The imaging assessment of nodal disease can be challenging for the radiologist because there are multiple sites to review and differing opinions about criteria for abnormal nodes. The ability to accurately detect nodal metastases is improved with knowledge of the criteria for abnormal nodes, the nodal drainage patterns, and common imaging pitfalls. In this article, we introduce these basic concepts and review the appropriate approach for evaluation of metastatic cervical lymph nodes on cross-sectional neck imaging. This presentation would cover the following topics: criteria for abnormal nodes which includes size, morphology, margin and internal content of the lymph nodes ( cystic changes, Ca, etc. ), site Classification based on the system devised by American head and neck society and American academy of otolaryngology-head and neck surgery, features Important for Staging and the radiologist’ s role is to describe characteristics pertinent to the N staging, important features for Management such as extra capsular spread. It would also have a brief review of advanced imaging techniques for nodal metastases and the indications for FNA in head and neck lymphadenopathies.

Background: The extent of lymph node involvement is the most significant prognostic indicator in resected locoregional colorectal cancer.Objectives: This study aimed to investigate the prognostic value of total lymph nodes identified and ratio of lymph nodes in resected colorectal cancer.Patients and Methods: Two hundred seventy five patients with histologically proven resected locoregional invasive colorectal adenocarcinoma from 2003 to 2011 were included. All patients were treated with standard surgical resection for their colorectal cancer. Patients with incomplete data, or unresectable tumors or distant metastases were excluded from the study. All potential prognostic variables were evaluated for their impact on the local control, disease-free, and overall survival rates.Results: Of the 275 patients, 162 were men and 113 were women with a median age of 54 (range 23-84) years. The mean total lymph nodes were significantly higher in colon cancer than rectal cancer (11 versus 7.5, P=0.001). In node positive (stage III) patients, the mean lymph nodes ratio was 0.5 for rectal cancers and 0.37 for colon cancers respectively showing a nonsignificant (P=0.05) trend toward higher lymph nodes ratio in rectal cancer patients. In univariate analysis, the mean total number of lymph node identified was a prognostic factor for 5-year disease free (P=0.04) and overall survival (P=0.02) rates. In node positive patients, lymph nodes ratio was a prognostic factor for 5-year local control (P=0.04), disease free survival (P=0.01), and overall survival (P=0.01) rates. On multivariate analysis, advanced primary tumor stage, rectal primary site and the presence of perineural invasion were independent adverse prognostic factors for overall survival.Conclusions: Total lymph nodes identified and ratio of lymph nodes are associated with oncological outcomes outcomes in patients with colorectal cancer.

Background: Sentinel lymph node biopsy is used as an accurate staging procedure to detect early breast cancer. Several studies have documented that sentinel lymph node biopsy can accurately determine the status of axillary nodes. Sentinel node biopsy offers the advantage of accurately staging the axilla and eliminating the need for a full axillary dissection for patients who have a negative sentinel node. The aim of this study is to determine the predictors of non-sentinel lymph node metastasis by sentinel node biopsy.Methods: In this study, all patients (n=88) who underwent sentinel node biopsy for invasive breast cancer from June 2005 to June 2010 in Shahid Faghihi Hospital, Shiraz, Iran were enrolled. We reviewed the medical files of patients and their tumor characteristics. Statistical analysis was performed to determine whether any of these characteristics alone could accurately predict the remaining non-sentinel node status.SPSS statistical package was used.Results: The mean age of the patients was 46.1 years. Tumor size was 2.73 cm. Of the 88 patients who underwent complete axillary node dissection, 34 had metastases in the non-sentinel nodes, with a mean of 4 positive non-sentinel nodes in each patient.Statistically, neither the patient's age nor the clinicopathological features of the tumor were significantly associated with non-sentinel node metastases (all: P>0.05).Conclusion: Our study shows that neither the primary tumor characteristics nor the size of metastasis in the sentinel lymph node can predict the status of non-sentinel nodes.However, further investigation is necessary. Complete axillary node dissection should remain the most appropriate management for patients with positive sentinel lymph nodes.

Background: We investigated the role of metastatic central lymph node ratio (CLNR) for characterizing FDG-avid cervical lymph nodes (LNs).Materials and Methods: Enrolled patients underwent total thyroidectomy and had FDG-avid LNs incidentally detected on postoperative PET/CT. CLNR (%) was calculated as follows: (number of metastatic LNs/number of removed central LNs) x 100. We investigated clinic opathologic factors significant for predicting metastasis.Results: Of the 59 patients, 23 had metastatic LNs. The frequency of pN1b stage and LN location were significant factors for predicting metastases. Among 29 patients with FDG-avid LNs located in mid to lower neck compartments, high CLNR (>40%) was the only significant factor on multivariate analyses (OR, 9.89; 95% CI, 1.54-63.65; P=0.016).Conclusion: CLNR was a significant factor for characterizing FDG-avid LNs especially located in mid to lower neck compartments.

Nearly four decades, Riviera classification, which is a clinically based system, was the only system for cervical adenopathy classification. The best possible classification of cervical nodal disease may be accomplished by using both clinical palpation and also information’s provided by imaging, because imaging can reveal clinically silent lymph nodes. Most head and neck tumors spread to the neck nodes as a part of their natural history, depending on the primary site. Up to 80% of patients with upper aero digestive mucosal malignancies will have cervical nodal metastasis At presentation. The occurrence of nodal metastasis has a profound effect on the management and prognosis of the patient’s .nodal metastasis is the most important prognostic factor in squalors cell carcinoma of the head and neck. In general it decreases the overall survival by half, and extra capsular spread worsens the prognosis by another half. Our purpose in this presentation is to review imaging classification of cervical lymph nodes.

Background: Cervical cancer is the second most common type of cancer among women. Effective screening programs can help cancer detection in early phases and reduce death. Metastasis to lymph nodes is one of the most prognostic factors in patients who underwent surgery. Also, a positive result from pathology report alert oncologist as a cause of death. Sentinel lymph node biopsy has been widely studied and clinically used for many types of cancer. Methods: Two techniques exist for detecting sentinel node in cervical cancer, which are Blue dye and gamma probe with radioactive isotope (99mTc). Moreover, lymphoscintigraphy has many advantages over the stain method. Detecting the sentinel node is performed via laparoscopy or laparotomy; former method is better and more accurate. Results: Various researchers have focused on this method and its positive results; its superiority against full lymphadenectomy has been declared in previous studies. Moreover, the role of sentinel lymph nodes biopsy in cervical cancer is still being extensively studied. Sentinel lymph nodes (SLN) method has a higher accuracy level to detect metastasis. Conclusion: Hence, it can be considered as a more appropriate alternative for pelvic lymph node dissection (PLND), which is a standard technique. Altering the method to a standard clinical method needs in-depth researches and studies.