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BackTable / ENT / Article
Level 6 Lymph Nodes: Role in Cancer Diagnosis & Treatment
Reilly Fogarty • Updated May 8, 2025 • 33 hits
Level 6 lymph nodes, also referred to as the central compartment lymph nodes, are located in the anterior portion of the neck. These nodes play a significant role in draining lymphatic fluid from critical structures like the thyroid glands, larynx, and trachea. They are frequently involved in thyroid and laryngeal cancers, making their evaluation essential for staging and treatment planning. This article explores the anatomy, drainage patterns, and clinical significance of level 6 lymph nodes.
Table of Contents
(1) Anatomy of Level 6 Lymph Nodes
(2) Drainage of Level 6 Lymph Nodes
(3) Clinical Significance of Level 6 Lymph Nodes
(4) Clinical Management
Anatomy of Level 6 Lymph Nodes
Level 6 lymph nodes are situated in the central compartment of the neck. The anatomical boundaries of this compartment are as follows:
• Superior boundary: Hyoid bone.
• Inferior boundary: Suprasternal notch.
• Lateral boundaries: Common carotid arteries.
• Anterior boundary: Platysma muscle.
• Posterior boundary: Trachea.
These nodes include pretracheal, paratracheal, and prelaryngeal lymph nodes (often called the Delphian nodes). Their close proximity to structures like the thyroid gland, larynx, and trachea makes them integral to the lymphatic drainage of the central neck region.
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Drainage of Level 6 Lymph Nodes
Level 6 lymph nodes are responsible for draining lymphatic fluid from several key structures, including:
• Thyroid Gland: These nodes are the primary drainage site for lymphatic fluid from the thyroid glands, making them important in the context of thyroid cancer.
• Larynx: Lymphatic fluid from the larynx, particularly the subglottic region, drains into the level 6 nodes.
• Trachea and Esophagus: The cervical portions of the trachea and esophagus contribute to the lymphatic flow directed through these nodes.
• Parathyroid Glands: These small glands adjacent to the thyroid also drain into level 6 lymph nodes.
This drainage pattern highlights the central role these nodes play in the lymphatic system of the neck and their frequent involvement in malignancies originating from these structures.
Clinical Significance of Level 6 Lymph Nodes
Level 6 lymph nodes are critical in the staging and management of cancers originating in the thyroid, larynx, and other central neck structures. Their involvement often indicates advanced disease and influences treatment strategies.
• Thyroid Cancer: Level 6 lymph nodes are commonly involved in differentiated thyroid carcinomas, including papillary and follicular thyroid cancers. Central neck dissection, which targets these nodes, is often performed to manage metastatic spread.
• Laryngeal Cancer: Cancers of the larynx, particularly subglottic and advanced supraglottic cancers, may metastasize to level 6 lymph nodes.
Esophageal Cancer: Although less common, cervical esophageal cancers can spread to these nodes, necessitating their evaluation in staging and treatment planning.
Clinical Management
The management of level 6 lymph nodes typically involves the following:
• Imaging: Techniques like ultrasound, CT scans, and PET scans are used to detect metastases or enlargement of these nodes.
• Surgical Resection: Central neck dissection is commonly performed for patients with thyroid cancer and other malignancies involving level 6 nodes.
• Adjuvant Therapy: Radiation therapy or radioactive iodine treatment may be recommended when these nodes are affected, particularly in thyroid cancer cases.
Additional resources:
[1] Robbins KT, Clayman G, Levine PA, et al. Neck dissection classification update: Revisions proposed by the American Head and Neck Society and the American Academy of Otolaryngology-Head and Neck Surgery. Arch Otolaryngol Head Neck Surg. 2002;128(7):751-758. doi:10.1001/archotol.128.7.751.
[2] Huo L, Wu Q, Sun X, et al. The role of central compartment lymph nodes in thyroid cancer management. Head Neck. 2021;43(5):1501-1510. doi:10.1002/hed.26627.
[3] Kim H, Lee A, Ryu H, et al. Level 6 lymph nodes in differentiated thyroid carcinoma: Clinical significance. Oral Oncol. 2021;67:48-55. doi:10.1016/j.oraloncology.2021.03.003.
[4] Spector ME, Zaki HS, Kumar P. Evaluation of central compartment lymph nodes in thyroid and laryngeal cancer. Laryngoscope. 2022;132(1):123-130. doi:10.1002/lary.28549.
[5] Ferris RL, Mlynarek AM, LaVigne S, et al. Central neck dissection and level 6 lymph nodes in head and neck oncology. J Clin Oncol. 2020;38(19):2204-2211. doi:10.1200/JCO.20.01114.
Podcast Contributors
Dr. Mihir Patel
Dr. Mihir Patel is an otolaryngologist head and neck surgeon and assistant professor with Emory Healthcare in Atlanta, Georgia.
Dr. Ashley Agan
Dr. Ashley Agan is an otolaryngologist in Dallas, TX.
Cite This Podcast
BackTable, LLC (Producer). (2024, May 21). Ep. 172 – HPV & Oropharyngeal Cancer: Evolving Insights & Implications [Audio podcast]. Retrieved from https://www.backtable.com
Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.
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