Annals of Medicine (Dec 2022)

Prevalence and risk factors of retro-styloid lymph node metastasis in oropharyngeal carcinoma

  • Ryo Toya,
  • Tetsuo Saito,
  • Yoshiyuki Fukugawa,
  • Tomohiko Matsuyama,
  • Tadashi Matsumoto,
  • Shinya Shiraishi,
  • Daizo Murakami,
  • Yorihisa Orita,
  • Toshinori Hirai,
  • Natsuo Oya

DOI
https://doi.org/10.1080/07853890.2022.2031270
Journal volume & issue
Vol. 54, no. 1
pp. 436 – 441

Abstract

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Background Supporting data defining the selection criteria of level VIIb for inclusion in the target volume in radiotherapy (RT) planning are insufficient. We evaluated the prevalence of level VIIb retro-styloid lymph node metastasis (RSLNM) and associated risk factors in patients with oropharyngeal carcinoma (OPC). Materials and methods We retrospectively reviewed pre-treatment [18F]-fluoro-2-deoxy-d-glucose–positron emission tomography/computed tomography (CT) along with contrast-enhanced thin slice CT and magnetic resonance (MR) images of 137 patients pathologically confirmed as having OPC who underwent RT. The location of lymph nodes (LNs) was confirmed on the planning CT images. Fisher’s exact test and logistic regression analyses were made to determine the risk factors of RSLNM. Results RSLNM was confirmed in 18 (13%) patients. All RSLNMs were located within level VIIb on the planning CT images. No patients exhibited LNM in contralateral level VIIb. Furthermore, no patients with negative or single ipsilateral cervical LNM had RSLNM. Fisher’s exact test revealed that smoking status (p=.027), multiple ipsilateral cervical LNM (p=.045) and LN ≥15 mm in the upper limit of ipsilateral level II (p<.001) were significantly associated with RSLNM. Logistic regression analyses revealed that the presence of LNs ≥15 mm in upper limit of ipsilateral level II was significantly associated with RSLNM (odds ratio: 977.297; 95% confidence interval: 57.629–16573.308; p<.001). Conclusions RSLNM is relatively common in patients with OPC with a prevalence rate of approximately 10%. The prevalence of RSLNM in patients with negative or single ipsilateral cervical LNM and contralateral RSLNM is extremely low; therefore, level VIIb can be excluded from the target volume in such patients. LN ≥15 mm in the upper limit of ipsilateral level II is a risk factor for RSLNM. Ipsilateral level VIIb should be included in the target volume for patients with this risk factor.KEY MESSAGE Retro-styloid lymph node metastasis (RSLNM) prevalence is ∼10% in oropharyngeal carcinoma. Lymph node ≥15 mm in ipsilateral level II upper limit is a risk factor for RSLNM.

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