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Cervical lymph node staging

contributed by Dr Frank Gaillard on July 24, 2009

System: Head & Neck
Section: Staging
Tag: needs rewriting

Cervical lymph node staging is important in a variety of tumours, especially squamous cell carcinoma of the head and neck.

TNM nodal staging

Nodal staging is the same for squamous cell carcinomas of most regions of the upper aerodigestive tract of the head and neck, including those of the of the oral cavity, oropharynx, hypopharynx and larynx.

  • Nx : nodes cannot be assessed
  • N0 : no regional nodal metastases
  • N1 : single ipsilateral node, ≤ 3cm
  • N2
    • N2a : single ipsilateral node, 3 - 6 cm
    • N2b : multiple ipsilateral nodes, < 6 cm
    • N2c
      • bilateral nodal metastases OR
      • contralateral nodal metastases < 6 cm
  • N3 : any nodal metastasis > 6 cm

Size criteria

  • most nodes should be less than 10mm in short-axis except...
  • submental - submandibular : 15 mm
  • retropharyngeal : 8 mm

if using size criteria alone then 10 - 20 % error rate.

The long to short axis ratio has also been proposed 2 to help evaluate enlarged nodes in the setting of head and neck SCC. When nodes have a ratio of > 2 (ie long and flat) 95% are benign. When the ratio is less than 2 (ie rounder) then a similar proportion where malignant.

Size-independent criteria

See also