EFFICACY OF ULTRASONOGRAPHY IN ASSESSING CERVICAL LYMPH NODE METASTASIS IN HEAD AND NECK CARCINOMA
Objectives: The study was conducted to assess the value of ultrasonography (USG) for lymph node metastasis in patients with carcinoma of oral cavity.
Materials and Methods: A total of 20 cases were selected with a primary tumor of the oral cavity. Ninety-two lymph nodes were detected by ultrasound of 5 mm or more in diameter. The patients were examined preoperatively for palpable lymph nodes clinically and ultrasonographic examination of the bilateral neck. Ultrasonographic parameters, such as size, shape, boundaries (well-delineated/ poorly delineated) and internal echoes for the lymph nodes were recorded.
Results: The histologic positive rate was 25%, 80% and 93% for nodes between 5 and 10 mm, 10 and 15 mm and for nodes 15 mm or more in size, respectively. Ultrasonographic findings showed a high significance as the size of nodes increases. The positive rate of 86% for the round nodes of 9 mm or more in size showed a high significance. The positive rate was 93% for well-delineated nodes and 68% for poorly delineated nodes. The most frequent echo pattern was homogenous followed by hypoechoic with the positive rate for metastasis ranging from 83% to 88%.
Conclusion: The diagnostic validity of USG as compared with histopathology showed the sensitivity of 86% and specificity of 73% with an overall efficiency of about 82% in detecting lymph node metastasis. USG is useful for preoperative evaluation of the neck, as the most reliable, inexpensive and easily available method. It is essential for diagnosis, staging, and therapy choices.
of head and neck cancer. Arch Otolaryngol 1988;111:735-9
2) Baatenburg de Jong RJ, Rongen RJ, Laméris JS, Harthoorn M, Verwoerd CD, Knegt P. Metastatic neck disease. Palpation vs ultrasound examination. Arch Otolaryngol Head Neck Surg 1989;115:689-90.
3) Bruneton JN, Balu-Maestro C, Marcy PY, Melia P, Mourou MY. Very high frequency (13 MHz) ultrasonographic examination of the normal neck: detection of normal lymph nodes and thyroid nodules. J Ultrasound Med 1994;13:87-90
4) Bruneton JN, Roux P, Caramella E, Demard F, Vallicioni J, Chauvel P. Ear, nose, and throat cancer: Ultrasound diagnosis of metastasis to cervical lymph nodes. Radiology 1984;152:771-3.
5) Sumi M, Ohki M, Nakamura T. Comparison of Sonography and CT for differentiating benign from malignant cervical lymph nodes in patients with squamous cell carcinoma of the head and neck. AJR Am J Roentgenol 2001;176:1019-24.
6) Moritz JD, Ludwig A, Oestmann JW. Contrast -Enhanced Color Doppler Sonography for evaluation of enlarged cervical lymph nodes in head and neck tumors. AJR Am J Roentgenol 2000;174:1279-84.
7) Hajek PC, Salomonowitz E, Turk R, Tscholakoff D, Kumpan W, Czembirek H. Lymph nodes of the neck: Evaluation with the US. Radiology 1986;158:739-42.
8) Snow GB, Annyas AA, van Slooten EA, Bartelink H, Hart AA. Prognostic factors in neck node metastasis. ClinOtolaryngol 1982;7:185-92.
9) Van den Brekel MW, Stel HV, Castelijns JA, Nauta JJ, van der Waal I, Valk J, et al. Cervical lymph node metastasis: Assessment of radiological criteria. Radiology 1990;177:379-84.
10) Marchal G, Oyen R, Verschakelen J, Gelin J, Baert AL, Stessens RC. Sonographic appearance of lymph nodes. J Ultrasound Med 1985;4:417-9.
11) Yoshinaka H, Nishi M, Kajisa T, Kuroshima K, Morifuji H. Ultrasonic detection of lymph node metastasis in the region around the celiac axis in the oesopharyngeal and gastric cancer. J Clin Ultrasound 1985;13:153-60.
12) Ali S, Tiwari RM, Snow GB. False positive and false negative neck nodes. Head Neck Surg 1985;8:78-82.
13) Martis C, Karabouta I, Lazaridis N. Incidence of lymph nodes metastasis in elective (prophylactic) neck dissection for oral carcinoma. J Maxillofacial Surg
14) Zhou J, Zhu SY, Liu RC, Luo F, Shu DX. Vascularity index of laryngeal cancer derived from 3-D ultrasound: A predicting factor for the in vivo assessment of cervical lymph node status. Ultrasound Med Biol 2009;35:1596-600.