title: Small atypical cervical nodes detected on sonography in patients with squamous cell carcinoma of the head and neck: probability of metastasis.
abstract: OBJECTIVE
  The purpose of this study was to assess the probability of metastasis of small atypical cervical lymph nodes detected on sonography in patients with squamous cell carcinoma (SCC) of the head and neck.
  
  
  METHODS
  We reviewed, retrospectively and blindly, sonographic findings of 148 patients (118 men and 30 women; mean age, 58.2 years) who underwent curative neck dissection. Each lymph node was classified by using a 4-point scale: 1, definitely benign; 2, indeterminate (small [short-axis diameter <10 mm for levels I and II and <7 mm for levels III-VI] atypical node); 3, definitely metastatic; and 4, large (>3-cm) metastatic. Lymph nodes were considered atypical if they met at least 1 of the following criteria: a long- to short-axis diameter ratio of less than 2.0, absence of a normal echogenic hilum, and heterogeneous echogenicity of the cortex. These results were verified, on a level-by-level basis, with histopathologic findings.
  
  
  RESULTS
  Small atypical nodes were found on sonography in 63 cervical levels of 48 patients, of which 18 (28.6%) were proved to have metastatic nodes. The probability of metastasis was significantly higher with than without a large (>3-cm) ipsilateral metastatic node (0.50 versus 0.20; P = .038) and marginally higher with than without an ipsilateral metastatic node (0.41 versus 0.16; P = .061) but not significantly associated with the T stage of the primary tumor (P = .238) or the presence of an ipsilateral tumor (P = .904).
  
  
  CONCLUSIONS
  Metastasis was encountered in about 30% of small atypical cervical nodes on sonography in patients with SCC of the head and neck. Our results indicate that small atypical nodes must be interpreted with consideration of metastatic nodes in the ipsilateral neck.
authors.affiliation: Department of Radiology, Kangwon National University College of Medicine, Chuncheon, Korea.
authors.forename: Heung Cheol
authors.initials: HC
authors.lastname: Kim
authors.forename: Dae Young
authors.initials: DY
authors.lastname: Yoon
authors.forename: Suk Ki
authors.initials: SK
authors.lastname: Chang
authors.forename: Heon
authors.initials: H
authors.lastname: Han
authors.forename: So Jung
authors.initials: SJ
authors.lastname: Oh
authors.forename: Jin Hwan
authors.initials: JH
authors.lastname: Kim
authors.forename: Young-Soo
authors.initials: YS
authors.lastname: Rho
authors.forename: Hwoe Young
authors.initials: HY
authors.lastname: Ahn
authors.forename: Keon Ha
authors.initials: KH
authors.lastname: Kim
authors.forename: Yoon Cheol
authors.initials: YC
authors.lastname: Shin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000601:surgery; D016009:Chi-Square Distribution; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology* / Q000601:surgery; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D014463:Ultrasonography