![]() ![]() To this end, our classification was initially designed to be used adjunctively with the American Joint Committee on Cancer (AJCC) classification. The contribution of imaging may be especially germane to those lymph nodes that are situated deeply and that, by their very location, are difficult, if not impossible, to palpate. We believe that the anatomical precision offered by current-day computed tomography (CT) and magnetic resonance imaging (MRI) can resolve some of these issues and can contribute significantly to an improved classification of nodal disease. However, when these varied classifications are reviewed and compared, there remain several areas that either are not precisely defined or are defined so variously that the present systems preclude precise classification of nodal disease in these areas and potentially could lead to confusion. Since then, a number of clinically and radiologically based classifications have been proposed that use such nonanatomical terminology. In 1981, Shah et al 5 suggested that the anatomically based terminology should be replaced with a simpler "level"-based system. Many of the landmarks used in these classifications had their origin in the superficial triangles of the neck, areas that were easily accessible to palpation and referred to by familiar names. His work followed an earlier classification by Trotter 3 in 1930, which was based on an even earlier work by Poirer and Charpy 4 in 1909. However, when it comes to nodal classifications, such well-accepted criteria are often difficult to identify.įor nearly 4 decades, the most commonly used classification for the cervical lymph nodes was that developed by Rouviere 2 in 1938. The definition of a classification is "a systematic arrangement in groups or categories according to established criteria." 1 This definition implies that there are, in fact, established criteria. It is our desire that the best attributes of imaging, combined with those of the physical assessment, can result in a better and more consistently reproducible nodal staging than is possible by either approach alone. The imaging-based nodal classification proposed herein has been developed in consultation with surgeons interested in such classifications in the hope that the resultant classification would find ready acceptance by both clinicians and imagers. Because the majority of patients with head and neck malignancies presently undergo sectional imaging prior to treatment planning, we felt a need to integrate anatomical imaging criteria with the 2 most commonly used nodal classifications: those of the American Joint Committee on Cancer and those of the American Academy of Otolaryngology–Head and Neck Surgery. In the past 2 decades, computed tomography and magnetic resonance imaging have offered progressively more refined anatomical precision, reproducibility, and visualization of deep, clinically inaccessible structures. These classifications do not agree precisely and exhibit sufficient variation that competent physicians could arrive at slightly different staging of the patient's nodal disease. Some classifications have used surgical landmarks, others physical assessment criteria. Over the past 18 years, numerous classifications have been proposed to distinguish among the diverse nodal levels. Shared Decision Making and Communication. ![]() Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography. ![]()
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