The role of diagnostic imaging in identifying cervical metastases in oral cavity cancer

Radiologic imaging is an integral part of the diagnostic evaluation of the newly diagnosed or suspected head and neck cancer patient. At the M.D. Anderson Cancer Center, for most head and neck malignancies we prefer CT for evaluation of the neck. Small nodes, or those that are nonpalpable because of location (e.g., lateral retropharyngeal or deep to the sternocleidomastoid muscle) but are nevertheless abnormal based on necrosis, shape, clustering, or other criteria, can be diagnosed with CT. This diagnosis, important for its treatment and prognostic implications, requires knowledge not only of the known or suspected primary cancer, its location, and expected sites of nodal drainage, but also of the proper imaging technique and appearance of nodal metastases. This chapter will familiarize the reader with imaging strategies, radiographic appearance, and other findings that may diagnose or suggest a likehood of nodal metastasis.