The Radiology Assistant : Cervical Lymph Node Map (2024)

Overview

The Radiology Assistant : Cervical Lymph Node Map (1)

In this cervical lymph node map the levels were extended to 10.

Some of these are being divided into sub-levels to correspond more completely with the TNM atlas.

The Radiology Assistant : Cervical Lymph Node Map (2)

Borders

Important landmarks are:

  • Hyoid bone
  • Cricoid
  • Carotids
  • Sternocleidomastoid muscle
  • Manubrium of sternum

Axial CT

The Radiology Assistant : Cervical Lymph Node Map (3)

Axial CT slices in correlation to overview illustration.

The Radiology Assistant : Cervical Lymph Node Map (4)

Axial CT slices in more detail.
Enlarge images by clicking on them.

Levels

The Radiology Assistant : Cervical Lymph Node Map (5)

I - Submental and submandibular

Nodes in level I are at risk of developing metastases from cancers of the oral cavity, anterior nasal cavity and the soft tissues of the mid-face and the submandibular gland.

The Radiology Assistant : Cervical Lymph Node Map (6)

Level Ia
is a median region located between the anterior belly of the digastric muscles, which contains the submental nodes.

Level Ib
contains the submandibular nodes located in the space between the inner side of the mandible laterally and the digastric muscle medially, from the symphysis menti anteriorly to the submandibular gland posteriorly.

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II - Upper jugular

Level II receives lymphatics from the face, the parotid gland, and the submandibular, submental and retropharyngeal nodes.
Level II also directly receives the collecting lymphatics from the nasal cavity, the pharynx, the larynx, the external auditory canal, the middle ear, and the sublingual and submandibular glands[1].

Level II can be divided into level IIa and level IIb by drawing a line at the posterior edge of the internal jugular vein.

The Radiology Assistant : Cervical Lymph Node Map (8)

The nodes in level IIa and IIb are at risk of harboring metastases from cancers of the nasal and oral cavity, nasopharynx, oropharynx, hypopharynx, larynx and major salivary glands.

Level IIb is more likely associated with primary tumors of the oropharynx or nasopharynx, and less frequently with tumors of the oral cavity, larynx or hypopharynx[1].

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III - Mid jugular

Level III receives efferent lymphatics from levels II and V, and some efferent lymphatics from the retropharyngeal, pretracheal and recurrent laryngeal nodes.
It collects the lymphatics from the base of the tongue, tonsils, larynx, hypopharynx and thyroid gland.

The Radiology Assistant : Cervical Lymph Node Map (10)

The inferior border of the cricoid is the border between level III and IVA.

Nodes in level III are at risk of harboring metastases from cancers of the oral cavity, nasopharynx, oropharynx, hypopharynx and larynx.

The Radiology Assistant : Cervical Lymph Node Map (11)

IV - Lower jugular and medial supraclavicular

The border between level IVa and IVb is set arbitrarily 2 cm cranial to the sterno-clavicular joint.

The Radiology Assistant : Cervical Lymph Node Map (12)

Level IVa
These nodes are at risk for harboring metastases from cancers of the hypopharynx, larynx, thyroid and cervical esophagus.
Rarely metastases from the anterior oral cavity may manifest in this location with minimal or no proximal nodal disease.

Level IVb
These nodes are at risk for harboring metastases from cancers of the hypopharynx, subglottic larynx, trachea, thyroid and cervical esophagus.

The Radiology Assistant : Cervical Lymph Node Map (13)

V - Posterior triangle and Supraclavicular

Level V contains the nodes of the posterior triangle group located posteriorly to the sternocleidomastoid muscle around the lower part of the spinal accessory nerve and the transverse cervical vessels.

Nodes in level V are most often associated with primary cancers of the nasopharynx, the oropharynx, the cutaneous structures of the posterior scalp, and the thyroid gland.

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Level Vc - Supraclavicular

This level contains the lateral supraclavicular nodes located in the continuation of the posterior triangle nodes (level Va and Vb) from the cervical transverse vessels down to a limit set arbitrarily 2 cm cranial to the sternal manubrium.
It corresponds partly to the area known as the supraclavicular fossa.

Level Vc receives efferent lymphatics from the posterior triangle nodes (level Va and Vb) and is more commonly associated with nasopharyngeal tumors[1].

Transverse cervical artery
Scroll through the images for the anatomy of the transverse cervical artery.

The Radiology Assistant : Cervical Lymph Node Map (15)

VI - Anterior cervical

This level contains the superficial anterior jugular nodes (level VIa) and the deeper prelaryngeal, pretracheal, paratracheal and recurrent laryngeal nerve nodes (level VIb).

The Radiology Assistant : Cervical Lymph Node Map (16)

Level VIa
This level contains the superficially located anterior jugular nodes.

Level VIb
This level is contained between the medial borders of the common carotid arteries.
The nodes in this area are:

  • pre-laryngeal nodes in front of the larynx and cricoid
  • pre-tracheal nodes in front of the trachea
  • paratracheal nodes also called recurrent laryngeal nerve nodes

The Radiology Assistant : Cervical Lymph Node Map (17)

Delphian lymph node

The Delphian lymph node derived its name from the oracle of Delphi, whose prophecy would be a death secondary tolaryngeal cancer.

