title: Nodal vascularity as an indicator of cervicofacial metastasis in oral cancer: A Doppler sonographic study.
abstract: BACKGROUND
  The objective of this study was to assess nodal vascularity by Doppler sonography and to find out the correlation between clinical and various Doppler sonographic features for the detection of the metastatic nodes in oral cancer patients.
  
  
  METHODS
  A total number of 55 patients of histopathologically proven oral cancer presenting with enlarged superficial cervicofacial lymph nodes were included in the study. Patients were subjected to clinical examination according to a specially designed proforma and the TNM staging was done. If more than one enlarged nodes were present, then the node with the largest diameter was chosen for further Doppler ultrasonographic examination followed by fine needle aspiration cytology test of the same node.
  
  
  RESULTS
  Correlations of patterns of color Doppler flow signals with cytological diagnosis showed that central type of vascular pattern was statistically significant parameter for benign lymph nodes and peripheral type of vascularity was highly significant parameter for malignant lymphadenopathy. It was found that the cut-off value of resistive index 0.6 was statistically significant in the assessment of metastatic node (P < 0.01) with a sensitivity of 45.5% and specificity of 93.9%. On comparison of the clinical features (TNM staging) with Doppler sonographic features, it was found that the characteristic features suggestive of malignant lymph nodes on Doppler sonography such as peripheral blood flow and high resistive index were more consistently and frequently associated with the higher sub-stages of T3 and T4 and N2b and N2c of TNM staging system.
  
  
  CONCLUSIONS
  Nodal vascularity may be used to differentiate benign from malignant lymphadenopathy. Proper judicious use of non-invasive color Doppler ultrasonographic examination provides an opportunity to eliminate the need for biopsy in reactive nodes and provide treatment in a more precise manner.
authors.affiliation: Department of Oral Medicine and Radiology, Institute of Dental Studies and Technologies, Modinagar, Uttar Pradesh, India.
authors.forename: Ankur
authors.initials: A
authors.lastname: Aggarwal
authors.affiliation: Mahatma Gandhi Postgraduate Institute of Dental Sciences, Puducherry, India.
authors.forename: M Jonathan
authors.initials: MJ
authors.lastname: Daniel
authors.affiliation: Mahatma Gandhi Postgraduate Institute of Dental Sciences, Puducherry, India.
authors.forename: Shyam
authors.initials: S
authors.lastname: Singh
authors.affiliation: Department of Orthodontics, Malla Reddy Institute of Dental Sciences, Suraram Cross Road, Qutbullapur, Hyderabad, Andhra Pradesh, India.
authors.forename: Prashant
authors.initials: P
authors.lastname: Patil
authors.affiliation: Government Dental College, Mumbai, India.
authors.forename: Farah
authors.initials: F
authors.lastname: Hindustanwala
authors.affiliation: Swami Devi Dyal Dental College, Barwala, Haryana, India.
authors.forename: Shubhra Vikas
authors.initials: SV
authors.lastname: Kaushik
keywords: Cervical lymphadenopathy; color Doppler ultrasound; metastasis; oral cancer
references.citation: J Clin Ultrasound. 2004 Jul-Aug;32(6):273-6
references.pmid: 15211672
references.citation: Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998 Oct;86(4):482-8
references.pmid: 9798237
references.citation: AJR Am J Roentgenol. 1988 Jul;151(1):115-6
references.pmid: 3287861
references.citation: Radiology. 1994 Mar;190(3):853-6
references.pmid: 8115639
references.citation: Angiogenesis. 2010 Jun;13(2):149-60
references.pmid: 20383743
references.citation: AJR Am J Roentgenol. 1994 Apr;162(4):965-8
references.pmid: 8141027
references.citation: Eur Arch Otorhinolaryngol. 1994;251(7):404-9
references.pmid: 7857628
references.citation: AJR Am J Roentgenol. 1997 May;168(5):1311-6
references.pmid: 9129432
references.citation: Clin Radiol. 2001 Mar;56(3):197-201
references.pmid: 11247696
references.citation: Eur J Gynaecol Oncol. 2004;25(5):568-70
references.pmid: 15493167
references.citation: Br J Radiol. 1998 Aug;71(848):828-33
references.pmid: 9828794
references.citation: Dentomaxillofac Radiol. 2008 May;37(4):205-12
references.pmid: 18460573
references.citation: AJR Am J Roentgenol. 1995 Oct;165(4):981-4
references.pmid: 7677005