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Head and Neck
Diagnosis
Oral Cavity
Malignant Tumors
Submandibular Space Nodal Squamous Cell Carcinoma
Submandibular Space Nodal Squamous Cell Carcinoma
Bronwyn E. Hamilton, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          TERMINOLOGY

          • Abbreviations

            • Submandibular space (SMS) nodal squamous cell carcinoma (SCCa)

          • Synonyms

            • Extracapsular extension/spread = extranodal extension (ENE)

          • Definitions

            • Level I nodal metastasis from primary H&N SCCa

          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. Bae MR et al: 18F-FDG PET/CT versus CT/MR imaging for detection of neck lymph node metastasis in palpably node-negative oral cavity cancer. J Cancer Res Clin Oncol. 146(1):237-44, 2020
                                              2. 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
                                              3. Baik SH et al: Prognostic value of cervical nodal necrosis observed in preoperative CT and MRI of patients with tongue squamous cell carcinoma and cervical node metastases: a retrospective study. AJR Am J Roentgenol. 213(2):437-43, 2019
                                              4. Subramaniam N et al: Lymph node staging systems in oral squamous cell carcinoma: a comparative analysis. Oral Oncol. 97:92-8, 2019
                                              5. Amin MB et al: AJCC Cancer Staging Manual. 8th Ed. Springer New York, 2017
                                              6. Yu Y et al: Level IB nodal involvement in oropharyngeal carcinoma: implications for submandibular gland-sparing intensity-modulated radiotherapy. Laryngoscope. 125(3):608-14, 2015
                                              7. Furukawa M et al: The prevalence of lymph node metastases in clinically N0 necks with oral cavity squamous cell carcinoma: is CT good enough for nodal staging? Acta Radiol. 55(5):570-8, 2014
                                              8. Lanzer M et al: Preservation of ipsilateral submandibular gland is ill advised in cancer of the floor of the mouth or tongue. Laryngoscope. 124(9):2070-4, 2014
                                              9. Roh JL et al: 18F fluorodeoxyglucose PET/CT in head and neck squamous cell carcinoma with negative neck palpation findings: a prospective study. Radiology. 271(1):153-61, 2014
                                              10. Richard C et al: Preoperative combined 18-fluorodeoxyglucose positron emission tomography and computed tomography imaging in head and neck cancer: does it really improve initial N staging? Acta Otolaryngol. 130(12):1421-4, 2010
                                              11. Cianchetti M et al: Diagnostic evaluation of squamous cell carcinoma metastatic to cervical lymph nodes from an unknown head and neck primary site. Laryngoscope. 119(12):2348-54, 2009
                                              12. de Bondt RB et al: Diagnostic accuracy and additional value of diffusion-weighted imaging for discrimination of malignant cervical lymph nodes in head and neck squamous cell carcinoma. Neuroradiology. 51(3):183-92, 2009
                                              13. 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
                                              14. Ahuja AT et al: Ultrasound of malignant cervical lymph nodes. Cancer Imaging. 8:48-56, 2008
                                              15. Mack MG et al: Cervical lymph nodes. Eur J Radiol. 66(3):493-500, 2008
                                              16. De Zinis LO et al: Prevalence and localization of nodal metastases in squamous cell carcinoma of the oral cavity: role and extension of neck dissection. Eur Arch Otorhinolaryngol. 263(12):1131-5, 2006
                                              17. Ahuja AT et al: Sonographic evaluation of cervical lymph nodes. AJR Am J Roentgenol. 184(5):1691-9, 2005
                                              18. King AD et al: Necrosis in metastatic neck nodes: diagnostic accuracy of CT, MR imaging, and US. Radiology. 230(3):720-6, 2004
                                              19. Okada Y et al: An analysis of cervical lymph nodes metastasis in oral squamous cell carcinoma. Relationship between grade of histopathological malignancy and lymph nodes metastasis. Int J Oral Maxillofac Surg. 32(3):284-8, 2003
                                              20. 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
                                              21. Ying M et al: Sonographic appearances of cervical lymph nodes: variations by age and sex. J Clin Ultrasound. 30(1):1-11, 2002
                                              22. Chikui T et al: Multivariate feature analysis of sonographic findings of metastatic cervical lymph nodes: contribution of blood flow features revealed by power Doppler sonography for predicting metastasis. AJNR Am J Neuroradiol. 21(3):561-7, 2000
                                              23. Som PM et al: Imaging-based nodal classification for evaluation of neck metastatic adenopathy. AJR Am J Roentgenol. 174(3):837-44, 2000
                                              24. Yuasa K et al: Computed tomography and ultrasonography of metastatic cervical lymph nodes in oral squamous cell carcinoma. Dentomaxillofac Radiol. 29(4):238-44, 2000
                                              25. DiNardo LJ: Lymphatics of the submandibular space: an anatomic, clinical, and pathologic study with applications to floor-of-mouth carcinoma. Laryngoscope. 108(2):206-14, 1998
                                              26. Weissman JL et al: Anterior facial vein and submandibular gland together: predicting the histology of submandibular masses with CT or MR imaging. Radiology. 208(2):441-6, 1998
                                              27. Merritt RM et al: Detection of cervical metastasis. A meta-analysis comparing computed tomography with physical examination. Arch Otolaryngol Head Neck Surg. 123(2):149-52, 1997
                                              28. Nguyen C et al: Metastatic squamous cell carcinoma to cervical lymph nodes from unknown primary mucosal sites. Head Neck. 16(1):58-63, 1994
                                              29. Chagas JF: Cervical lymph nodes in cancer of the head and neck. Rev Paul Med. 111(4):16-7, 1993
                                              30. Som PM: Detection of metastasis in cervical lymph nodes: CT and MR criteria and differential diagnosis. AJR Am J Roentgenol. 158(5):961-9, 1992
                                              31. Candela FC et al: Patterns of cervical node metastases from squamous carcinoma of the oropharynx and hypopharynx. Head Neck. 12(3):197-203, 1990
                                              32. Strasnick B et al: Occult primary tumors. The management of isolated submandibular lymph node metastases. Arch Otolaryngol Head Neck Surg. 116(2):173-6, 1990
                                              Related Anatomy
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                                              Related Differential Diagnoses
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                                              References
                                              Tables

