[Magnetic resonance imaging diagnosis of cervical lymph node metastasis from lingual squamous cell carcinoma]

Abstract

Background & objective: The identification of cervical lymph node metastasis is very important for the treatment and prognosis prediction of lingual squamous cell carcinoma. Simple palpation is unsatisfactory for the accurate diagnosis of cervical lymph node metastasis. Magnetic resonance imaging (MRI) has been increasingly used to evaluate cervical lymph node status. This study was to explore MRI features of cervical lymph nodes metastasis from lingual squamous cell carcinoma, and to investigate the role of MRI in diagnosing this kind of metastasis.

Methods: The MR images of 448 nodal levels in 92 patients with lingual squamous cell carcinoma were analyzed, and compared with their pathologic diagnoses.

Results: Of the 488 nodal levels, 166 (37.1%) were proved pathologically as metastases, level II was the most commonly involved. False-positive and false-negative rates of MRI diagnoses were higher in levels I, and II than in levels III, IV, and V. There is no statistical difference in the incidence of cervical lymph nodes metastases of different nodal levels between squamous cell carcinoma of corpus linguae and that of radix linguae. Obvious central nodal necrosis was seen in 76 nodal levels at MR images,which were proved pathologically as metastatic nodes. Extracapsular nodal invasions in 34 nodal levels had irregular contour, and infiltration of adjacent fat tissues around lymph nodes, among which carotid artery walls were encased in 2 cases. With the diagnostic criteria of metastasis as the minimal nodal diameter of >/= 8 mm or central nodal necrosis, the diagnostic sensitivity, specificity, and accuracy of MRI were 79.5%, 90.4%, and 86.4%, respectively.

Conclusions: The incidence of cervical lymph nodes metastasis from lingual squamous cell carcinoma is highest in level II. MRI diagnostic criteria of cervical lymph nodes metastasis are nodal size, central nodal necrosis, and irregular contour of lymph nodes. MRI may diagnose lymph node metastasis in levels III-V with high accuracy, While its diagnosis accuracy on levels I-II is affected by the sites, which weakens its clinical value.