[Does ultrasonographic-morphologic staging of lymph nodes in head and neck cancer lend itself to automation?].
OBJECTIVE
B-scan ultrasound imaging is an obligatory examination of great clinical relevance in patients with head and neck cancer. The procedure, however, is dependent on an experienced examiner and thus requires higher personal resources than other examination techniques. In addition, its subjective character leads to possible deficits in reliability and objectivity. Established sonomorphologic criteria (echo-contour, echo-density, echo-structure, boundary) should therefore be matched to the findings of computer aided sonomorphometry.


METHODS
200 sonographic images of the cervical region of patients with oral carcinoma were analysed semi- and fully automatically as well as interactively by standard image analysis software (Quantimed 500, Leica, Germany). The results were evaluated statistically and correlated to the findings of both an experienced and inexperienced examiner.


RESULTS
Fully automatic image analysis was impossible, as the software did not correctly identify the lymph nodes without interactive support. Quality of the semiautomatic and interactive image analysis mainly depended on the correct manual identification of the boundaries of the lymph node. Regarding this criterion the image analysis software was not able to compensate for the deficits of an inexperienced examiner.


CONCLUSIONS
Delegation of the sonographic analysis to inexperienced, less qualified personnel, even with the help of image analysis software, seems to be inadvisable. This is especially the case if three-dimensional information from the real time analysis is not available.
Univ.-Klinik und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie, Johannes Gutenberg-Universität Mainz. groetz@mkg.klinik.uni-mainz.de
K A
KA
Grötz
F
F
Krummenauer
B
B
Al-Nawas
K
K
Jaud
R
R
Brahm
W
W
Wagner
D001331:Automation; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging* / Q000473:pathology*; D009062:Mouth Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology; D009367:Neoplasm Staging / Q000379:methods; D015588:Observer Variation; D015203:Reproducibility of Results; D012984:Software; D014463:Ultrasonography