It is a pretracheal node in level VIa located anterior to the cricoid and in between the cricothyroid muscles.

The Radiology Assistant : Cervical Lymph Node Map (18)

The recurrent laryngeal nerves branch off the vagus, the left at theaortic arch, and the right at the rightsubclavian artery.

The left laryngeal nerve can be compressed by subaortic lymph node metastases in the aorto-pulmonary window as seen in patients with lung cancer.

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VII - Retropharyngeal and retrostyloid

Retropharyngeal nodes receive lymphatics from the mucosa of the nasopharynx, the Eustachian tube and the soft palate.

These nodes are at risk of harboring metastases from cancers of the nasopharynx, the posterior pharyngeal wall and the oropharynx (mainly the tonsillar fossa and the soft palate).

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Level VIIa - retropharyngeal

These nodes lie within the retropharyngeal space, extending cranially from the upper edge of the first cervical vertebrae (massa lateralis) to the cranial edge of the body of the hyoid bone caudally (figure).

This space is bounded anteriorly by the pharyngeal constrictor muscles and posteriorly by the longus capitis and longus colli muscles.
Laterally, the retropharyngeal nodes are limited by the medial edge of the internal carotid artery.

Retropharyngeal nodes receive efferent lymphatics from the mucosa of the nasopharynx, the Eustachian tube and the soft palate.
These nodes are at risk of harboring metastases from cancers of the nasopharynx, the posterior pharyngeal wall and the oropharynx (mainly the tonsillar fossa and the soft palate).

The Radiology Assistant : Cervical Lymph Node Map (21)

Level VIIb - retrostyloid

The retro-styloid nodes are the cranial continuation of the level II nodes.
They are located in the fatty space around the jugulo-carotid vessels up to the base of skull at the jugular foramen.

The Radiology Assistant : Cervical Lymph Node Map (22)

Click to enlarge

The retro-styloid space is delineated by the internal carotid artery medially, by the styloid process and the deep parotid lobe laterally, by the vertebral body of C1 and the base of skull posteriorly and by the pre-styloid para-pharyngeal space anteriorly.

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VIII - Parotid

This level contains the parotid node group, which includes the subcutaneous pre-auricular nodes, the superficial and deep intraparotid nodes and the subparotid nodes.

These nodes extend from the zygomatic arch and the external auditory canal down to the mandible.

They extend from the subcutaneous tissue laterally to the styloid process medially, and from the posterior edge of the masseter and the pterygoid muscles anteriorly to the anterior edge of the sternocleidomastoid muscle and the posterior belly of the digastric muscle posteriorly[1].

The Radiology Assistant : Cervical Lymph Node Map (24)

Click to enlarge

The parotid group receive lymphatic from the frontal and temporal skin, the eyelids, the conjunctiva, the auricle, the external acoustic meatus, the tympanum, the nasal cavities, the root of the nose, the nasopharynx, and the Eustachian tube.

They are at risk of harboring metastases from cancers of the frontal and temporal skin, orbit, external auditory canal, nasal cavities and parotid gland.

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IX - Buccofacial

Level IX contains the malar and bucco-facial node group, which includes inconsistent superficial lymph nodes around the facial vessels on the external surface of the buccinator muscle.
These nodes extend from the caudal edge of the orbit (cranially) down to the caudal edge of the mandible (caudally) where they reached level Ib.

They lay on the buccinators muscle (medially) in the sub-cutaneous tissue, from the anterior edge of the masseter muscle and the Bichat’s fat pad (posteriorly) to the anterior sub-cutaneous tissue of the face.

The Radiology Assistant : Cervical Lymph Node Map (26)

The bucco-facial nodes receive efferent vessels from the nose, the eyelids, and the cheek.

They are at risk of harboring metastases from cancers of the skin of the face, the nose, the maxillary sinus (infiltrating the soft tissue of the cheek) and the buccal mucosa.

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X - Retroauricular and occipital

Level Xa contains the retroauricular (also called mastoid) and subauricular nodes, which includes superficial nodes lying on the mastoid process from the cranial edge of the external auditory canal cranially to the tip of the mastoid caudally.

Level Xb contains the occipital lymph nodes, which are the cranial and superficial continuation of the level Va nodes up to the cranial protuberance. They lie from the posterior edge of the sternocleidomastoid muscle to the anterior (lateral) edge of the trapezius muscle.

The Radiology Assistant : Cervical Lymph Node Map (28)

Lymph node metastases in level X are from skin cancers of the retro-auricular area (Xa) and skin cancers of the occipital area (Xb).

Click on the image below to get more information about Medical Action Myanmar, a medical organization run by Nini Tun and Frank Smithuis, who happens to be the brother of Robin Smithuis.

