              • Level V for posterior cervical space (PCS); strictly posterior to SCM

                                                          IMAGING

                                                          • General Features

                                                            • CT Findings

                                                              • MR Findings

                                                                • Ultrasonographic Findings

                                                                  • Nonvascular Interventions

                                                                    • Nuclear Medicine Findings

                                                                      • Imaging Recommendations

                                                                        DIFFERENTIAL DIAGNOSIS

                                                                          PATHOLOGY

                                                                          • General Features

                                                                            CLINICAL ISSUES

                                                                            • Presentation

                                                                              • Demographics

                                                                                • Natural History & Prognosis

                                                                                  • Treatment

                                                                                    • Staging of Head & Neck Squamous Cell Carcinoma

                                                                                      DIAGNOSTIC CHECKLIST

                                                                                      • Consider

                                                                                        • Image Interpretation Pearls

                                                                                          Selected References

                                                                                          1. Faraji F et al: Computed tomography performance in predicting extranodal extension in HPV-positive oropharynx cancer. Laryngoscope. 130(6):1479-86, 2020
                                                                                          2. Garreau B et al: The necessity of level IIb dissection for clinically negative neck oral squamous cell carcinoma. J Stomatol Oral Maxillofac Surg. 121(6):658-60, 2020
                                                                                          3. Jović A et al: Diffusion-weighted MRI: impact of the size of the ROI in detecting metastases in subcentimeter lymph nodes in head and neck squamous cell carcinoma. Neuroradiology. 62(8):987-94, 2020
                                                                                          4. Prestwich RJD et al: Second-look PET-CT following an initial incomplete PET-CT response to (chemo)radiotherapy for head and neck squamous cell carcinoma. Eur Radiol. 30(2):1212-20, 2020
                                                                                          5. Toya R et al: Diagnostic value of FDG-PET/CT for the Identification of extranodal extension in patients with head and neck squamous cell carcinoma. Anticancer Res. 40(4):2073-7, 2020
                                                                                          6. Zhai TT et al: Pre-treatment radiomic features predict individual lymph node failure for head and neck cancer patients. Radiother Oncol. 146:58-65, 2020
                                                                                          7. Hosokawa S et al: Relevance of level IIb neck dissection in patients with head and neck squamous cell carcinomas. World J Surg. 43(12):3059-64, 2019
                                                                                          8. Nishio N et al: Diagnosis of cervical lymph node metastases in head and neck cancer with ultrasonic measurement of lymph node volume. Auris Nasus Larynx. 46(6):889-95, 2019
                                                                                          9. Roberts TJ et al: Number of positive nodes is superior to the lymph node ratio and American Joint Committee on Cancer N staging for the prognosis of surgically treated head and neck squamous cell carcinomas. Cancer. 122(9):1388-97, 2016
                                                                                          10. Park SH et al: Surgical outcomes of 156 spinal accessory nerve injuries caused by lymph node biopsy procedures. J Neurosurg Spine. 23(4):518-25, 2015
                                                                                          11. Arya S et al: Oral cavity squamous cell carcinoma: role of pretreatment imaging and its influence on management. Clin Radiol. 69(9):916-30, 2014
                                                                                          12. Giacomini CP et al: Ultrasonographic evaluation of malignant and normal cervical lymph nodes. Semin Ultrasound CT MR. 34(3):236-47, 2013
                                                                                          13. Kainuma K et al: Prevalence of level V metastasis in head and neck squamous cell carcinoma. Acta Otolaryngol. 133(2):218-24, 2013
                                                                                          14. Lee SH et al: Diagnostic value of only 18F-fluorodeocyglucose positron emission tomography/computed tomography-positive lymph nodes in head and neck squamous cell carcinoma. Otolaryngol Head Neck Surg. 147(4):692-8, 2012
                                                                                          15. Greene F, Trotti A III, Fritz A, Compton C, Byrd DR, Edge S. AJCC Cancer Staging Handbook. 7th ed. Chicago, IL: American Joint Committee on Cancer; 2010
                                                                                          16. Durazzo MD et al: Anatomic landmarks for localization of the spinal accessory nerve. Clin Anat. 22(4):471-5, 2009
                                                                                          17. Lee SH et al: Anatomical variations of the spinal accessory nerve and its relevance to level IIb lymph nodes. Otolaryngol Head Neck Surg. 141(5):639-44, 2009
                                                                                          18. Ahuja AT et al: Ultrasound of malignant cervical lymph nodes. Cancer Imaging. 8:48-56, 2008
                                                                                          19. Elsheikh MN et al: Elective supraomohyoid neck dissection for oral cavity squamous cell carcinoma: is dissection of sublevel IIB necessary? Oral Oncol. 44(3):216-9, 2008
                                                                                          20. Smith R et al: Patterns of lymph node metastases to the submuscular recess. J Otolaryngol. 36(4):203-7, 2007
                                                                                          21. Civantos FJ et al: Lymphatic mapping and sentinel lymphadenectomy for 106 head and neck lesions: contrasts between oral cavity and cutaneous malignancy. Laryngoscope. 112(3 Pt 2 Suppl 109):1-15, 2006
                                                                                          22. Lim YC et al: Level IIb lymph node metastasis in laryngeal squamous cell carcinoma. Laryngoscope. 116(2):268-72, 2006
                                                                                          23. Lim YC et al: Level V lymph node dissection in oral and oropharyngeal carcinoma patients with clinically node-positive neck: is it absolutely necessary? Laryngoscope. 116(7):1232-5, 2006
                                                                                          24. Hudgins PA et al: Selective neck dissection: CT and MR imaging findings. AJNR Am J Neuroradiol. 26(5):1174-7, 2005
                                                                                          25. McDuffie CM et al: Predictive factors for posterior triangle metastasis in HNSCC. Laryngoscope. 115(12):2114-7, 2005
                                                                                          26. Coskun HH et al: Selective neck dissection for clinically N0 neck in laryngeal cancer: is dissection of level IIb necessary? Otolaryngol Head Neck Surg. 131(5):655-9, 2004
                                                                                          27. Lev S et al: Imaging of cystic lesions. Radiol Clin North Am. 38(5):1013-27, 2000
                                                                                          28. Curtin HD et al: Comparison of CT and MR imaging in staging of neck metastases. Radiology. 207(1):123-30, 1998
                                                                                          29. Kaji AV et al: Imaging of cervical lymphadenopathy. Semin Ultrasound CT MR. 18(3):220-49, 1997
                                                                                          30. Davidson BJ et al: Posterior triangle metastases of squamous cell carcinoma of the upper aerodigestive tract. Am J Surg. 166(4):395-8, 1993
                                                                                          31. Parker GD et al: Radiologic evaluation of the normal and diseased posterior cervical space. AJR Am J Roentgenol. 157(1):161-5, 1991