Computed tomography and ultrasonographic evaluation of metastatic cervical lymph nodes with surgicoclinicopathologic correlation

Abstract

The detection of cervical lymph nodal metastasis and carotid artery invasion by metastatic lymph nodes is an important issue in the management of head and neck malignancies. This study compared the evaluation of metastasis by palpation, ultrasonography (USG) and computed tomography (CT) in patients with known head and neck malignancies. Twenty-five consecutive patients with head and neck malignancy were prospectively evaluated for the presence of cervical lymphadenopathy and carotid artery invasion. All patients underwent clinical examination (palpation), USG and CT examination. A modified CT criteria was employed which yielded acceptable results for the detection of metastatic nodes. Radical neck dissection was performed for 26 neck sides, and the results of pre-operative evaluation were confirmed by the surgical and histopathological findings. Palpation, ultrasound and CT have comparable sensitivity in the determination of metastasis involving cervical lymph nodes. Thus palpation should be employed as the primary method of assessment of secondaries in the neck. However, palpation is less sensitive than CT and USG in the detection of carotid artery involvement, hence the clinical suspicion of arterial invasion should be confirmed by either CT or USG which have similar accuracy in the detection of carotid artery invasion.

Assessment of Cervical Lymph Nodes in Squamous Cell Carcinoma of the Head and Neck

“…These results go in accordance with the observations made by Van den Brekel [23] and Sarvanan et al [17]. Sarvanan et al [17] suggested that the presence of central necrosis was the most specific sign of metastatic lymphadenopathy. They reported 100% sensitivity and specificity for central nodal necrosis criteria.…”

“…They noted the decrease of false positive results from 63% to 5% using the L/S ratio. Sarvanan et al [17] have showed similar sensitivity (94.44%) and higher specificity (100%) than that reported by Steinkamp et al [18].…”

“…Ultrasound scanning provided the highest sensitivity (97.1%), specificity (93%), and accuracy (95.96%) for detecting metastatic cervical lymph nodes in our patients. Negative predictive value = 68.4% The reported incidence of false positive clinical examination of the neck in patients with squamous cell carcinoma of the oral cavity and oropharynx ranged between 10% to 33% [16,17]. Clinically occult cervical nodal disease is occurring in 15%-40% of patients undergoing elective neck dissection for cancer arising in this area [16].…”

“…The lymph nodes were assigned similar levels to that of the clinical examination. We followed the criteria proposed by Sarvanan et al [17] for CT assessment of the lymph nodes based on the minimal axial diameter of the node as follows: a size of 11 mm or greater in the transverse plane was considered as a metastatic node. Central hypodensity with peripheral rim enhancement suggestive of necrosis or conglomeration of three or more lymph nodes in the drainage region of the primary tumor were also taken as metastatic lymph nodes.…”

Análise da invasão da artéria carótida por metástases linfonodais de carcinoma epidermóide de vias aero-digestivas superiores

“…Many papers [4][5][6]12,[16][17][18] have described CT as the best method for image-based staging of cervical lymph nodes. These studies compared image findings with pathology lab findings, obtaining good sensitivity and specificity values in staging cervical lymph nodes, and consequently, their relation with the carotid artery.…”