Lallemant Benjamin, Reynaud Christophe, Alovisetti Caroline, Debrigode Charles, Ovtchinnikoff Serge, Chapuis Heliette, Lallemant Jean-Gabriel
Department of Oto-Rhino-Laryngology, Hôpital Carémeau, Nîmes, France.
Acta Otolaryngol. 2007 Mar;127(3):318-22. doi: 10.1080/00016480600806299.
This update will enable us to precisely address the involvement pattern of level VI and to standardize treatment procedures in order to refine their indications and eventually improve their results and avoid treatment morbidity.
The neck level classification is being used worldwide to describe the lymph nodes status of the neck. It provides standardized data to properly evaluate and then improve our protocols for the management of neck metastasis in an evidence-based medical manner. Although level VI treatment is challenging in cancer of the larynx, pharynx, trachea, esophagus, and thyroid, our knowledge about its involvement relies on few non-standardized data, due to the inadequate definition of this region.
We propose an updated radiological and surgical definition of level VI, with the introduction of two sublevels which fulfill surgical, radiotherapy, radiological, and pathological concerns.
Level VIa encompasses prelaryngeal, intercricothyroidal, pretracheal, and perithyroidal nodes. Level VIb encompasses inferior laryngeal nodes. Within the traditional limits of level VI, all lymph nodes lying between the inferior border of the hyoid bone and the inferior border of the cricoid cartilage belong to level VIa. Between the inferior border of the cricoid cartilage and the top of the suprasternal notch, lymph nodes lying in front of the posterior face of the thyroid gland belong to level VIa; those lying behind this boundary belong to level VIb. We also discuss the definition of the superior mediastinal lymph nodes, which should not be mistaken for level VI.
本次更新将使我们能够精确描述Ⅵ区的受累模式，并规范治疗程序，以优化其适应证，最终改善治疗效果并避免治疗相关并发症。
颈部淋巴结分区在全球范围内用于描述颈部淋巴结状态。它提供标准化数据，以便以循证医学的方式正确评估并改进我们针对颈部转移瘤的治疗方案。尽管在喉癌、下咽癌、气管癌、食管癌和甲状腺癌中，Ⅵ区的治疗具有挑战性，但由于该区域定义不充分，我们对其受累情况的了解仅基于少数非标准化数据。
我们提出了Ⅵ区更新后的影像学和外科定义，引入了两个亚区，以满足手术、放疗、影像学和病理学方面的需求。
Ⅵa区包括喉前、环甲膜间、气管前和甲状腺周围淋巴结。Ⅵb区包括喉下淋巴结。在传统的Ⅵ区范围内，舌骨下缘与环状软骨下缘之间的所有淋巴结均属于Ⅵa区。环状软骨下缘与胸骨上切迹顶部之间，位于甲状腺后面的淋巴结属于Ⅵa区；位于该边界后面的淋巴结属于Ⅵb区。我们还讨论了上纵隔淋巴结的定义，不应将其与Ⅵ区混淆。
