Training Collections
Library Memberships
On-demand course library with video lectures, expert case reviews, and more
Fellowship Certificate™ Programs
Practice-focused training programs designed to help you gain experience in a specific subspecialty area.
Ultimate Learning Pass
Unlock access to our full Course Library and all self-paced Fellowships.
Continuing Medical Education (State CME)
Complete all of your state CME requirements in one convenient place.
Noon Conference (Free)
Get access to free live lectures, every week, from top radiologists.
Case of the Week (Free)
Get a free weekly case delivered right to your inbox.
Case Crunch: Rapid Case Review (Free)
Register for free live board reviews.
Dr. Resnick's MSK Conference
Learn directly from the MSK Master himself.
Lower Extremities MRI Conference
Musculoskeletal Imaging
Emergency Imaging
PET Imaging
Pediatric Imaging
For Training Programs
Supplement your training program with case-based learning for residents, registrars, fellows, and more.
For Private Practices
Upskill in high growth, advanced imaging areas.
Compliance
NewTrack, fulfill, and report on all your radiologists' credentialing and licensing requirements.
Emergency Call Prep
Prepare trainees to be on call for the emergency department with this specialized training series.
Training Collections
Library Memberships
On-demand course library with video lectures, expert case reviews, and more
Fellowship Certificate™ Programs
Practice-focused training programs designed to help you gain experience in a specific subspecialty area.
Ultimate Learning Pass
Unlock access to our full Course Library and all self-paced Fellowships.
Continuing Medical Education (State CME)
Complete all of your state CME requirements in one convenient place.
Noon Conference (Free)
Get access to free live lectures, every week, from top radiologists.
Case of the Week (Free)
Get a free weekly case delivered right to your inbox.
Case Crunch: Rapid Case Review (Free)
Register for free live board reviews.
Dr. Resnick's MSK Conference
Learn directly from the MSK Master himself.
Lower Extremities MRI Conference
Musculoskeletal Imaging
Emergency Imaging
PET Imaging
Pediatric Imaging
For Training Programs
Supplement your training program with case-based learning for residents, registrars, fellows, and more.
For Private Practices
Upskill in high growth, advanced imaging areas.
Compliance
NewTrack, fulfill, and report on all your radiologists' credentialing and licensing requirements.
Emergency Call Prep
Prepare trainees to be on call for the emergency department with this specialized training series.
7 topics, 29 min.
18 topics, 1 hr. 26 min.
Principles of T Staging of Oral Cavity Squamous Cell Malignancy
4 m.Principles of N and M Staging of Oral Cavity Squamous Cell Malignancy
6 m.Diagnosis of Oral Tongue Squamous Cell Malignancy
6 m.T Staging of Oral Tongue Squamous Cell Malignancy
6 m.N and M Staging of Oral Tongue Squamous Cell Malignancy
5 m.Diagnosis of Buccal Mucosal Squamous Cell Malignancy
4 m.T Staging of Buccal Mucosal Squamous Cell Malignancy
3 m.N and M Staging of Buccal Mucosal Squamous Cell Malignancy
3 m.Diagnosis of Alveolar Mucosal Squamous Cell Malignancy
7 m.T Staging of Alveolar Mucosal Squamous Cell Malignancy
6 m.Diagnosis of Retromolar Trigone Squamous Cell Malignancy
6 m.T Staging of Retromolar Trigone Squamous Cell Malignancy
5 m.Diagnosis of Hard Palate Squamous Cell Malignancy
4 m.T Staging of Hard Palate Squamous Cell Malignancy
4 m.Diagnosis of Floor of Mouth Squamous Cell Malignancy
9 m.T Staging of Floor of Mouth Squamous Cell Malignancy
6 m.N and M Staging of Floor of Mouth Squamous Cell Malignancy
5 m.Marrow Infiltration and Perineural Infiltration in the Oral Cavity
5 m.7 topics, 24 min.
21 topics, 1 hr. 9 min.
