Staging von Kopf-Hals-Tumoren mit bildgebenden Verfahren

Zusammenfassung

Das Staging maligner Tumoren dient hauptsächlich der stadiengerechten Auswahl einer angemessenen Therapie. Bei Kopf-Hals-Tumoren spielen - neben der klinischen Untersuchung und Endoskopie - dabei insbesondere die modernen Schnittbildverfahren eine entscheidende Rolle.

Der vorliegende II. Teil dieses Artikels soll den Stellenwert der Schnittbilddiagnostik zum N- und M-Staging maligner Kopf-Hals-Tumoren illustrieren und aufzeigen, wie die Therapieauswahl durch den radiologischen Befund gesteuert wird. Leitlinien zur Durchführung der Untersuchung und zu wichtigen Details der Befundung können daraus abgeleitet werden.

Abstract

Staging of malignant tumours is predominantly addressed to facilitate selection of the appropriate treatment. Adjacent to physical examination and endoscopy, modern crossectional imaging plays a crucial role in the head and neck region.

The second part of this article efforts to illustrate the value of crossectional imaging in N- and M-staging of head and neck tumours and to highlight, how treatment selection is influenced by radiological findings. Guidelines to perform and evaluate the examination are presented.

Key words

Head neck region - cancer staging - carcinoma - larynx - pharynx - oropharynx - nasopharynx - hypopharynx - oral - nasal - maxillary - maxillar - sphenoidal - ethmoidal - ethmoid cell - frontal sinus cavity - parotid - thyroid - supraglottic - infraglottic - glottic - malignant salivary gland tumor - tumour - MRI - CT - PET - magnetic resonance - crossectional treatment selection - imaging procedures · computer tomography - USPIO - t-staging - n-staging - m-staging - nodal - distant metastasis - AJCC - UICC

Kernaussagen

N-Staging

Bedeutung. Der Lymphknotenstatus beeinflusst sowohl die Primärtherapie als auch die Prognose. Die Einteilung der zervikalen Lymphknoten in 7 Lymphknotenlevel dient unter anderem dazu, die Art der Neck Dissection (selektiv oder radikal) festzulegen. Die Klassifikation des Lymphknotenstatus ist für alle Kopf-Hals-Tumoren einheitlich - ausgenommen Schilddrüsentumoren und Nasopharynxkarzinome.

Bildgebung. Die Sonographie des Halses ist die Standardmethode zum Lymphknotenstaging maligner Kopf-Hals-Tumoren. Kriterien zur Unterscheidung zwischen benigne und maligne sind kugelige Umwandlung, Echogenität, Lymphknotenform und -größe, Gruppierung und zentrale Nekrose. Möglicherweise wird in Zukunft die USPIO-verstärkte MRT an Bedeutung zunehmen.

M-Staging

Für alle Tumoren werden die Stadien M0 (keine Fernmetastasen) und M1 (Fernmetastasen vorhanden) unterschieden. Ein M1-Staging bedeutet für alle Kopf-Hals-Tumoren ein klinisches Stadium IVc, die schlechteste Prognosegruppe und in der Regel eine palliative Therapie. Bei nahezu allen Patienten mit Fernmetastasen liegen auch Metastasen in der Lunge vor, die mit Abstand der häufigste Ort einer Fernmetastasierung bei Plattenepithelkarzinomen der Kopf-Hals-Region ist.

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