                                              Tables

                                              KEY FACTS

                                              • Terminology

                                                • Imaging

                                                  • Top Differential Diagnoses

                                                    • Clinical Issues

                                                      TERMINOLOGY

                                                      • Abbreviations

                                                        • Submandibular space (SMS) nodal squamous cell carcinoma (SCCa)

                                                      • Synonyms

                                                        • Extracapsular extension/spread = extranodal extension (ENE)

                                                      • Definitions

                                                        • Level I nodal metastasis from primary H&N SCCa

                                                      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. Bae MR et al: 18F-FDG PET/CT versus CT/MR imaging for detection of neck lymph node metastasis in palpably node-negative oral cavity cancer. J Cancer Res Clin Oncol. 146(1):237-44, 2020
                                                                                          2. 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
                                                                                          3. Baik SH et al: Prognostic value of cervical nodal necrosis observed in preoperative CT and MRI of patients with tongue squamous cell carcinoma and cervical node metastases: a retrospective study. AJR Am J Roentgenol. 213(2):437-43, 2019
                                                                                          4. Subramaniam N et al: Lymph node staging systems in oral squamous cell carcinoma: a comparative analysis. Oral Oncol. 97:92-8, 2019
                                                                                          5. Amin MB et al: AJCC Cancer Staging Manual. 8th Ed. Springer New York, 2017
                                                                                          6. Yu Y et al: Level IB nodal involvement in oropharyngeal carcinoma: implications for submandibular gland-sparing intensity-modulated radiotherapy. Laryngoscope. 125(3):608-14, 2015
                                                                                          7. Furukawa M et al: The prevalence of lymph node metastases in clinically N0 necks with oral cavity squamous cell carcinoma: is CT good enough for nodal staging? Acta Radiol. 55(5):570-8, 2014
                                                                                          8. Lanzer M et al: Preservation of ipsilateral submandibular gland is ill advised in cancer of the floor of the mouth or tongue. Laryngoscope. 124(9):2070-4, 2014
                                                                                          9. Roh JL et al: 18F fluorodeoxyglucose PET/CT in head and neck squamous cell carcinoma with negative neck palpation findings: a prospective study. Radiology. 271(1):153-61, 2014
                                                                                          10. Richard C et al: Preoperative combined 18-fluorodeoxyglucose positron emission tomography and computed tomography imaging in head and neck cancer: does it really improve initial N staging? Acta Otolaryngol. 130(12):1421-4, 2010
                                                                                          11. Cianchetti M et al: Diagnostic evaluation of squamous cell carcinoma metastatic to cervical lymph nodes from an unknown head and neck primary site. Laryngoscope. 119(12):2348-54, 2009
                                                                                          12. de Bondt RB et al: Diagnostic accuracy and additional value of diffusion-weighted imaging for discrimination of malignant cervical lymph nodes in head and neck squamous cell carcinoma. Neuroradiology. 51(3):183-92, 2009
                                                                                          13. 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
                                                                                          14. Ahuja AT et al: Ultrasound of malignant cervical lymph nodes. Cancer Imaging. 8:48-56, 2008
