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Published on: August 19, 2021
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Imaging Approach for Cervical Lymph Node Metastases from Unknown Primary Tumor.
Sota Masuoka1, Takashi Hiyama1, Hirofumi Kuno1
1From the Department of Diagnostic Radiology (S.M., T.H., H.K., K.S., T.K.) and Department of Pathology and Clinical Laboratories (S.S.), National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa 277-8577, Japan.
Summary
Imaging helps identify unknown primary head and neck cancers presenting as neck lymph node (LN) metastasis. Characteristic imaging findings and locations can pinpoint the primary tumor site, guiding diagnosis and treatment.
Area of Science:
- Radiology
- Oncology
- Head and Neck Surgery
Background:
- Neck swelling from lymph node (LN) metastasis is an early sign of head and neck cancer, sometimes without an obvious primary tumor.
- Accurate diagnosis of unknown primary cervical LN metastases is crucial for appropriate treatment planning.
Purpose of the Study:
- To review diagnostic imaging strategies for identifying primary tumors in patients with unknown primary cervical LN metastases.
- To correlate LN metastasis characteristics and locations with potential primary tumor sites.
Main Methods:
- Discussion of diagnostic imaging approaches, including analysis of LN metastasis distribution and characteristics.
- Emphasis on characteristic findings such as nodal levels, cystic changes, and calcifications.
- Inclusion of advanced imaging techniques like fluorine 18 fluorodeoxyglucose PET/CT.
Main Results:
- Unknown primary LN metastasis commonly involves nodal levels II and III, often linked to HPV-positive oropharyngeal squamous cell carcinoma.
- Cystic changes in LNs suggest HPV-associated oropharyngeal cancer; calcifications may indicate histologic type and primary site.
- Metastases at levels IV and VB warrant consideration of non-head and neck primary sites.
Conclusions:
- Imaging findings, including anatomic disruption, can reveal small mucosal or submucosal lesions.
- Fluorine 18 fluorodeoxyglucose PET/CT aids in primary tumor detection.
- Effective imaging facilitates prompt diagnosis and optimal patient management.
