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Letters to the Editor
June 2000

A Criterion for Distinguishing Level V Nodes From Clavicular Nodes—Reply

Arch Otolaryngol Head Neck Surg. 2000;126(6):807. doi:

In reply

Drs Butman and Lee have raised a question regarding the definition of supraclavicular nodes in our imaging-based nodal classification. This is, in fact, the single nodal definition that we struggled with the most for many months, and we discussed the difficulty in defining this nodal group in our article.

If one accepts our tenet that the Ho triangle is the "gold standard" for defining the supraclavicular fossa, then with the patient erect, it is possible to palpate the top of supraclavicular nodes, the majority of which are caudal to the top of the clavicle. These nodes are easily evaluated clinically, and if the Ho triangle is the gold standard, imaging will never be as accurate as palpation for this 1 nodal group.

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