0:01

Hello, everyone.

0:02

Dr. Sydney Levy here, rounding off our

0:04

discussion on the diagnosis and staging of

0:07

hypopharyngeal squamous cell malignancy.

0:10

I'd like to conclude our talk by discussing the

0:14

changes which have occurred between the 7th and

0:17

8th editions of the AJCC staging guidelines.

0:23

So, from a T staging perspective, the previous

0:27

T3 criterion of esophageal invasion of a

0:31

tumor has been divided into T3a and T3b.

0:37

T3a refers to esophageal mucosal invasion,

0:41

whereas T3b refers to esophageal muscle invasion.

0:46

This sometimes can be difficult to tell radiologically.

0:50

However, if there's clearly invasion of the

0:53

esophageal muscle, as has occurred indeed in this

0:57

post-cricoid example, which we have already discussed

1:01

in a previous vignette, then that is when we can

1:05

say that the lesion is a T3b lesion, at least.

1:10

From an N staging perspective, N staging

1:13

has been divided into two different staging

1:15

systems to reflect human papillomavirus status.

1:19

However, usually in the hypopharynx, most tumors are

1:24

HPV negative, so this is normally not as relevant.

1:29

But if you find out or are informed that the tumor is HPV

1:34

positive, you need to employ the appropriate staging system

1:38

for that, which we have discussed in previous vignettes.

1:42

In addition, from an N staging perspective, and with

1:46

respect to human papillomavirus negative malignancy,

1:50

we now have an N3b stage, which reflects extranodal

1:56

extension in a similar fashion to the oropharynx.

2:02

We have discussed extranodal extension in previous

2:05

vignettes, but I should remind you that it is

2:10

strictly a clinical or pathological diagnosis.

2:14

However, if we see an irregular infiltrative

2:17

margin of a lymph node, which is morphologically

2:21

abnormal, then we should raise suspicion of

2:24

extranodal extension and therefore N3b status.

2:30

So, in summary, the staging of hypopharyngeal malignancy

2:35

obeys the TNM staging system of other areas of

2:41

the head and neck, however, there have been some

2:43

important changes in particular with respect to

2:47

T staging and esophageal mucosal or muscle involvement.

2:52

N staging depending on human papillomavirus status

2:56

and the radiological suspicion of extranodal extension.

Hypopharynx - Changes in AJCC Staging Guidelines

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0:01

Hello, everyone.

0:02

Dr. Sydney Levy here, rounding off our

0:04

discussion on the diagnosis and staging of

0:07

hypopharyngeal squamous cell malignancy.

0:10

I'd like to conclude our talk by discussing the

0:14

changes which have occurred between the 7th and

0:17

8th editions of the AJCC staging guidelines.

0:23

So, from a T staging perspective, the previous

0:27

T3 criterion of esophageal invasion of a

0:31

tumor has been divided into T3a and T3b.

0:37

T3a refers to esophageal mucosal invasion,

0:41

whereas T3b refers to esophageal muscle invasion.

0:46

This sometimes can be difficult to tell radiologically.

0:50

However, if there's clearly invasion of the

0:53

esophageal muscle, as has occurred indeed in this

0:57

post-cricoid example, which we have already discussed

1:01

in a previous vignette, then that is when we can

1:05

say that the lesion is a T3b lesion, at least.

1:10

From an N staging perspective, N staging

1:13

has been divided into two different staging

1:15

systems to reflect human papillomavirus status.

1:19

However, usually in the hypopharynx, most tumors are

1:24

HPV negative, so this is normally not as relevant.

1:29

But if you find out or are informed that the tumor is HPV

1:34

positive, you need to employ the appropriate staging system

1:38

for that, which we have discussed in previous vignettes.

1:42

In addition, from an N staging perspective, and with

1:46

respect to human papillomavirus negative malignancy,

1:50

we now have an N3b stage, which reflects extranodal

1:56

extension in a similar fashion to the oropharynx.

2:02

We have discussed extranodal extension in previous

2:05

vignettes, but I should remind you that it is

2:10

strictly a clinical or pathological diagnosis.

2:14

However, if we see an irregular infiltrative

2:17

margin of a lymph node, which is morphologically

2:21

abnormal, then we should raise suspicion of

2:24

extranodal extension and therefore N3b status.

2:30

So, in summary, the staging of hypopharyngeal malignancy

2:35

obeys the TNM staging system of other areas of

2:41

the head and neck, however, there have been some

2:43

important changes in particular with respect to

2:47

T staging and esophageal mucosal or muscle involvement.

2:52

N staging depending on human papillomavirus status

2:56

and the radiological suspicion of extranodal extension.

Report

Description

Faculty

Sidney Levy, PhD, MBBS

Radiologist and Nuclear Medicine Specialist

I-MED

Lesson

Oral Cavity Anatomy

Lesson

Oral Cavity Staging of Squamous Cell Malignancy

Lesson

Lymph Node Levels of the Neck

Lesson

Oropharynx

Lesson

Hypopharynx

Lesson

Larynx

Lesson

Sinonasal

Lesson

Perineural Tumor Spread

Hypopharynx - Changes in AJCC Staging Guidelines