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ISRN Otolaryngology
Volume 2013 (2013), Article ID 232968, 7 pages
Clinical Study

Can Axial-Based Nodal Size Criteria Be Used in Other Imaging Planes to Accurately Determine “Enlarged” Head and Neck Lymph Nodes?

1Princess Margaret Cancer Centre, Joint Department of Medical Imaging, University of Toronto, 610 University Avenue, Room 3-956, Toronto, ON, Canada M5G 2M9
2Department of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, 155 College Street, Suite 425, Toronto, ON, Canada M5T 3M6
3Department of Paediatrics, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON, Canada M5G 1X8

Received 31 March 2013; Accepted 6 June 2013

Academic Editors: C. Y. Chien, A. D. Rapidis, and D. Thurnher

Copyright © 2013 Eric S. Bartlett et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Objective. We evaluate if axial-based lymph node size criteria can be applied to coronal and sagittal planes. Methods. Fifty pretreatment computed tomographic (CT) neck exams were evaluated in patients with head and neck squamous cell carcinoma (SCCa) and neck lymphadenopathy. Axial-based size criteria were applied to all 3 imaging planes, measured, and classified as “enlarged” if equal to or exceeding size criteria. Results. 222 lymph nodes were “enlarged” in one imaging plane; however, 53.2% (118/222) of these were “enlarged” in all 3 planes. Classification concordance between axial versus coronal/sagittal planes was poor (kappa = −0.09 and −0.07, resp., ). The McNemar test showed systematic misclassification when comparing axial versus coronal ( ) and axial versus sagittal ( ) planes. Conclusion. Classification of “enlarged” lymph nodes differs between axial versus coronal/sagittal imaging planes when axial-based nodal size criteria are applied independently to all three imaging planes, and exclusively used without other morphologic nodal data.