Computed tomography of cervical and retropharyngeal lymph nodes: normal anatomy, variants of normal, and applications in staging head and neck cancer. Part II: pathology.

Forty-one patients were examined (39 prospectively and 2 retrospectively) with computed tomography (CT) to determine its value in staging cervical and retropharyngeal nodal metastases. Precise surgical confirmation of CT findings was available in 25 patients. CT correctly increased the stage of the disease in six necks, and showed extranodal extent more precisely than the clinical examination in six others. The clinical evaluation proved superior to CT at predicting the extent of extranodal disease in two patients. Both CT and the clinical examination failed to detect microscopic tumor in normal-size nodes in two patients and falsely predicted tumor in enlarged nodes in one. CT offers information important for management and prognosis that is not available from the clinical examination in patients who have already been treated for cancer of the neck, and in patients with extranodal spread or retropharyngeal adenopathy. In the untreated neck CT will increase the stage of the disease from N0 to N1 about 5% of the time. Simple criteria for integrating CT into current clinical-diagnostic staging systems based on this and other experience are presented.