Neck Lymphnode Levels for Radiologist

Whenever we are reporting a Head and Neck malignancy, radiologists should be aware of the following system of  levels which is universally understood by surgeons and pathologists.

Simplified numerical classification system

Group IA nodes are located in the submental space, between the anterior bellies of the digastric muscles.

Group IB (submandibular) nodes are found in the submandibular space

Groups II, III and IV are internal jugular nodes and they are divided into these three groups by two landmarks: the hyoid bone and the inferior border of the cricoid cartilage. Group II nodes are located above the hyoid cartilage Group III nodes are found between the hyoid bone and cricoid cartilage  and Group IV nodes are located below the cricoid cartilage

 Group V nodes are found in the posterior triangle Group V nodes can be identified on axial images posterior to the posterior margin of the sternocleidomastoid muscle.

Group VI nodes are anteriorly located: between the hyoid bone superiorly, the suprasternal notch inferiorly and between the carotid sheaths laterally.

Further reading and references:

Cervical lymphadenopathy: what radiologists need to know. Vincent Chong. Cancer Imaging. 2004; 4(2): 116–120.