Anatomy and Boundaries of the Oropharynx
4 m.Anatomy of the Tongue Base
4 m.Anatomy of the Palatine Tonsil
4 m.Anatomy of the Soft Palate
3 m.Anatomy of the Posterior Oropharyngeal Wall
3 m.Oropharyngeal SCC of the Base of Tongue
4 m.Oropharyngeal Carcinoma: Nodal Drainage and Differential Dx
5 m.Staging Oropharynx Cancer, T-staging
4 m.Staging Oropharynx Cancer, N-Staging
6 m.Oropharynx - Base of Tongue SCC: T-Staging
3 m.Base of Tongue Oropharyngeal Carcinoma, N & M Staging
3 m.Oropharynx - SCC of the Palatine Tonsil
4 m.Oropharynx - Palatine Tonsil SCC: Paths of Spread
5 m.Oropharynx - Lymphadenopathy and HPV-Related SCC
3 m.Oropharynx - Palatine Tonsil SCC - T Staging
4 m.Oropharynx - Palatine Tonsil SCC - N/M Staging
4 m.Oropharynx - SCC of the Soft Palate
3 m.Oropharynx - SCC: Paths of Spread and Differential Dx
4 m.Oropharynx - Soft Palate SCC: Nodal Drainage
2 m.Oropharynx - Soft Palate SCC - TNM Staging
3 m.Oropharynx - Base of Tongue Mucoepidermoid Carcinoma
5 m.18 topics, 56 min.
Hypopharynx anatomy
4 m.Hypopharynx - The Piriform Sinus Anatomy
5 m.Hypopharynx - The Postcricoid Space Anatomy
4 m.Hypopharynx - The Posterior Hypopharyngeal Wall Anatomy
5 m.Hypopharynx - Piriform Sinus SCC
5 m.Hypopharynx - Piriform Sinus Carcinoma - Local Spread
4 m.Hypopharyngeal SCC - Nodal Drainage
3 m.Hypopharyngeal SCC - Differential Dx
2 m.Hypopharyngeal Carcinoma - T Staging
3 m.Hypopharyngeal SCC - N Staging
3 m.Hypopharynx - Piriform Sinus SCC - T Staging
5 m.Hypopharynx - Piriform Sinus SCC - N/M Staging
4 m.Hypopharynx - Postcricoid Space SCC
4 m.Hypopharynx - Postcricoid Space SCC - Local Spread
4 m.Hypopharynx - Postcricoid SCC - Differential Diagnoses
2 m.Hypopharynx - Postcricoid Space SCC: T Staging
3 m.Hypopharynx - Postcricoid Space SCC - N/M Staging
3 m.Hypopharynx - Changes in AJCC Staging Guidelines
4 m.18 topics, 1 hr. 3 min.
Larynx Anatomy
5 m.Larynx Anatomy: Supraglottic, Glottic, and Subglottic Sites
9 m.The Supraglottic Larynx
4 m.The Glottic Larynx.
3 m.The Subglottic Larynx
3 m.Laryngeal SCC - T Staging
7 m.Laryngeal SCC - Cartilage Invasion
4 m.Laryngeal SCC: Local and Nodal Extension
4 m.Supraglottic SCC- Differential Diagnoses
3 m.Laryngeal SCC: Glottic Origin
5 m.Larynx - Glottic SCC: Patterns of Local Spread
4 m.Laryngeal SCC of the Subglottis
3 m.Larynx - Subglottic Carcinomas: Patterns of Spread & Differential Dx
3 m.Laryngeal SCC: T Staging
4 m.Larynx - Glottic SCC: T Staging
3 m.Laryngeal SCC: N Staging
2 m.Glottic SCC: T Staging
4 m.Laryngeal SCC: N and M Staging
3 m.5 topics, 14 min.
3 topics, 16 min.
0:01
Hello, everyone.
0:02
Dr. Sidney Levy here, continuing our staging of this
0:05
right palatine tonsillar squamous cell malignancy.
0:10
I would like to focus on N staging.
0:12
We do not know if this patient is human papillomavirus
0:16
positive or negative, and therefore we need
0:19
to stage, keeping both possibilities in mind.
0:24
In this case, the patient has a single
0:27
ipsilateral right level 2A lymph node,
0:32
measuring less than three centimeters
0:34
without extranodal extension.
0:37
So let me take you through what all of that means.
0:40
First thing to say is, how do we know that it's level 2A?
0:45
It is level 2A because it is abutting the internal
0:52
jugular vein, which is here, with the lymph node being
0:56
here, and there is no fat plane between the two.
1:01
So although it is posterior or posterolateral to
1:05
the internal jugular vein, because there is no
1:09
fat plane separating it from the internal jugular
1:12
vein, it is still considered a level 2A lymph
1:15
node as opposed to a level 2B lymph node.
1:19
Next thing, how much does it measure?
1:23
It is two and a half centimeters,
1:25
so therefore less than three centimeters.
1:28
Next thing, is there evidence of extranodal extension?
1:32
Remembering that this is a clinical or pathological
1:35
diagnosis, we can only infer that it may be present
1:39
if there is macroscopic evidence of infiltration of
1:43
nodal metastatic tissue into surrounding soft tissue.
1:47
In this particular case, on our T1-weighted
1:50
imaging, we see a well-circumscribed lymph node
1:55
without any evidence of infiltrative properties,
1:59
blurred margins, or other worrisome features.