                                                                                          15. Mack MG et al: Cervical lymph nodes. Eur J Radiol. 66(3):493-500, 2008
                                                                                          16. De Zinis LO et al: Prevalence and localization of nodal metastases in squamous cell carcinoma of the oral cavity: role and extension of neck dissection. Eur Arch Otorhinolaryngol. 263(12):1131-5, 2006
                                                                                          17. Ahuja AT et al: Sonographic evaluation of cervical lymph nodes. AJR Am J Roentgenol. 184(5):1691-9, 2005
                                                                                          18. King AD et al: Necrosis in metastatic neck nodes: diagnostic accuracy of CT, MR imaging, and US. Radiology. 230(3):720-6, 2004
                                                                                          19. Okada Y et al: An analysis of cervical lymph nodes metastasis in oral squamous cell carcinoma. Relationship between grade of histopathological malignancy and lymph nodes metastasis. Int J Oral Maxillofac Surg. 32(3):284-8, 2003
                                                                                          20. 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
                                                                                          21. Ying M et al: Sonographic appearances of cervical lymph nodes: variations by age and sex. J Clin Ultrasound. 30(1):1-11, 2002
                                                                                          22. Chikui T et al: Multivariate feature analysis of sonographic findings of metastatic cervical lymph nodes: contribution of blood flow features revealed by power Doppler sonography for predicting metastasis. AJNR Am J Neuroradiol. 21(3):561-7, 2000
                                                                                          23. Som PM et al: Imaging-based nodal classification for evaluation of neck metastatic adenopathy. AJR Am J Roentgenol. 174(3):837-44, 2000
                                                                                          24. Yuasa K et al: Computed tomography and ultrasonography of metastatic cervical lymph nodes in oral squamous cell carcinoma. Dentomaxillofac Radiol. 29(4):238-44, 2000
                                                                                          25. DiNardo LJ: Lymphatics of the submandibular space: an anatomic, clinical, and pathologic study with applications to floor-of-mouth carcinoma. Laryngoscope. 108(2):206-14, 1998
                                                                                          26. Weissman JL et al: Anterior facial vein and submandibular gland together: predicting the histology of submandibular masses with CT or MR imaging. Radiology. 208(2):441-6, 1998
                                                                                          27. Merritt RM et al: Detection of cervical metastasis. A meta-analysis comparing computed tomography with physical examination. Arch Otolaryngol Head Neck Surg. 123(2):149-52, 1997
                                                                                          28. Nguyen C et al: Metastatic squamous cell carcinoma to cervical lymph nodes from unknown primary mucosal sites. Head Neck. 16(1):58-63, 1994
                                                                                          29. Chagas JF: Cervical lymph nodes in cancer of the head and neck. Rev Paul Med. 111(4):16-7, 1993
                                                                                          30. Som PM: Detection of metastasis in cervical lymph nodes: CT and MR criteria and differential diagnosis. AJR Am J Roentgenol. 158(5):961-9, 1992
                                                                                          31. Candela FC et al: Patterns of cervical node metastases from squamous carcinoma of the oropharynx and hypopharynx. Head Neck. 12(3):197-203, 1990
                                                                                          32. Strasnick B et al: Occult primary tumors. The management of isolated submandibular lymph node metastases. Arch Otolaryngol Head Neck Surg. 116(2):173-6, 1990