![]() Of the 124 patients, who were followed for at least one year, 42 showed these characteristics, and none of these showed any progression to malignancy at follow-up. We found a very high number of patients (42/124) with lymph nodes that did not appear to be fully normal at US examination, particularly those with structural alterations in the hilus and slight loss of physiologic curvature of the outlines, with moderate thickening of the cortex. A second US examination was performed on the same area after at least 12 months. The following parameters of the US performed on the lymph nodes were evaluated: number and size, aspects of the outline, including any extroflexion of the outline and contours morphology, homogeneity and thickness of the cortex and aspects of the hilus, characteristics of the vascularisation of the lymph node at color-power Doppler. The study population consisted of patients who presented consecutively to our facility for a control between 1 January 2009 and 30 July 2010 and who had undergone surgery for a melanoma, at least 6 months earlier, in areas draining to lymph nodes of the groin but choosing – for this study - the opposite side to the natural drainage. We evaluated such lesions among a cohort of patients. Pathologic criteria apply for patients treated surgically, with cervical lymph node dissection, for whom multiple whole lymph nodes are available for microscopic evaluation.Among patients undergoing follow-up after surgery for melanoma, ultrasound (US) very often reveals lymph nodes in groin area, that do not show clear characters of a metastatic lesion yet that have atypical US features, which could result in diagnostic uncertainty. ![]() N3b: metastasis in a node with clinically overt ENE(+) (ENE c).N3a: metastasis in a node, >6 cm, and ENE(−).N2c: metastasis in bilateral or contralateral nodes, all ≤6 cm, and ENE(−).N2b: metastasis in multiple ipsilateral nodes, all ≤6 cm, and ENE(−).N2a: metastasis in single ipsilateral node, >3 cm and ≤6 cm, and ENE(−).N1: metastasis in single ipsilateral node, ≤3 cm, and no extranodal extension (ENE(−)).Clinical evaluation synthesizes information from such sources as physical examination, imaging, and fine-needle aspiration. These findings are skin invasion, muscular infiltration, dense tethering/fixation to adjacent structures, or neural invasion with dysfunction involving a cranial nerve, the brachial plexus, the sympathetic trunk, or the phrenic nerve.Ĭlinical criteria apply for patients treated nonsurgically, without cervical lymph node dissection. Clinically overt ENE in a node measuring 3 cm or smaller is cN3b but pathologic ENE in a similarly sized node would be pN2a, reflecting the higher bar to demonstrate clinically overt ENE.Ĭlinical determination of ENE requires unambiguous findings on physical examination and supporting radiological evidence radiologic evidence is insufficient 3. The major difference between the two surrounds categorization of a node measuring 3 cm or less with extranodal extension. Nodal involvement can be evaluated clinically (cN) or pathologically (pN). ![]() The emphasis on ENE is new since prior editions. Notable exclusions of head and neck cancers are HPV-related oropharynx cancer, nasopharynx cancer, mucosal melanoma, and thyroid cancers ( differentiated, medullary, or anaplastic).Ĭervical nodal staging categorizes metastatic lymph nodes according to location, multiplicity, size measured in greatest dimension, and presence of extranodal extension (ENE). This system applies for epithelial cancers (most commonly squamous cell carcinoma) of most regions of the head and neck, including those of the skin, maxillary sinus, nasal cavity and ethmoid sinus, oral cavity, oropharynx, major salivary glands, hypopharynx, larynx, and unknown primary. ![]() Cervical lymph node staging refers to evaluating regional nodal metastasis from primary cancer of the head and neck. The following article reflects the 8th edition of the TNM staging system published by the American Joint Committee on Cancer, which is used for staging starting January 1, 2018 1,2. ![]()
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