Abstract:Background: Lymph node metastasis in the cervical region posterior to level V (PLV) can occurs in patients with nasopharyngeal carcinoma (NPC), but the significance of lymph node metastasis in this region and the delineation of the radiotherapy target area have not been reported. We aimed to explore the distribution pattern and prognosis of metastatic lymph nodes in the PLV region in patients with NPC. Methods: We retrospectively studied 605 cases of NPC diagnosed by pathological detection from December 2011 t… Show more
“…The involved groups of lymph nodes are also important to note as seen in a study by Chaoyang Jiang et al, which showed that metastasis to lymph node posterior to level V had independent prognostic factor for Distant metastasis free survival. 21 The biopsy obtained by nasal endoscopy in our study showed that non-keratinizing undifferentiated carcinoma (33/34) was seen in almost all the cases. This is the major histological subtype seen in endemic regions.…”
: Nasopharyngeal carcinoma in Nagaland has the highest age adjusted rates for both men (14.4 /100,000) and women (6.5 /100,000) in India. Most of the patients presents with usual vague symptoms related to mass in nasal cavity and higher clinical stage which affects the treatment outcome. The aim of this study is to present 34 cases of patients with Nasopharyngeal carcinoma initially presenting with palpable neck nodes and discuss the clinical findings and literature review on screening methodology with focus on Plasma EBV DNA.: Retrospective analysis of all cases of metastatic nasopharyngeal carcinoma diagnosed by Fine needle aspiration cytology on palpable cervical lymph node and histologically confirmed by endoscopic biopsy.: Total of 34 cases were included with 23 men and 11 women. The age ranged from 16 to 79 years with average of 46.6 years. The most common clinical presentation was painless neck swelling followed by epistaxis. 33/34 cases are of Non keratinizing undifferentiated nasopharyngeal carcinoma. Majority of the cases presented in stage III (19/34) followed by stage IV (10/34). : Nasopharyngeal carcinoma is a major health problem in Nagaland. Development of a good NPC screening protocol including molecular techniques remains to be explored, in order to develop and contribute to the early detection of the disease and a favourable treatment outcome.
“…The involved groups of lymph nodes are also important to note as seen in a study by Chaoyang Jiang et al, which showed that metastasis to lymph node posterior to level V had independent prognostic factor for Distant metastasis free survival. 21 The biopsy obtained by nasal endoscopy in our study showed that non-keratinizing undifferentiated carcinoma (33/34) was seen in almost all the cases. This is the major histological subtype seen in endemic regions.…”
: Nasopharyngeal carcinoma in Nagaland has the highest age adjusted rates for both men (14.4 /100,000) and women (6.5 /100,000) in India. Most of the patients presents with usual vague symptoms related to mass in nasal cavity and higher clinical stage which affects the treatment outcome. The aim of this study is to present 34 cases of patients with Nasopharyngeal carcinoma initially presenting with palpable neck nodes and discuss the clinical findings and literature review on screening methodology with focus on Plasma EBV DNA.: Retrospective analysis of all cases of metastatic nasopharyngeal carcinoma diagnosed by Fine needle aspiration cytology on palpable cervical lymph node and histologically confirmed by endoscopic biopsy.: Total of 34 cases were included with 23 men and 11 women. The age ranged from 16 to 79 years with average of 46.6 years. The most common clinical presentation was painless neck swelling followed by epistaxis. 33/34 cases are of Non keratinizing undifferentiated nasopharyngeal carcinoma. Majority of the cases presented in stage III (19/34) followed by stage IV (10/34). : Nasopharyngeal carcinoma is a major health problem in Nagaland. Development of a good NPC screening protocol including molecular techniques remains to be explored, in order to develop and contribute to the early detection of the disease and a favourable treatment outcome.