The Radiology Assistant : Cervical Lymph Node Map (2024)

FAQs

What is cervical lymph node mapping? ›

Lymph node mapping is a detailed head and neck ultrasound that evaluates lymph nodes around the thyroid gland and in the neck adjacent to the thyroid gland. By identifying suspicious lymph nodes prior to surgery, your thyroid doctor can accurately inform your surgeon on how extensive your thyroid surgery needs to be.

Where are the cervical lymph nodes located ___? ›

Deep cervical lymph nodes are associated with their positions adjacent to the internal jugular vein, which runs near the sides of the neck. They are known as the lateral jugular, anterior jugular, and jugulo-digastric lymph nodes.

What are level 5 lymph nodes in the neck? ›

Level 5 Cervical Lymph Nodes

The posterior triangle group is divided into sublevels 5A & 5B by omohyoid. Level 5 cervical neck lymph nodes drain the naso- and oro-pharynx. The anatomical locations are: Superior: skull base SCM and trapezius muscles.

What are the level 6 lymph nodes in the cervix? ›

Level VI nodes (located anteriorly and centrally) are found adjacent to the thyroid gland, thyroid cartilage, larynx and oesophagus. The facial, parotid, mastoid, occipital and retropharyngeal are not included in the simplified level classification system.

When should I worry about cervical lymph nodes? ›

swelling with no other symptoms, which may be a sign of cancer or an autoimmune disease. a hard and painless swelling in the lymph node. a rapid change in the size of the lymph node. swelling in more than one area of lymph nodes, such as in the neck and the groin.

Is lymph node mapping painful? ›

During mapping, the injection of a radioactive tracer or isosulfan blue dye to differentiate the SLN is acutely painful.

Are cervical lymph nodes cancerous? ›

When Swollen Cervical Lymph Nodes Could Be Cancer. Swollen cervical lymph nodes are rarely a sign of cancer. 3 However, painless swelling of one or more lymph nodes, especially the cervical lymph nodes, is a key warning sign of lymphoma, including Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL).

How do you treat cervical lymph nodes? ›

Cervical lymphadenopathy usually resolves on its own when the underlying condition is treated. If you have an infection, antimicrobial or antibiotic medications may be necessary. Autoimmune conditions may require anti-inflammatory drugs or other treatments.

What causes enlarged cervical lymph nodes? ›

Malignancies, infections, autoimmune disorders, iatrogenic, and other miscellaneous conditions are considered as the causes for cervical lymphadenopathy. Unexplained cervical lymphadenopathy is a cause of concern for physician and patient because sometimes it could be the manifestation of an underlying malignancy.

What is a suspicious lymph node in neck? ›

Doctors call it lymphadenopathy. Swollen lymph nodes are a sign that your immune system is fighting off infection or illness. Swollen lymph nodes are more likely to be benign than malignant. Benign means the lymph nodes don't contain cancer cells. Malignant means they do contain cancer cells.

Which lymph nodes are worrisome? ›

In general, lymph nodes greater than 1 cm in diameter are considered to be abnormal. Supraclavicular nodes are the most worrisome for malignancy.

What size are cancerous lymph nodes in neck? ›

Lymph nodes measuring more than 1 cm in the short axis diameter are considered malignant.

What percentage of swollen cervical lymph nodes are cancerous? ›

Most cases of lymphadenopathy aren't caused by cancer. Malignancies are reported in as few as 1.1 percent of primary-care patients with swollen lymph nodes, according to a review in American Family Physician.

What makes a lymph node suspicious on ultrasound? ›

The sonographic appearances of normal nodes differ from those of abnormal nodes. Sonographic features that help to identify abnormal nodes include shape (round), absent hilus, intranodal necrosis, reticulation, calcification, matting, soft-tissue edema, and peripheral vascularity.

What is a significant size for cervical lymph nodes? ›

Lymph nodes with a short axis greater than 10 mm (mm) are usually considered abnormal; exceptions are deep cervical lymph nodes, in which a maximum diameter of 15 mm is considered within normal limits [1, 2, 4–7].

How is a lymph node mapping done? ›

To do so, a surgeon injects a radioactive substance, a blue dye, or both near the tumor. The surgeon then uses a device to detect lymph nodes that contain the radioactive substance or looks for lymph nodes that are stained with the blue dye.

Are cervical lymph nodes serious? ›

Malignancies, infections, autoimmune disorders, iatrogenic, and other miscellaneous conditions are considered as the causes for cervical lymphadenopathy. Unexplained cervical lymphadenopathy is a cause of concern for physician and patient because sometimes it could be the manifestation of an underlying malignancy.

What is the significance of sentinel lymph node mapping? ›

Sentinel lymph nodes are an important part of the immune system, and they contain the cells that monitor foreign substances, like bacteria, viruses and cancer. Sentinel lymph node mapping helps to identify the lymph nodes that are at highest risk for containing cancer.

Can cervical lymph nodes be cancerous? ›

Malignant lymph nodes in the neck include metastases and lymphoma. Cervical nodal metastases are common in patients with head and neck cancers, and their assessment is important as it affects treatment planning and prognosis.

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