2:02
So therefore, no radiological evidence
2:05
to suggest extranodal extension.
2:08
So, everything I've been saying
2:10
so far applies to HPV-negative tumors.
2:16
This single ipsilateral level 2A lymph node
2:19
measuring less than 3 cm without evidence of
2:22
extranodal extension means that the tumor may be
2:26
staged as an N1 tumor if found to be HPV-negative.
2:32
In this particular instance, if the tumor is found
2:35
to be HPV-positive, it still remains N1 due to the
2:40
fact that it is an ipsilateral lymph node measuring
2:44
less than or equal to 6 cm, with no evidence
2:48
of contralateral or bilateral nodal disease.
2:52
From an M stage point of view, in the head and
2:55
neck, there was no evidence of distant disease,
2:58
which usually involves bone, lung, or liver.
3:01
But remember, we need other imaging, such as
3:04
CT or PET-CT, in order to confirm this.
3:08
So in summary, this tumor is a T3 N1 M0 tumor,
3:15
irrespective of human papillomavirus status,
3:19
by virtue of the fact that it measures more than
3:22
4 centimeters in maximal dimension and has a single
3:26
ipsilateral lymph node measuring less than
3:29
3 centimeters with no evidence of extranodal extension and
3:34
no evidence of distant disease within the head and neck.
Interactive Transcript
0:01
Hello, everyone.
0:02
Dr. Sidney Levy here, continuing our staging of this
0:05
right palatine tonsillar squamous cell malignancy.
0:10
I would like to focus on N staging.
0:12
We do not know if this patient is human papillomavirus
0:16
positive or negative, and therefore we need
0:19
to stage, keeping both possibilities in mind.
0:24
In this case, the patient has a single
0:27
ipsilateral right level 2A lymph node,
0:32
measuring less than three centimeters
0:34
without extranodal extension.
0:37
So let me take you through what all of that means.
0:40
First thing to say is, how do we know that it's level 2A?
0:45
It is level 2A because it is abutting the internal
0:52
jugular vein, which is here, with the lymph node being
0:56
here, and there is no fat plane between the two.
1:01
So although it is posterior or posterolateral to
1:05
the internal jugular vein, because there is no
1:09
fat plane separating it from the internal jugular
1:12
vein, it is still considered a level 2A lymph
1:15
node as opposed to a level 2B lymph node.
1:19
Next thing, how much does it measure?
1:23
It is two and a half centimeters,
1:25
so therefore less than three centimeters.
1:28
Next thing, is there evidence of extranodal extension?
1:32
Remembering that this is a clinical or pathological
1:35
diagnosis, we can only infer that it may be present
1:39
if there is macroscopic evidence of infiltration of
1:43
nodal metastatic tissue into surrounding soft tissue.
1:47
In this particular case, on our T1-weighted
1:50
imaging, we see a well-circumscribed lymph node
1:55
without any evidence of infiltrative properties,
1:59
blurred margins, or other worrisome features.
2:02
So therefore, no radiological evidence
2:05
to suggest extranodal extension.
2:08
So, everything I've been saying
2:10
so far applies to HPV-negative tumors.
2:16
This single ipsilateral level 2A lymph node
2:19
measuring less than 3 cm without evidence of
2:22
extranodal extension means that the tumor may be
2:26
staged as an N1 tumor if found to be HPV-negative.
2:32
In this particular instance, if the tumor is found
2:35
to be HPV-positive, it still remains N1 due to the
2:40
fact that it is an ipsilateral lymph node measuring
2:44
less than or equal to 6 cm, with no evidence
2:48
of contralateral or bilateral nodal disease.
2:52
From an M stage point of view, in the head and
2:55
neck, there was no evidence of distant disease,
2:58
which usually involves bone, lung, or liver.
3:01
But remember, we need other imaging, such as
3:04
CT or PET-CT, in order to confirm this.
3:08
So in summary, this tumor is a T3 N1 M0 tumor,
3:15
irrespective of human papillomavirus status,
3:19
by virtue of the fact that it measures more than
3:22
4 centimeters in maximal dimension and has a single
3:26
ipsilateral lymph node measuring less than
3:29
3 centimeters with no evidence of extranodal extension and
3:34
no evidence of distant disease within the head and neck.
Report
Description
Faculty
Sidney Levy, PhD, MBBS
Radiologist and Nuclear Medicine Specialist
I-MED
Tags
PET
Oral Cavity/Oropharynx
Nuclear Medicine
Neuroradiology
Neuro
Neoplastic
MRI
Head and Neck
CT
© 2025 Medality. All Rights Reserved.