“… 15 The metastatic status of the CLNs is an essential indicator in the cN staging of NPC and has crucial implications for the target volume delineation and planning radiotherapy. 3 , 4 …”
Section: Discussionmentioning
confidence: 99%
“… 2 The metastatic status of the CLNs is an essential indicator in the staging of NPC and has crucial implications for the formulation of treatment plans, such as induction chemotherapy and target volume delineation. 3 , 4 …”
Background: The Node Reporting and Data System (Node-RADS) is a recently proposed classification system for the categorization of lymph nodes in radiological images. This study was conducted to retrospectively evaluate the diagnostic accuracy of the Node-RADS score for metastatic cervical lymph nodes on magnetic resonance imaging (MRI) of patients with nasopharyngeal carcinoma (NPC). Methods: We retrospectively analyzed cervical lymph nodes of NPC cases. Two radiologists independently evaluated each lymph node on the MRI scans using Node-RADS. Interobserver agreement between 2 radiologists for Node-RADS score assessment was evaluated by linear weighted kappa statistics. The correlation between metastasis and the Node-RADS score of each lymph node was analyzed using multivariate regression analysis. To investigate the diagnostic performance of the Node-RADS score, we further conducted receiver operating characteristic curve analysis. Correspondently, the sensitivity, specificity, positive predictive value, and negative predictive value of each different cutoff (>1, >2, >3, and >4) were computed. Results: In all, 119 patients with NPC were assessed, including 203 cervical lymph nodes consisting of 140 (69%) of 203 metastatic and 63 (31%) of 203 benign. The kappa agreement between the 2 readers for the Node-RADS score was 0.863 (95% CI = 0.830-0.897, P < .001). Node-RADS score on MRI scan was shown to be an independent predictive factor of lymph node metastasis after multivariate regression analysis (odds ratio [OR] = 6.745, 95% CI = 3.964-11.474, P < .001). Node-RADS achieved an area under the curve (AUC) of 0.950 (95% CI = 0.921-0.979) in diagnosing metastatic lymph nodes. When Node-RADS >2 was identified as the best cutoff based on balanced values, the sensitivity and positive predictive value were 0.92 and 0.94, respectively. Conclusions: Our study suggests that the Node-RADS score has high accuracy in predicting NPC cervical lymph node metastasis. Nevertheless, this conclusion requires confirmation in a larger cohort of patients with NPC.
“…Unfortunately, the PLV region is often overlooked. We have reported the correlations between the PLV region and other NNL, the distribution of metastatic lymph nodes in the PLV region in our previous studies 9 , 10 , but what is the boundary of PLV region and how to delineate it is still unclear. Figure 1 The yellow line represents trapezius, the red line represents levator scapulae, the green line presents the serratus anterior muscle, and the purple line presents the supraspinatus.…”
Section: Introductionmentioning
confidence: 96%
“…1 ). Several studies have reported the metastasis rate of PLV region is 1.3–4.9% 7 – 9 . Unfortunately, the PLV region is often overlooked.…”
The lymph node involvement in the posterior to level V (PLV) region is mainly observed in nasopharyngeal carcinoma (NPC). Recently, we have reported the distribution of metastatic lymph nodes in the PLV region and there are correlations between the neck node levels (NNL) of NPC, but what is the boundary of the PLV region and how to delineate it remains unclear, and we further to elaborate whether the bilateral level Va should be covered as intermediate-risk nodal regions (CTVn2, about 60 Gy equivalent) for all T and N categories based on these correlations. A total of 1021 consecutive NPC patients with N1-3 stage from January 2012 to December 2020 were reviewed. The lymph node metastasis level of each patient was evaluated according to the updated guidelines proposed in 2013. According to the distribution pattern of lymph node metastasis and the anatomical structure in the PLV region, the boundaries of PLV region was delineated, and whether it is appropriate to cover the bilateral level Va as CTVn2 for all the NPC patients was further discussed. The correlations of level Va with other NNL were studied using logistic regression model. The cranial boundary of PLV region is the caudal border of cricoid cartilage, the caudal boundary is the plane serratus anterior muscle begins to appear, the anterior boundary is the anterior border of trapezius, and the posterior boundary is the convergence of levator scapulae and trapezius. Laterally, the PLV region is limited by the medial edge of trapezius and medially by the lateral surface of levator scapulae. The nodal spread in level Va is based on the lymph node metastasis of level IIb in NPC. The PLV region is a missing NNL of head and neck tumors, especially in NPC. The proposed boundaries of the PLV region can provide a preliminary proposal for the further revision of NNL in head and neck tumors. It is theoretically feasible to reduce the prophylactic irradiation dose of the bilateral level Va in patients with N0 stage or with isolated metastases in level VIIa.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
