Question 2757
{"accessible":true,"alternatives":[{"id":13457,"text":"N1"},{"id":13458,"text":"N2"},{"id":13459,"text":"N2a"},{"id":13460,"text":"N2b"},{"id":13461,"text":"N2c"},{"id":13462,"text":"N3"}],"archived":false,"correctAlternativeId":13457,"explanation":"\u003cp\u003eThis question helps to show how having relevant pathology results can make TNM staging easier for radiologists and those attending tumor board / MDMs.\u003c/p\u003e\u003cp\u003eIf P16 is positive then all you need to know is are there ipsilateral nodes (N1), bilateral or contralateral nodes (N2) or any nodes greater than 6 cm in long axis (N3). This patient has nodal disease less than 6 cm in longest axis, ipsilateral to the oropharyngeal mass making this an N1 categorization.\u003c/p\u003e\u003cp\u003eIf the P16 status is negative, then a node between 3-6 cm is important to record, as well as if there are multiple ipsilateral nodes. This could be a N2b categorization if P16 negative.\u003c/p\u003e\u003cp\u003eReviewing pathology results if available when reporting (e.g. earlier US or surgical biopsy) to confirm P16 status is useful to help you create clinically useful reports. (Note the P16 status is not currently known in this Radiopaedia case).\u003c/p\u003e","id":2757,"imageUrl":"https://prod-images-static.radiopaedia.org/images/52326916/a0a541c2a435b39c5d9a7abd26b8b2_big_gallery.jpeg","imageAttribution":{"kind":"case","rID":75843},"imageAttributionCaseInfo":{"title":"Tonsillar carcinoma","contributor_name":"Saad Ahmed Saad Hassan","contributor_param":"saad-ahmed-saad-hassan","case_rid":75843,"case_param":"tonsillar-carcinoma-3"},"firstQuestionPath":"/questions/2757","nextQuestionPath":null,"relatedArticles":[{"id":6621,"title":"Cervical lymph node (staging)","link":"/articles/cervical-lymph-node-staging-1?lang=us"}],"alsoUsedIn":[{"id":1721,"kind":"Course","title":"2023 Virtual Conference Private Use - page 1721","link":"https://radiopaedia.org/courses/2023-virtual-conference-private-use/pages/1721"},{"id":365,"kind":"LiveSchedule","title":"365","link":"https://radiopaedia.org/admin/live_schedules/365"},{"id":273,"kind":"LiveSchedule","title":"273","link":"https://radiopaedia.org/admin/live_schedules/273"},{"id":1475,"kind":"Course","title":"2023 Virtual Conference Private Use - page 1475","link":"https://radiopaedia.org/courses/2023-virtual-conference-private-use/pages/1475"},{"id":1475,"kind":"Course","title":"Head \u0026 Neck Lectures - page 1475","link":"https://radiopaedia.org/courses/head-neck-lectures/pages/1475"}],"stem":"\u003cp\u003eThis 70 year old patient presented with a right neck lump. On assessment, a right palatine tonsil mass was also identified. The presenting lump corresponds with a 42 mm right level IIA node, with foci of cystic change and heterogenous enhancement. Small right sided IIB and III nodes are also seen, but no abnormal contralateral nodes are identified.\u003c/p\u003e\u003cp\u003eIf this is a P16 positive / HPV mediated tumor, with this imaging and report what is the nodal categorization as per AJCC TNM 8th edition: \u003c/p\u003e","menuLinks":[{"text":"Report problem with question","url":"https://docs.google.com/forms/d/e/1FAIpQLSfO3soWYhOjJ7yErSysyCe5V4A1CqW7WK3rDA7MtAkecMGqNw/viewform?entry.1624461248\u0026entry.553583435=https://radiopaedia.org/questions/2757"}],"attemptsPercentages":[{"alternativeId":"13458","percentage":23},{"alternativeId":"13460","percentage":19},{"alternativeId":"13461","percentage":6},{"alternativeId":"13459","percentage":16},{"alternativeId":"13462","percentage":11},{"alternativeId":"13457","percentage":25}],"promptToLogin":false,"questionManager":false,"articleId":"hpv-mediated-p16-positive-oropharyngeal-cancer-staging"}