Retropharyngeal lymphadenopathy in nasopharyngeal carcinoma

This study reports the incidence, numer, size and distribution of enlarged lateral retropharyngeal (LRP) nodes in patients with nasopharyngeal carcinoma (NPC).

One-hundred and fourteen patients with histopathologically proven NPC were staged prospectively with magnetic resonance imaging (MRI) and computed tomography (CT). T1-weighted, gadolinium-DTPA enhanced, T2-weighted images and CT were obtained.

Ninety-one (80%) patients showed enlargement of both LRP and cervical nodes. LRP lymphadenopathy was detected in 59 (65%) of these 91 patients. A total of 347 neck nodes were identified. There were 72 enlarged LRP nodes (average 13 mm, range 6-34 mm). Sixteen groups of fused nodes were also seen (average 24 mm, range 15-40 m). Thirty-two patients (35%) with cervical lymphadenopathy showed no LRP lymphadenopathy. LRP nodes were seen at the following levels: C1, 35 (49%) nodes; C1/C2, 23 (32%); C2, 13 (18%) and C2/C3, one (1%). It is not known if all these nodes are due to metastasis or hyperplasia as no histopathological proof is available.

LRP lymphadenopathy may be seen in up to 65% of NPC patients with neck node enlargement. All the retropharyngeal nodes were located in the lateral group. Although medial retropharyngeal nodes are mentioned in the literature, they were not seen in this study. LRP nodes should be documented when surgical resection is contemplated in malignancy of the head and neck.