Cervical Lymph Node Groups

Anatomical Classification

• The European Society of Nuclear Medicine recommends classifying cervical lymph nodes into six main anatomical groups, Level I-VI, which is the standard terminology for surgical planning and oncological evaluation 1
• The American Joint Committee on Cancer recommends including Level I (submental and submandibular region) in selective neck dissection for oral cavity tumors with N0 disease 2

Surgical Approach

• The National Comprehensive Cancer Network recommends selective neck dissection (three or fewer nodal levels) for N0 disease 2
• The National Comprehensive Cancer Network recommends comprehensive neck dissection (all Level I-V) for N3 disease 3

Imaging Criteria

• The American College of Radiology recommends considering lymph nodes with a round shape, loss of fatty hilum, heterogeneous internal structure, necrotic centers, and irregular borders as suspicious 2
• The American College of Radiology recommends considering lymph nodes larger than 1.5 cm as suspicious 3

Histological Evaluation

• The College of American Pathologists recommends examining at least 6 lymph nodes in selective neck dissection specimens 2

Important Considerations

• The European Society of Nuclear Medicine warns of "shine-through" and "scatter" problems in submandibular and submental areas, particularly in oral cavity tumors 4
• The European Society of Nuclear Medicine notes that the sentinel lymph node identification rate is lower in oral cavity tumors compared to other oral squamous cell carcinoma sub-sites (4)