Malignant lymph nodes of the head and neck: imaging pearls, pitfalls, and practical approach to reporting in the era of extranodal extension.

Accurate characterization and reporting of cervical lymph nodes is critical when evaluating head and neck malignancies, as findings directly impact staging, treatment planning, and prognosis. Knowledge of lymphatic drainage patterns predicts nodal spread of disease and conversely, may help in identifying primary malignancy. Variability in size criteria for an abnormal lymph node across literature makes reporting difficult when used in isolation; however, careful attention to morphologic changes improves diagnostic accuracy. FDG-PET imaging serves as a valuable complementary tool when available, detecting metabolically active nodes that may appear normal on anatomic imaging. Identifying radiologic features of extranodal extension impacts AJCC staging and subsequently, treatment course. For lymphoproliferative disorders, diffuse lymphadenopathy presents a challenge in reporting size and number of lymph nodes. This article provides a systematic, reproducible checklist approach for lymph node reporting in the head and neck, thereby reducing inter-reader variability and producing a useful radiologic report for the multidisciplinary team.Clinical trial number Not applicable.