1. Patterns of lymph node metastasis from nasopharyngeal carcinoma based on the 2013 updated consensus guidelines for neck node levels
XiaoShen Wang*, ChaoSu Hu*, HongMei Ying*, XiaYun He*, ZhengRong Zhou†, JianHui Ding†
* Department of Radiation Oncology and † Department of Diagnostic Radiology, Fudan University Shanghai Cancer Center. Department of Oncology, Shanghai Medical College of Fudan University, Shanghai,

2. objective WANG XS, et al. Fudan University Shanghai Cancer Center
To explore the patterns of node spread from NPC
based on the updated guidelines.
WANG XS, et al. Fudan University Shanghai Cancer Center

3. Methods
Patients with NPC were required to undergo MRI. The scan range extended from 2cm above the anteroir clinoid process to the inferior margin of the sternal end of the clavicle.
All MR images were evaluated by the multi-disciplinary treatment group of NPC.
WANG XS, et al. Fudan University Shanghai Cancer Center

4. Results
From January 2010 to January 2013, 3100 cases of newly diagnosed NPC were enrolled in the study.
A total of 2679 (86.4%）cases had involved lymph nodes.
WANG XS, et al. Fudan University Shanghai Cancer Center

5. WANG XS, et al. Fudan University Shanghai Cancer Center
Detailed distribution of the 2679 cases with involved nodes
Level No. of patients percentage (%) Ia Ib
IIa
IIb
III
IVa
IVb Va Vb Vc
VIa
VIb
VIIa
VIIb
VIII IX Xa Xb
WANG XS, et al. Fudan University Shanghai Cancer Center

6. Retropharyngeal lymph node
2012（75.1%）had RPLN. Only 6（0.2%）were at the medial group, accompanied with lateral RPLN and other node metastasis.
Only one medial RPLN can be identified in a patient, whereas the number of the lateral RPLNs per affected side varied between 1 and 4.
WANG XS, et al. Fudan University Shanghai Cancer Center

7. The Upper border of levelⅡnode
upper border Number(%)
level Ⅱb level Ⅱa
Upper border of C (4.9%)
Half of C （21.0％） 0
Below C （74.1％） (100%)
Total
WANG XS, et al. Fudan University Shanghai Cancer Center

8. Illustration of level II node beyond the consensus guidelines
WANG XS, et al. Fudan University Shanghai Cancer Center

9. Node beyond level V ①
35 nodes were beyond the level V range, located at ①.
WANG XS, et al. Fudan University Shanghai Cancer Center

10. Nodes beyond the updated guidelines
WANG XS, et al. Fudan University Shanghai Cancer Center

11. Conclusions:
This is the first description of nodal spread patterns based on the updated consensus guidelines.
Invovelment of RPLNs were mainly located at the lateral group, the medial group was rarely seen.
Nodal involvement spread in an orderly pattern in NPC.
The upper border of level II should be skull base.
The level V borders recommended in this consensus guidelines can not fully cover all lymphadenopathies for NPC.
WANG XS, et al. Fudan University Shanghai Cancer Center