Retropharyngeal lymph node metastasis in nasopharyngeal carcinoma detected by magnetic resonance imaging

Abstract

BACKGROUND. Retropharyngeal lymph node (RLN) metastasis was not included in the current American Joint Committee on Cancer (AJCC) staging system (6th edition) for nasopharyngeal carcinoma (NPC).The object of the current study was to investigate the prognostic value and staging categories of RLN metastasis in NPC detected by magnetic resonance imaging (MRI). METHODS. All 924 consecutive patients with newly diagnosed NPC were examined with MRI before treatment with definitive intent radiotherapy. RESULTS. The incidence of RLN metastasis was 73.5%. On multivariate analysis, RLN metastasis was found to be an independent prognostic factor for distant metastasis‐free survival (DMFS) in all patients (P = .040). In patients with N0 disease, significant differences were observed between patients with and those without RLN metastasis after adjusting for T classification (P = .046). With regard to laterality, no significant differences were observed in DMFS between patients with unilateral and bilateral RLN metastasis in N0 disease (P = .734). No significant difference in the hazards ratios for either DMFS or disease‐free survival (DFS) was found between patients with N0 disease with RLN metastasis and patients with N1 disease (P = .092 and P = .149, respectively). When RLN was classified as N1 disease, there was a better segregation of different N classifications in terms of DFS and DMFS curves, whereas the difference in hazards ratios for N0 and N1 disease was more obvious in DMFS (from 0.461 vs 0.785 to 0.317 vs 0.690). CONCLUSIONS. The results of the current MRI‐based study demonstrate that RLN metastasis affects the DMFS rates of NPC. The authors propose that RLN metastasis be classified as N1 disease, regardless of its laterality. Cancer 2008. ©2008 American Cancer Society.

Diffusion-weighted imaging to differentiate metastatic from non-metastatic retropharyngeal lymph nodes in nasopharyngeal carcinoma

“…5 Although MRI has proven to be an invaluable tool for distinguishing RLN and cervical lymph node metastasis, 2,15,16 functional imaging, such as DWI, has been shown to facilitate diagnosis of lymph node metastasis in other malignant diseases. [17][18][19][20] Here, we evaluated the utility of DWI in differentiating metastatic from benign RLN in NPC, compared the accuracy of size-and ADC-based criteria in RLN metastasis and determined whether DWI would at all improve the diagnostic accuracy of RLN metastasis.…”

“…Spread of the disease to RLNs has been associated with a poor prognostic outcome in patients with NPC, and therefore, a diagnosis of RLN metastasis has been classified as N1 stage disease. 4,5 However, the deep anatomical location of RLNs makes it difficult to diagnose metastatic disease histopathologically. Diagnostic criteria for distinguishing metastatic from benign lymph nodes have been limited to those obtained by standard MRI and are based on measurements of the size and shape of nodes and signal intensities that correspond to the presence of capsular spread and central necrosis.…”

Ekspresi mRNA LMP2A Epstein-Barr Virus dari Biopsi Jaringan dalam Blok Parafin Berpotensi sebagai Biomarka dalam Diagnosis Karsinoma Nasofaring

“…Pendahuluan KNF mempunyai sifat berbeda dibandingkan dengan keganasan pada kepala leher yang lain, karena sifatnya yang sangat invasif dan sangat mudah bermetastasis (Liu et al, 2003;Jiang et al, 2004;Ma et al, 2007;Tang et al, 2008). Salah satu penyebab KNF adalah infeksi oleh Epstein-Barr Virus (EBV) (Gu et al, 2012;Shen et al, 2015).…”

Prognostic Significance of Maximum Primary Tumor Diameter in Nasopharyngeal Carcinoma

“…Tang et al reported that the incidence of retropharyngeal lymph node metastasis was 73.5% in 924 consecutive patients with newly diagnosed, untreated, non-metastatic NPC, as diagnosed by MRI [20]. Chua et al included the retropharyngeal lymph nodes that were embedded in the primary tumor in their measurement of tumor volume [7].…”

“…Firstly, MRI, which can provide a clear distinction between the retropharyngeal nodes and primary tumor, has been widely used in the staging of NPC [21]. Secondly, retropharyngeal node involvement has already been reported to significantly affect DMFS in NPC, leading to the reclassification of retropharyngeal node involvement as N1, instead of T2, disease [1,20].…”