J Korean Soc Radiol.  2015 Apr;72(4):271-281. 10.3348/jksr.2015.72.4.271.

Comparative Study of Lymph Node Metastasis from Squamous Cell Carcinoma and Non-Squamous Cell Carcinoma on Neck CT

• Lee HN
• Han JK
• Kim HH
• Shin HC
• Kim IY
• Jou SS

• KMID: 1941758
• DOI: http://doi.org/10.3348/jksr.2015.72.4.271

Abstract

PURPOSE
To assess the differential imaging findings of metastatic lymph nodes in squamous cell carcinoma (SCC) and non-squamous cell carcinoma (non-SCC) on neck CT and to facilitate the identification of primary focus before performing a biopsy.
MATERIALS AND METHODS
We retrospectively analyzed 46 patients with SCC and 50 patients with non-SCC who underwent neck CT from January 2006 to January 2011. Patients were divided into two groups; SCC and non-SCC. The total number of lymph nodes was 204 in the SCC group and 530 in the non-SCC group. Two observers were asked to assess the characteristics of abnormal lymph nodes (number, margin types, enhancement patterns, size, bilaterality, calcification, fat infiltration, conglomeration, invasion of adjacent tissue, and nodal distribution). Nodal distribution was evaluated by imaging-based nodal classification on neck CT.
RESULTS
Between the SCC group and the non-SCC group except for cases of thyroid cancer, the number of lymph nodes and the number of lymph nodes smaller than 3 cm in the non-SCC group except for cases of thyroid cancer were significantly greater than those in the SCC group (p < 0.05).
CONCLUSION
The number of lymph nodes, the number of lymph nodes smaller than 3 cm, and nodal distribution are helpful in differential diagnosis between SCC and non-SCC before performing a biopsy.

MeSH Terms

Biopsy
Carcinoma, Squamous Cell*
Classification
Diagnosis, Differential
Humans
Lymph Nodes*
Neck*
Neoplasm Metastasis*
Retrospective Studies
Thyroid Neoplasms

Figure

• 

  Fig. 1 Cervical lymph node metastasis in a 69-year-old man who present with palpable left sided neck mass. Axial CT images show enlarged lymph node in the left neck at level IIB. Attenuations value of the highest enhancement portion (arrowhead) and the lowest enhancement portion (arrow) are 96 Hounsfield units (HU) and 67 HU, respectively. Because the attenuation values differed by over 20 HU, the enhancement pattern is defined as heterogeneous enhancement. Percutaneous needle biopsy is performed and the histologic diagnosis is metastatic squamous cell carcinoma. The primary focus was unknown.

• 

  Fig. 2 Cervical lymph node metastasis in a 78-year-old woman. Axial image reveals enlarged lymph nodes in the right neck level IA, IB. The lymph node shows central water attenuation (below 25 Hounsfield units) with peripheral enhancement, enhancement pattern is defined as peripheral thick wall enhancement (> 1 mm). Invasion of the anterior belly of the digastric muscle is also noted (arrow). Percutaneous needle biopsy is performed and the histologic diagnosis is metastatic squamous cell carcinoma. Primary focus was tongue cancer.

• 

  Fig. 3 Cervical lymph node metastasis in a 70-year-old woman. Precontrast axial image reveals intranodal calcification (arrow in A). Postcontrast axial image (B) shows enlarged lymph nodes with heterogeneous enhancement noted in left neck level II. Percutaneous needle biopsy is performed and histologic diagnosis is metastatic medullary carcinoma. Primary focus is medullary thyroid carcinoma.

• 

  Fig. 4 Cervical lymph node metastasis in a 64-year-old man. Axial image shows enlarged lymph node with peripheral thick wall enhancement in right neck level III. Perinodal fat tissue infiltration is also noted. Percutaneous needle biopsy is performed and the histologic diagnosis is metastatic papillary carcinoma. Primary focus is papillary thyroid carcinoma.

• 

  Fig. 5 Cervical lymph node metastasis in a 78-year-old woman who present with palpable left neck mass. Axial image shows conglomerated lymph node with homogeneous enhancement in the left neck at supraclavicular level. Left internal jugular vein is not clearly visible due to tumor invasion. Encasement of left internal carotid artery is also noted (arrow). Percutaneous needle biopsy is performed and the histologic diagnosis is metastatic squamous cell carcinoma. Primary focus is bladder cancer.

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