Preoperative cervical lymph node size evaluation in patients with malignant head/neck tumors: comparison between ultrasound and computer tomography.
OBJECTIVE
The spread of malignant lymph nodes due to malignancies of the head and neck is systematically observed. However, sentinel lymph nodes in the cervical region, such as in the axillary or supraclavicular regions, are not described. Therefore, precise preoperative lymph node screening of all neck compartments is required.


METHODS
Forty-five patients with a primary malignant tumor in the head and neck area underwent lymph node staging of the head by means of both CT and ultrasound as a preoperative evaluation. The lymph nodes were classified on the origin of the level system proposed by Som et al. (174:837-844, 2000), which is based on the recommendation of the American College of Radiology introduced in 1990. According to the manual measurement of World Health Organization and the Revised Response Evaluation Criteria in Solid Tumors, the longest transversal and longitudinal diameters were measured by ultrasound, while only the two longest transversal diameters were recorded by CT. The study was conducted by two independent observers. These results were compared with the histopathological results as references.


RESULTS
Six hundred and twenty-four lymph nodes were detected, 64 of which were malignant. Most of the transformed lymph nodes were found in level IIa, II b and III. A more precise measurement was given using ultrasound. The correct positive rate of sonographically detected malignant lymph nodes was significantly higher compared to the CT reading.


CONCLUSIONS
Cervical lymph node staging can be performed safely by ultrasound. It is a cheap, easy-to-handle and cost-effective diagnostic method. However, only the uppermost regions of the neck are accessible with a linear transducer. Despite this restriction, ultrasound is a reliable and valuable tool for screening lymph nodes in the case of a head or neck malignancy.
Hohlweg-Majert
Bettina
B
Department of Oral and Maxillofacial Surgery, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Str. 22, Munich 81675, Germany. majert@mkg.med.tum.de
Metzger
Marc C
MC
Voss
Pit J
PJ
Hölzle
Frank
F
Wolff
Klaus-Dietrich
KD
Schulze
Dirk
D
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology*; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000175:diagnosis* / Q000000981:diagnostic imaging; D008297:Male; D008403:Mass Screening / Q000191:economics / Q000379:methods; D008875:Middle Aged; D008953:Models, Anatomic; D009367:Neoplasm Staging; D011300:Preoperative Care; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy; D014057:Tomography, X-Ray Computed / Q000379:methods; D014463:Ultrasonography / Q000379:methods